Perceptual Assessment Research Articles

The Effects of Remote Signal Transmission and Recording on Acoustical Measures of Simulated Essential Vocal Tremor: Considerations for Remote Treatment Research and Telepractice

PurposeStudies on medical and behavioral interventions for essential vocal tremor (EVT) have shown inconsistent effects on acoustical and perceptual outcome measures across studies and across participants. Remote acoustical and perceptual assessments might facilitate studies with larger samples of participants and repeated measures that could clarify treatment effects and identify optimal treatment candidates. Furthermore, remote acoustical and perceptual assessment might allow clinicians to monitor clients’ treatment responses and optimize treatment approaches during telepractice. Thus, the purpose of this study was to evaluate the accuracy of remote signal transmission and recording for acoustical and perceptual assessment of EVT. MethodSimulations of EVT were produced using a computational model and were recorded using local and remote procedures to represent client- and clinician-end recordings respectively. Acoustical analyses measured the extent and rate of fundamental frequency (fo) and intensity modulation to represent vocal tremor severity and the cepstral peak prominence (CPPS) to represent voice quality. The data were analyzed using repeated measures analysis of variance (ANOVA) with recording as the within-subjects factor and sex of the computational model as the between-subjects factor. ResultsThere was a significant main effect of recording on the rate of fo modulation and significant interactions of recording and sex for the extent of intensity modulation, rate of intensity modulation, and CPPS. Posthoc pairwise comparisons and analysis of effect size indicated that recording procedures had the largest effect on the extent of intensity modulation for male simulations, the rate of intensity modulation for male and female simulations, and the CPPS for male and female simulations. Despite having disabled all known software and computer audio enhancing options and having stable ethernet connections, there was inconsistent attenuation of signal amplitude in remote recordings that was most problematic for samples with a breathy voice quality but also affected samples with typical and pressed voice qualities. ConclusionsAcoustical measures that correlate to perception of vocal tremor and voice quality were altered by remote signal transmission and recording. In particular, signal transmission and recording in Zoom altered time-based estimates of intensity modulation and CPPS with male and female simulations of EVT and magnitude-based estimates of intensity modulation with male simulations of EVT. In contrast, signal transmission and recording in Zoom minimally altered time- and magnitude-based estimates of fo modulation with male and female simulations of EVT. Therefore, acoustical and perceptual assessments of EVT should be performed using audio recordings that are collected locally on the participant- or client-end, particularly when measuring modulation of intensity and CPP or estimating vocal tremor severity and voice quality. Development of procedures for collecting local audio recordings in remote settings may expand data collection for treatment research and enhance telepractice.

Impact of Acid, Weakly Acid and Alkaline Laryngopharyngeal Reflux on Voice Quality

To analyze pre to posttreatment voice changes regarding the type of reflux in patients with acid, weakly acid or alkaline laryngopharyngeal reflux (LPR). Patients with LPR, diagnosed using hypopharyngeal-esophageal multichannel intraluminal impedance pH-monitoring (HEMII-pH), were prospectively recruited from three University Hospitals. Patients were treated with a combination of diet, proton pump inhibitors, magaldrate and alginate for 3 months. The following clinical and voice quality outcomes were studied pre to posttreatment according to the type of reflux (acid, weakly acid, nonacid): HEMII-pH, gastrointestinal endoscopy features, reflux symptom score (RSS), reflux sign assessment (RSA), voice handicap index (VHI), perceptual voice assessment (grade of dysphonia and roughness), aerodynamic and acoustic measurements. From December 2018 to March 2021, 160 patients completed the evaluations, accounting for 60 acid, 52 weakly acid, and 48 alkaline cases of LPR. There were no baseline differences in clinical and voice quality outcomes between groups. RSS and RSA significantly improved from pre to posttreatment in the entire cohort and in all patient groups. VHI, dysphonia and roughness, maximum phonation time, Jitter, Shimmer and noise to harmonic ratio significantly improved from pre to posttreatment. Individuals with alkaline reflux reported better voice quality improvements as compared to acid and weakly acid reflux patients. Patients with acid and alkaline reflux reported better posttreatment voice quality outcomes as compared to weakly acid reflux patients. Future basic science and clinical studies are needed to better understand the histological changes of the vocal folds due to reflux of varying pH types and gastroduodenal enzyme content.

Speech Outcomes of a National Cohort of Children with Orofacial Cleft at 5 and 10 Years of age.

To assess speech outcomes at five and ten years of age in a nationwide study of children with orofacial cleft. Prospective study. Children born with orofacial cleft and having primary surgery in New Zealand. Speech samples were available for 151 five-year-old, and 163 ten-year-old children. Intelligibility, Acceptability, Velopharyngeal function, Hypernasality, Hyponasality, severity of airflow evaluated by perceptual speech assessment (using the standardised Rhinocleft assessment), and overall assessment of requirement for clinical intervention. A large proportion of five-year-old children had speech that was considered to be not completely intelligible, was not acceptable, and had inadequate velopharyngeal function. The noted deficiencies led to a clinical judgement that further speech and/or surgical intervention was required in 85% with cleft lip and palate, 65% with cleft palate and 26% with cleft lip. The proportion of children with poor speech outcomes in the ten-year-old children was lower, though of clinical importance, further intervention required for 25% with CLP, 15% with CP and 3% with CL. The number of sound production errors in both age groups followed the same pattern with fewest in those with CL and most in those with CLP. A significant proportion of children with orofacial cleft were found to have poor speech outcomes requiring further treatment. The outcomes are poor compared to centres reported in the UK and Scandinavia. New Zealand requires a review of the current services for individuals born with cleft to improve speech outcomes and interdisciplinary care.

Impact of subclinical mental disorders of voice function and quality of life in voice-speaking professions during the COVID-2019 pandemic

Objective: To investigate the risk of mental distress during the COVID-19 pandemic in individuals of the voice-speech professions and the possibility of its impact on voice function and quality of life. Materials and Methods: The study involved 33 people of voice-speech professions who were treated at the University Clinic of Zaporizhzhia State Medical University in 2020. The presence of mental disorders was determined by questionnaires using the hospital anxiety and depression scale (HADS). The patients were divided into 2 groups, depending on the absence and presence of significantly expressed symptoms. A specialized phoniatric examination using functional loads (measuring the time of maximum phonation (PMF), perceptual assessment of the voice according to the GRBAS scale), videostroboscopy of the larynx were carried out. The assessment of the mental impact of voice disorders on the quality of life was carried out according to the Voice Handicap Index (VHI) questionnaire. The statistical significance of the comparative indicators and the connection of their changes were established using the Spearman's rank correlation coefficient. Results: It was found that among the surveyed 33 people, 22 patients (group 1) had subclinical anxiety and depression, and 11 (group 2) had no significant symptoms. Patients with subclinically severe mental disorders (n = 22) showed a significant increase in the emotional indicator by 85.37% (p≤0.01). A high positive relationship was found between subclinical levels of anxiety and depression and disturbances in the phonatory cycle of the larynx. When conducting a Spearman correlation analysis between the data of perceptual assessment of the voice according to the GRBAS system, data of video stroboscopy of the larynx, indicators of anxiety and depression, and the results of the VHI questionnaire, a positive relationship of a high degree was established between the level of anxiety and vibratory insufficiency of the vocal folds (rs=0.95; p≤0.05), negative with the Navy (rs=-0.59; p≤0.05), as well as physical (rs=0.75; p≤0.05) and emotional (rs=0.79; p≤0.05) components of average quality of life. The data obtained indicate a significant effect of subclinical disorders of the mental state on impaired voice function and the emotional component of the quality of life in persons of vocal-speech professions. Conclusions: Screening of mental health in persons of voice-speech professions together with a baseline assessment of voice function and quality of life are important steps for monitoring potential voice disorders and the formation of risk groups in order to carry out preventive and therapeutic measures for voice disorders.

Perceptual quality assessment of nighttime video

The quality of nighttime videos is important for consumer photography and monitoring of video clearness. However, little work has been done on the study of nighttime video quality assessment. In this paper, to the best of our knowledge, we explore the study on the nighttime video quality assessment for the first time. First, we build a real-world nighttime video quality assessment database (NVQA) containing 200 videos with abundant content and diverse distortion. Additionally, we carry out subjective tests to rate all nighttime videos in the NVQA database. Thereafter, we proposed a blind nighttime video quality assessment model based on feature fusion and conducted experiments to evaluate the performance and efficiency of our proposed model. The experiment results demonstrate that our model outperforms most traditional methods.

Intelligibility and comprehensibility: A Delphi consensus study.

Intelligibility and comprehensibility in speech disorders can be assessed both perceptually and instrumentally, but a lack of consensus exists regarding the terminology and related speech measures in both the clinical and scientific fields. To draw up a more consensual definition of intelligibility and comprehensibility and to define which assessment methods relate to both concepts, as part of their definition. A three-round modified Delphi consensus study was carried out among clinicians, researchers and lecturers engaged in activities in speech disorders. Forty international experts from different fields (mainly clinicians, linguists and computer scientists) participated in the elaboration of a comprehensive definition of intelligibility and comprehensibility and their assessment. While both concepts are linked and contribute to functional human communication, they relate to two different reconstruction levels of the transmitted speech material. Intelligibility refers to the acoustic-phonetic decoding of the utterance, while comprehensibility relates to the reconstruction of the meaning of the message. Consequently, the perceptual assessment of intelligibility requires the use of unpredictable speech material (pseudo-words, minimal word pairs, unpredictable sentences), whereas comprehensibility assessment is meaning and context related and entails more functional speech stimuli and tasks. This consensus study provides the scientific and clinical communities with a better understanding of intelligibility and comprehensibility. A comprehensive definition was drafted, including specifications regarding the tasks that best fit their assessment. The outcome has implications for both clinical practice and scientific research, as the disambiguation improves communication between professionals and thereby increases the efficiency of patient assessment and care and benefits the progress of research as well as research translation. What is already known on the subject Intelligibility and comprehensibility in speech disorders can be assessed both perceptually and instrumentally, but a lack of consensus exists regarding the terminology and related speech measures in both the clinical and scientific fields. What this paper adds to existing knowledge This consensus study allowed for a more consensual and comprehensive definition of intelligibility and comprehensibility and their assessment, for clinicians and researchers. The terminological disambiguation helps to improve communication between experts in the field of speech disorders and thereby benefits the progress of research as well as research translation. What are the potential or actual clinical implications of this work? Unambiguous communication between professionals, for example, in a multidisciplinary team, allows for the improvement in the efficiency of patient care. Furthermore, this study allowed the assessment tasks that best fit the definition of both intelligibility and comprehensibility to be specified, thereby providing valuable information to improve speech disorder assessment and its standardization.

Predictors of Success After Furlow Palatoplasty for Repair of Cleft Palate: Does Syndrome Matter?

To determine predictors of success following Veau 1 and 2 cleft palate repair in patients with and without syndromes. Retrospective review of prospectively collected data. Tertiary care children's hospital. All children <18 months of age undergoing Furlow palatoplasty for Veau 1 and 2 cleft repair between 2000 and 2014 with postoperative perceptual speech assessment (PSA). In total, 368 consecutive patients were identified; 95 were excluded, resulting in 273 patients. Median age at surgery was 13.0 months (interquartile range [IQR], 11-15 months) with postoperative PSA at a median of 32.3 months (IQR, 26.3-44.5 months). Fifty patients (18.3%) had syndrome diagnosis; 59 patients (21.6%) had nonsyndromic Robin sequence. Velopharyngeal insufficiency (VPI) occurred in 27 patients (10.5%); 13 underwent secondary speech surgery. Cleft-related speech errors occurred in 46 patients (17.6%). Non-cleft-related speech errors occurred in 155 patients (59.6%) and reduced intelligibility in 127 patients (47.9%). Oronasal fistula occurred in 23 patients (8.8%) and was exclusive to Veau 2 clefts. In multivariate analysis, age >13 months at palatoplasty demonstrated a 6-fold higher rate of VPI (hazard ratio [HR], 6.64; P < .01), worse speech outcomes (HR, 6.04; P < .01; HR, 1.60; P < .01; HR, 1.57; P = .02), and greater speech therapy utilization (HR, 2.18; P < .01). VPI occurred in 10% of patients undergoing Furlow palatoplasty repair of Veau 1 or 2 clefts. Age <13 months at palatoplasty was associated with improved speech outcomes and lower VPI incidence (2.8% vs 16.2%). Syndromic diagnosis was associated with noncleft speech errors and reduced intelligibility on univariate analysis but not velopharyngeal function after palatoplasty.

GSW: A High Performance IQA Index Based on Global and Saliency Window Similarity

Perceptual image quality assessment (IQA) attracts significant attention in recent years. It is proved that both global score and an image’s visual saliency (VS) are consistent with subjective evaluation. The global quality score reflects the consistency of the overall structure between two images, and VS map contributes complementarily in evaluating perceptual quality. This paper presents an effective IQA index based on global and saliency window similarity, namely GSW. It chooses VS map as an image feature and uses a special strategy to draw the saliency window with largest significancy. Meanwhile, the background area is taken into account to guarantee the robustness of the quality score. Experimental results on four most widely used databases verify that, compared with state-of-the-art IQA methods, GSW performs consistently well can provide more accurate quality prediction with a low computational complexity.

Rehabilitation Management of Post Palatoplasty in Adolescent: Case Report

The objective of this study is to report comprehensive physical medicine and rehabilitation management of post-palatoplasty in an adolescent patient. The cleft palate repair is usually done in the first year of life in order to gain optimal speech function. To achieve normal communication development, normal hearing, normal oral and pharyngeal structures, adequate stimulation, and reinforcement from the environment for communication efforts are needed. Patient was assessed comprehensively using The International Classification of Functioning, Disability and Health (ICF) and by perceptual assessment for speech. The results showed that after one month intervention, the perceptions of hypernasality in plosive /b/ and affricates /c/ were found reduced significantly. There was improvement in articulation after one month of intervention.

A multimodal emotion recognition method based on facial expressions and electroencephalography

Human-robot interaction (HRI) systems play a critical role in society. However, most HRI systems nowadays still face the challenge of disharmony, resulting in an inefficient communication between the human and the robot. In this paper, a multimodal emotion recognition method is proposed to establish an HRI system with a low sense of disharmony. This method is based on facial expressions and electroencephalography (EEG). The image classification method of facial expressions and the suitable feature extraction method of EEG were investigated based on the public datasets. And then these methods were applied to both images and EEG data acquired by ourselves. In addition, the Monte Carlo method was used to merge the results and solve the problem of having a small dataset. The multimodal emotion recognition method was combined with the HRI system, where it achieved a recognition rate of 83.33%. Furthermore, in order to evaluate the HRI system from the user's point of view, a perceptual assessment method was proposed to evaluate our system, in which the system was scored by the participants based on their experience, achieving an average score of 7 (the scores were ranged from 0 to 10). Experimental results demonstrate the effectiveness and feasibility of the multimodal emotion recognition method, which can be useful to reduce the sense of disharmony of HRI systems.

Speech rate increase in primary progressive apraxia of speech and its cost on articulatory accuracy

ABSTRACT Impaired articulation (e.g., articulatory accuracy) and prosody (e.g., slow speech rate) are considered primary diagnostic criterions for apraxia of speech both in neurodegenerative and post-stroke contexts. The primary aim of this study was to investigate the ability of participants with primary progressive apraxia of speech (PPAOS), a neurodegenerative disease characterised by initially isolated progressive apraxia of speech, to increase speech rate and the interaction between articulatory accuracy and speech rate. The secondary aim was to investigate the effect of syllable frequency and structure on this interaction. Four speakers with PPAOS, and four sex- and age-matched healthy speakers (HS) read eight two-syllable words embedded two times in a ten-syllable carrier phrase. Syllable frequency and structure were manipulated for the first syllable of the target words and controlled for the second syllable. All sentences were produced at three different target speech rates (conditions): habitual, regular (five syllables/second), and fast (seven syllables/second). Prosodic measures for target words and sentences were computed based on acoustic analysis of speech rate. Articulatory measures for words and sentences were rated based on a perceptual assessment of articulatory accuracy. Results show slower speech rate and reduced articulatory accuracy in speakers with PPAOS compared to HS. Results suggest that speakers with PPAOS also have limited ability to increase their speech rate. Finally, results suggest that articulatory complexity influences speech rate but that the cost of speech rate increase on articulatory accuracy varies greatly across speakers with PPAOS and is not necessarily related to the extent of the increase when measured in a highly structured sentence production task. Theoretical and clinical implications of these findings are discussed.

Evaluation of the performance of machine learning algorithms applied to voice parameters in prioritizing candidate for office laryngoscopy: Automated triaging in focus

Background: We examined the performance of different Machine Learning Algorithms while also comparing two methods of voice assessment to look at the workability of automating triage of patient that will need prompt office laryngoscopy. Methods: We recruited consecutive adult subjects excluding those with a history of being regular singers or choristers in the past one year and those with the previous history of laryngeal trauma. We then carried out the perceptual voice assessments on the GRBAS Scale and also obtained the basic acoustic parameters of the voice samples. Laryngeal examinations with 70-degree Hopkins’ Rod were then carried out by another examiner for all the participants to identify gross laryngeal changes or lesions. We then evaluated each machine learning algorithm comparing the perceptual and acoustic parameters in determining how well each algorithm predicts the presence of those categorized with having lesion or not by the laryngeal examination. Results: One hundred and twenty respondents were analyzed out of which 89(74.2%) were females. The mean age was 46.5 ± 9.2 years. The perceptual evaluation generally outperformed the acoustic evaluation. Also, the Naïve Bayes Classifier (NBC) outperformed other algorithms with a F1 score of 0.55 followed by Artificial Neural Network (ANN) with the score of 0.53. However, the ANN outperformed the other with regards to the Area-under-the-curve (AUC). Conclusion: When these metrics are taken together, the ANN still remains the best algorithm for this dataset. We are however cognisance of the needed improvement to the various aspects of this work including a larger dataset more scientific sampling.

The Usefulness of Multi Voice Evaluation for Measuring Voice Recovery After Endolaryngeal Phonomicrosurgery in Patients with Vocal Fold Polyps

ObjectivesThe purpose of this study was to the usefulness of a five-variable model predicting perceived voice severity and incorporating acoustic analysis based on cepstral analysis and self-reported questionnaires, for measuring voice recovery after endolaryngeal phonomicrosurgery in patients with vocal fold polyps. MethodsIn this study, 72 patients with vocal fold polyps were included. Two voice evaluations, including acoustic analysis, self-reported questionnaires, and auditory perceptual assessments for each patient, were implemented before and after endolaryngeal phonomicrosurgery. Using these evaluations, we compared the mean values of the perceptual evaluation of voice, acoustic analysis parameters, self-reported questionnaires, and the five-variable model estimated severity pre- and post-endolaryngeal phonomicrosurgery. ResultsVarious parameters related to acoustic analysis, self-reported questionnaires, and auditory perceptual assessments were useful for measuring voice recovery after endolaryngeal phonomicrosurgery. In particular, a five-variable model incorporating spectral/cepstral analyses and self-reported questionnaires was able to effectively track voice changes after endolaryngeal phonomicrosurgery. ConclusionWe verified that most of the variables and the five-variable model were useful for measuring voice recovery in patients with vocal polyps after endolaryngeal phonomicrosurgery.

The Effect of Bilingualism on Production and Perception of Vocal Fry

(1) Determine the difference in vocal fry phonation in English and Spanish productions among bilingual young adults, (2) Characterize the effect of spoken language and native language on vocal fry production among English-Spanish bilingual speakers, (3) Identify the effect of first and second language knowledge of the listener in the voice perceptual assessment, and (4) Define the effect of the environment of the assessment (in situ vs. online), in the voice perceptual assessment. Exploratory cross-sectional study of 34 bilingual (Spanish-English) speakers and six inexperienced listeners. Participating speakers produced two speech samples (one in English and one in Spanish). Six inexperienced monolingual and bilingual listeners performed the voice perceptual assessment of vocal fry, General grade of hoarseness, and Roughness using a 4-point rating scale. Bilingual speakers used vocal fry more often when they were speaking in English (around 3%) compared with their production in Spanish (around 2%). Bilingual native English speakers used vocal fry more often during their productions in both languages compared with bilingual native Spanish speakers. Bilingual listeners had the highest agreement when identifying vocal fry in both languages. Differences in production of vocal fry between native speakers of American English and native speakers of Spanish may be evidence of transferring of vocal behavior (such as vocal fry) from one language to the second one. In addition, being a bilingual listener may have an important effect on the perceptual identification of voice quality in English and Spanish, as well as vocal fry in English.

Determining Medical Urgency of Voice Disorders Using Auditory-Perceptual Voice Assessments Performed by Speech-Language Pathologists.

This study examined whether speech-language pathologist auditory-perceptual voice assessments can predict the medical urgency of voice disorders. Twenty speech-language pathologists (SLPs) evaluated 25 voice samples recorded during initial voice evaluations. Voice samples represented a range of dysphonia severity (mild-severe) balanced across patient diagnoses. Diagnoses included: benign lesions, laryngeal cancer, non-organic voice disorders, laryngeal edema (associated with LPR), and laryngeal paralysis or paresis. Laryngeal cancer and severe unilateral laryngeal paralysis were considered urgent disorders. While blinded to patient information, SLPs rated severity of voice quality, predicted patient diagnosis, and determined whether the patient should be seen urgently by a laryngologist. SLPs were then given basic medical history information and rated medical urgency of voice disorder a second time. On average, SLPs correctly identified 65% of urgent voices and 87% of nonurgent voices when blinded to patient information. Accuracy improved significantly to 86% for urgent voices with medical history information (P < .001) and decreased to 77% for nonurgent voices. Accuracy was better when severity of voice quality was severe for urgent voices and mild for nonurgent voices (P < .001). SLPs indicated that patient smoking history and severity of dysphonia were most influential in their decision making. Diagnostic accuracy of auditory-perceptual assessments was poor. SLPs identified 86% of medically urgent voice disorders when auditory perceptual assessments were combined with medical history information. Further work is needed to determine what medical history information is most crucial to rating accuracy and what speech tasks might best separate urgent and nonurgent patients.

ɑ-Lactalbumin Improves Sleep and Recovery after Simulated Evening Competition in Female Athletes.

This study aimed to determine the efficacy of α-lactalbumin (A-LAC) supplementation for improving sleep and performance recovery after simulated evening competition in female athletes. Sixteen trained women (mean ± SD: age, 27 ± 7 yr; mass, 62 ± 10 kg; stature, 167 ± 8 cm) participated in this randomized double-blind three-arm crossover study. Participants completed a simulated evening competition before consuming either an A-LAC whey protein, whey protein placebo (PLA), or water control (CON) beverage. Sleep was monitored via polysomnography, and participants completed a series of physical, cognitive, and perceptual assessments before, and 14 and 24 h after simulated competition. Non-rapid eye movement stage 2 sleep increased after competition in A-LAC (pre, 199 ± 44 min; post, 212 ± 37 min) but decreased in CON (pre, 228 ± 43 min; post, 195 ± 40 min) and PLA (pre, 224 ± 25 min; post, 211 ± 35 min; P = 0.012). In addition, Yo-Yo Intermittent Recovery Test Level 1 distance improved over time in A-LAC (baseline, 664 ± 332 m; 14 h post, 667 ± 326 m; 24 h post, 781 ± 427 m) compared with CON (baseline, 741 ± 366 m; 14 h post, 648 ± 351 m; 24 h post, 720 ± 407 m) and PLA (baseline, 763 ± 394 m; 14 h post, 636 ± 366 m; 24 h post, 720 ± 396 m; P < 0.001). The findings indicate that A-LAC supplementation may be useful for retaining some sleep characteristics after evening competition, leading to improved physical performance in female athletes.

Pediatric Voice Handicap Index (pVHI): Validation in European Portuguese Children

ObjectivesTo determine reliability and validity of the European Portuguese pVHI version (pVHI-EP). Study designCross-sectional design. MethodsThe pVHI-EP and the talkative and global voice assessment scales were administered to the caregivers of children aged from 3 to 16 years old with and without dysphonia. Reliability (internal consistency and test-retest) was analyzed. The validity analyses performed were: (1) content validity by analyzing the percentage of missing data; (2) construct validity with intraclass correlation coefficients among pVHI-EP domains and overall score; (3) concurrent validity was conducted between pVHI-EP, the caregivers’ judgment of the child's voice severity on a visual analog scale and the Speech-Language Pathologist perceptual voice assessment; (4) known-groups validity between children with and without dysphonia, and (5) predictive validity by calculating receiver operating characteristics, sensitivity and specificity and determining cut-off points. ResultsA total of 283 children (61.5% boys, mean age 8.3 years) participated in the study. The pVHI-EP showed an excellent internal consistency for the pVHI-EP total data. Strong to moderate test-retest reliability confirms pVHI-EP reproducibility. Excellent to good intraclass correlation coefficients between the pVHI-EP overall and the domains confirms its construct validity. Weak to moderate concurrent validity with visual analog scale and Speech-Language Pathologist perceptual voice assessment was confirmed. The pVHI-EP significantly distinguished two groups of different voice conditions. A cut-off point of 10.5 with 95.9% sensitivity and 92.5% specificity was determined for the overall score of the pVHI-EP. ConclusionsThe pVHI-EP is a reliable and valid caregiver voice outcome tool for EP children with dysphonia.

Comprehensive performance analysis of objective quality metrics for digital holography

Objective quality assessment of digital holograms has proven to be a challenging task. While prediction of perceptual quality of the recorded 3D content from the holographic wavefield is an open problem; perceptual quality assessment from content after rendering, requires a time-consuming rendering step and a multitude of possible viewports. In this research, we use 96 Fourier holograms of the recently released HoloDB database to evaluate the performance of well-known and state-of-the-art image quality metrics on digital holograms. We compare the reference holograms with their distorted versions: (i) before rendering on the real and imaginary parts of the quantized complex-wavefield, (ii) after converting Fourier to Fresnel holograms, (iii) after rendering, on the quantized amplitude of the reconstructed data, and (iv) after subsequently removing speckle noise using a Wiener filter. For every experimental track, the quality metric predictions are compared to the Mean Opinion Scores (MOS) gathered on a 2D screen, light field display and a holographic display. Additionally, a statistical analysis of the results and a discussion on the performance of the metrics are presented. The tests demonstrate that while for each test track a few quality metrics present a highly correlated performance compared to the multiple sets of available MOS, none of them demonstrates a consistently high-performance across all four test-tracks.

Through-and-Through Dissection of the Soft Palate for Pharyngeal Flap Inset: A "Good-Fast-Cheap" Technique for Any Etiology of Velopharyngeal Incompetence.

Objective:To determine the efficacy and resource utilization of through-and-through dissection of the soft palate for pharyngeal flap inset for velopharyngeal incompetence (VPI) of any indication.Design:Retrospective review.Setting:Tertiary care center.Patients:Thirty patients were included. Inclusion criteria were diagnosis of severe VPI based on perceptual speech assessment, confirmed by nasoendoscopy or videofluoroscopy; VPI managed surgically with modified pharyngeal flap with through-and-through dissection of the soft palate; and minimum 6 months follow-up. Patients with 22q11.2 deletion syndrome were excluded.Intervention:Modified pharyngeal flap with through-and-through dissection of the soft palate.Main Outcome Measure(s):Velopharyngeal competence and speech assessed using the Speech-Language Pathologist 3 scale.Results:The median preoperative speech score was 11 of 13 (range, 7 to 13), which improved significantly to a median postoperative score of 1 of 13 (range 0-7; P < .001). Velopharyngeal competence was restored in 25 (83%) patients, borderline competence in 3 (10%), and VPI persisted in 2 (7%) patients. Complications included 1 palatal fistula that required elective revision and 1 mild obstructive sleep apnea that did not require flap takedown. Median skin-to-skin operative time was 73.5 minutes, and median length of stay (LOS) was 50.3 hours.Conclusions:This technique allows direct visualization of flap placement and largely restores velopharyngeal competence irrespective of VPI etiology, with low complication rates. Short operative time and LOS extend the value proposition, making this technique not only efficacious but also a resource-efficient option for surgical management of severe VPI.

Nasalance and perceived voice changes in patients undergoing septoplasty and turbinate hypertrophy reduction

The purpose of this study was to investigate the changes in voice nasality after septoplasty and turbinate hypertrophy reduction and to evaluate the effect of these changes on patients' voice-related quality of life. Sixty patients with nasal obstruction symptoms caused by septal deviation and inferior turbinate hypertrophy who underwent septoplasty and inferior turbinate hypertrophy reduction and 25 healthy controls were included. Active anterior rhinomanometry and acoustic rhinometry were utilized for the evaluation of nasal patency and nasometry was used for quantitative assessment of nasalance. All participants completed validated questionnaires for assessing nasal obstruction symptom severity, psychological status and the impact of voice performance on their quality of life preoperatively and 6months after septoplasty. Patients presented preoperatively statistically significantly lower nasalance scores and higher VHI scores than controls (p < 0.05). Septoplasty and inferior turbinate hypertrophy reduction led to improvement of nasalance for the nasal text and the physical subscale of the VHI scores. Postoperatively, there were no statistically significant differences in nasalance and VHI scores between patients and controls. Significant correlations were found only for the baseline and the postoperative nasalance scores for the nasal text and the total nasal cavity volume (p < 0.05). Postoperatively, patients who presented significant improvement of nasal obstruction symptoms and resolution of stress levels were more likely to positively evaluate the impact of their voice quality on their daily life (OR: 2.32, 95% CI 1.08-5.15, p = 0.041 and OR: 3.06, 95% CI 1.15-7.04, p = 0.038, respectively). Septoplasty and inferior turbinate hypertrophy reduction may increase the nasal resonance, but in the long term, this change appears not to be significant enough. The severity of nasal obstruction symptoms and psychological status mainly affect the patients' perceptual assessment regarding the effect of voice performance on their quality of life.