Relative Average Perturbation Research Articles

High and Wide: An In Silico Investigation of Frequency, Intensity, and Vibrato Effects on Widely Applied Acoustic Voice Perturbation and Noise Measures

This in silico study explored the effects of a wide range of fundamental frequency (fo), source-spectrum tilt (SST), and vibrato extent (VE) on commonly used frequency and amplitude perturbation and noise measures. Using 53 synthesizedtones produced in Madde, the effects of stepwise increases in fo, intensity (modeled by decreasing SST), and VE on the PRAAT parameters jitter % (local), relative average perturbation (RAP) %, shimmer % (local), amplitude perturbation quotient 3 (APQ3) %, and harmonics-to-noise ratio (HNR) dB were investigated. A secondary experiment was conducted to determine whether any fo effects on jitter, RAP, shimmer, APQ3, and HNR were stable. A total of 10 sinewaves were synthesizedin Sopran from 100 to 1000Hz using formant frequencies for /a/, /i/, and /u/-like vowels, respectively. All effects were statistically assessed with Kendall's tau-b and partial correlation. Increasing fo resulted in an overall increase in jitter, RAP, shimmer, and APQ3 values, respectively (P<0.01). Oscillations of the data across the explored fo range were observed in all measurement outputs. In the Sopran tests, the oscillatory pattern seen in the Madde fo condition remained and showed differences between vowel conditions. Increasing intensity (decreasing SST) led to reduced pitch and amplitude perturbation and HNR (P<0.05). Increasing VE led to lower HNR and an almost linear increase of all other measures (P<0.05). These novel data offer a controlled demonstration for the behavior of jitter (local) %, RAP %, shimmer (local) %, APQ3 %, and HNR (dB) when varying fo, SST, and VE in synthesizedtones. Since humans will vary in all of these aspects in spoken language and vowel phonation, researchers should take potential resonance-harmonics type effects into account when comparing intersubject or preintervention and postintervention data using these measures.

Effect of Voice and Articulation Parameters of a Home-Based Serious Game for Speech Therapy in Children With Articulation Disorder: Prospective Single-Arm Clinical Trial.

Articulation disorder decreases the clarity of language and causes a decrease in children's learning and social ability. The demand for non-face-to-face treatment is increasing owing to the limited number of therapists and geographical or economic constraints. Non-face-to-face speech therapy programs using serious games have been proposed as an alternative. The aim of this study is to investigate the efficacy of home therapy on logopedic and phoniatric abilities in children with articulation disorder using the Smart Speech game interface. This study is a prospective single-arm clinical trial. Children with articulation disorders, whose Urimal Test of Articulation and Phonology (U-TAP) was -2 SDs or less and the Receptive and Expressive Vocabulary Test score was -1 SD or more, were enrolled. A preliminary evaluation (E0) was conducted to check whether the children had articulation disorders, and for the next 4 weeks, they lived their usual lifestyle without other treatments. Prior to the beginning of the training, a pre-evaluation (E1) was performed, and the children trained at home for ≥30 minutes per day, ≥5 times a week, over 4 weeks (a total of 20 sessions). The Smart Speech program comprised oral exercise training, breathing training, and speech training; the difficulty and type of the training were configured differently according to the participants' articulation error, exercise, and vocal ability. After the training, postevaluation (E2) was performed using the same method. Finally, 8 weeks later, postevaluation (E3) was performed as a follow-up. A voice evaluation included parameters such as maximum phonation time (MPT), fundamental frequency (F0), jitter, peak air pressure (relative average perturbation), pitch, intensity, and voice onset time. Articulation parameters included a percentage of correct consonants (PCC; U-TAP word-unit PCC, U-TAP sentence-unit PCC, and three-position articulation test) and alternate motion evaluation (diadochokinesis, DDK). Data obtained during each evaluation (E1-E2-E3) were compared. A total of 13 children with articulation disorders aged 4-10 years were enrolled in the study. In voice parameters, MPT, jitter, and pitch showed significant changes in repeated-measures ANOVA. However, only MPT showed significant changes during E1-E2 (P=.007) and E1-E3 (P=.004) in post hoc tests. Other voice parameters did not show significant changes. In articulation parameters, U-TAP, three-position articulation test (TA), and DDK showed significant changes in repeated-measures ANOVA. In post hoc tests, U-TAP (word, sentence) and TA showed significant changes during E1-E2 (P=.003, .04, and .01) and E1-E3 (P=.001, .03, and .003), and DDK showed significant changes during E1-E2 only (P=.03). Home-based serious games can be considered an alternative treatment method to improve language function. Clinical Research Information Service KCT0006448; https://cris.nih.go.kr/cris/search/detailSearch.do/20119.

Voice analysis results in individuals with Alzheimer's disease: How do age and cognitive status affect voice parameters?

Reports of acoustic changes in the voice in individuals with Alzheimer's disease (AD) and the relationship of acoustic changes with age and cognitive status are still limited. This study aims to determine the changes in voice analysis results in AD, as well as the effects of age and cognitive status on voice parameters. The study included 47 (AD: 30; healthy: 17) women with a mean age of 76.13 years. The acoustic voice parameters mean fundamental frequency (F0), relative average perturbation (RAP), jitter percent (Jitt), shimmer percent (Shim), and noise-to-harmonic ratio were detected. The mini-mental state examination (MMSE) was utilized. F0, Shim, Jitt, and RAP values were found to be statistically significantly higher in individuals with AD compared to healthy individuals. There was a significant negative correlation between MMSE and F0, Jitt, RAP and Shim, and the MMSE score had a significant negative effect on F0, Jitt, and RAP (p<.05). Cognitive status was discovered to significantly impact the voice, with fundamental frequency and frequency and amplitude perturbations increasing as cognitive level decreases. In order to contribute to the therapy process for voice disorders, cognitive functions can be focused on in addition to voice therapy.

The Influence of Presbylarynx Status on Objective Measures of the Aging Voice

The primary objective of this study was to assess objective voice measures in an elderly population representative of those seen in a tertiary laryngology practice, stratified by sex and presbylarynx status, and compare their measures to each other and to a cohort of young adult patients aged 40 years or less. The secondary objectives of this study were to evaluate and compare the strobovideolaryngoscopy findings across all groups and compare the voice complaints and subjective questionnaire results between the presbylarynx and non-presbylarynx groups. Two hundred and eighty-six adult voice patients (147 females/139 males) were included in this study and stratified into one of three groups: (1) young adults aged 40 years or less (n = 122), (2) patients over the age of 60 without presbylarynx (n = 78), and (3) patients over the age of 60 with a diagnosis of presbylarynx (n = 86). The acoustic analysis included fundamental frequency (F0), voice intensity, standard deviation of the fundamental frequency (SDFF), jitter (Jitt), relative average perturbation (RAP), shimmer (Shim), noise-to-harmonic ratio (NHR), and others. The aerodynamic and pulmonary assessment included maximum phonation time (MPT), S/Z ratio, mean flow rate (MFR), forced expiratory volume in 1 second (FEV1), and maximal mid-expiratory flow (FEF25-75). Coexisting vocal fold conditions and pathologies were also characterized and compared. Statistical analysis was performed using SPSS 28.0.0.0 (IBM, Armonk, NY). All tests were performed in two-tailed, and a P value of less than 0.05 was considered statistically significant. Assessment of vocal fold features revealed a significantly higher prevalence of benign vocal fold lesions in the young adult group for males and females compared to both elderly groups but significantly lower prevalence of vocal fold edema only in young adult females compared to the elderly female groups. Among males, young adults differed significantly from both elderly groups with regard to SDFF, Shim, FEV1, and FEF25-75. However, Jitt and RAP only differed significantly between the young adult and presbylarynx groups. Among females, young adults differed significantly from both elderly groups for F0, SDFF, Jitt, RAP, NHR, CPP, MFR, FEV1, and FEF25-75. However, the non-presbylarynx group had a significantly lower S/Z ratio than the young adult and presbylarynx groups. A comparison of voice complaints between elderly groups revealed breathiness to be significantly more common in the presbylarynx group compared to the non-presbylarynx group, but no other significant differences were found in voice complaints or questionnaire scores. When interpreting objective voice measures, it is critical to consider differences in vocal fold features alongside age-related changes. In addition, sex-related differences in anatomy and the aging process may explain discrepancies in significant findings between young adults and elderly patients stratified by presbylarynx status. However, presbylarynx status alone appears insufficient to generate significant differences in most objective voice measures among the elderly. Yet, presbylarynx status may be sufficient to generate differences in perceptual voice symptoms.

Screening of Mild Cognitive Impairment Through Conversations With Humanoid Robots: Exploratory Pilot Study.

The rising number of patients with dementia has become a serious social problem worldwide. To help detect dementia at an early stage, many studies have been conducted to detect signs of cognitive decline by prosodic and acoustic features. However, many of these methods are not suitable for everyday use as they focus on cognitive function or conversational speech during the examinations. In contrast, conversational humanoid robots are expected to be used in the care of older people to help reduce the work of care and monitoring through interaction. This study focuses on early detection of mild cognitive impairment (MCI) through conversations between patients and humanoid robots without a specific examination, such as neuropsychological examination. This was an exploratory study involving patients with MCI and cognitively normal (CN) older people. We collected the conversation data during neuropsychological examination (Mini-Mental State Examination [MMSE]) and everyday conversation between a humanoid robot and 94 participants (n=47, 50%, patients with MCI and n=47, 50%, CN older people). We extracted 17 types of prosodic and acoustic features, such as the duration of response time and jitter, from these conversations. We conducted a statistical significance test for each feature to clarify the speech features that are useful when classifying people into CN people and patients with MCI. Furthermore, we conducted an automatic classification experiment using a support vector machine (SVM) to verify whether it is possible to automatically classify these 2 groups by the features identified in the statistical significance test. We obtained significant differences in 5 (29%) of 17 types of features obtained from the MMSE conversational speech. The duration of response time, the duration of silent periods, and the proportion of silent periods showed a significant difference (P<.001) and met the reference value r=0.1 (small) of the effect size. Additionally, filler periods (P<.01) and the proportion of fillers (P=.02) showed a significant difference; however, these did not meet the reference value of the effect size. In contrast, we obtained significant differences in 16 (94%) of 17 types of features obtained from the everyday conversations with the humanoid robot. The duration of response time, the duration of speech periods, jitter (local, relative average perturbation [rap], 5-point period perturbation quotient [ppq5], difference of difference of periods [ddp]), shimmer (local, amplitude perturbation quotient [apq]3, apq5, apq11, average absolute differences between the amplitudes of consecutive periods [dda]), and F0cov (coefficient of variation of the fundamental frequency) showed a significant difference (P<.001). In addition, the duration of response time, the duration of silent periods, the filler period, and the proportion of fillers showed significant differences (P<.05). However, only jitter (local) met the reference value r=0.1 (small) of the effect size. In the automatic classification experiment for the classification of participants into CN and MCI groups, the results showed 66.0% accuracy in the MMSE conversational speech and 68.1% accuracy in everyday conversations with the humanoid robot. This study shows the possibility of early and simple screening for patients with MCI using prosodic and acoustic features from everyday conversations with a humanoid robot with the same level of accuracy as the MMSE.

Comparison of Acoustic Voice Features Derived From Mobile Devices and Studio Microphone Recordings

Improvements in mobile device technology offer new opportunities for remote monitoring of voice for home and clinical assessment. However, there is a need to establish equivalence between features derived from signals recorded from mobile devices and gold standard microphone-preamplifiers. In this study acoustic voice features from android smartphone, tablet, and microphone-preamplifier recordings were compared. Data were recorded from 37 volunteers (20 female) with no history of speech disorder and six volunteers with Huntington's disease (HD) during sustained vowel (SV) phonation, reading passage (RP), and five syllable repetition (SR) tasks. The following features were estimated: fundamental frequency median and standard deviation (F0 and SD F0), harmonics-to-noise ratio (HNR), local jitter, relative average perturbation of jitter (RAP), five-point period perturbation quotient (PPQ5), difference of differences of amplitude and periods (DDA and DDP), shimmer, and amplitude perturbation quotients (APQ3, APQ5, and APQ11). Bland-Altman analysis revealed good agreement between microphone and mobile devices for fundamental frequency, jitter, RAP, PPQ5, and DDP during all tasks and a bias for HNR, shimmer and its variants (APQ3, APQ5, APQ11, and DDA). Significant differences were observed between devices for HNR, shimmer, and its variants for all tasks. High correlation was observed between devices for all features, except SD F0 for RP. Similar results were observed in the HD group for SV and SR task. Biological sex had a significant effect on F0 and HNR during all tests, and for jitter, RAP, PPQ5, DDP, and shimmer for RP and SR. No significant effect of age was observed. Mobile devices provided good agreement with state of the art, high-quality microphones during structured speech tasks for features derived from frequency components of the audio recordings. Caution should be taken when estimating HNR, shimmer and its variants from recordings made with mobile devices.

The Association of Objective Voice Measurement With Treatment of Vocal Fold Masses

Objectives/Hypothesis To determine the predictive value of objective voice measurements in patients with vocal fold masses for receiving medical or surgical management. Study Design Retrospective chart review. Methods Patients presented from January 2015 through March 2020 and diagnosed with vocal fold mass. Objective voice measurements studied were average fundamental frequency, jitter percent, relative average perturbation, shimmer percent, noise to harmonic ratio, standard deviation of fundamental frequency, maximum phonation time, and S:Z ratio. Non-parametric Mann Whitney U test, chi square and fisher exact test were used. Results Ninety-six patients (48 male and 48 female) were included. Males who received surgical management (MS) had significantly higher jitter percent (1.82 ± 1.34) than males who received medical management (MM) (1.16 ± 19.21), P = 0.02. Furthermore, MS had significantly higher relative average perturbation percent (1.06 ± 0.78) than MM (0.68 ± 0.57), P = 0.03. Females who received surgical management had significantly lower shimmer percent (3.74 ± 2.88) than females who received medical management (4.66 ± 2.42), P = 0.01. Univariate significance was found in some female confounding variables. A logistic regression model did not show significance. Conclusion Males with high jitter percent and relative average perturbation are more likely to receive surgical management for vocal fold masses. Females with lower shimmer percent are more likely to have surgical management of vocal fold masses when compared to the medical management group. Objective voice measures did not show significant predictive value when controlled for confounding variables. To determine the predictive value of objective voice measurements in patients with vocal fold masses for receiving medical or surgical management. Retrospective chart review. Patients presented from January 2015 through March 2020 and diagnosed with vocal fold mass. Objective voice measurements studied were average fundamental frequency, jitter percent, relative average perturbation, shimmer percent, noise to harmonic ratio, standard deviation of fundamental frequency, maximum phonation time, and S:Z ratio. Non-parametric Mann Whitney U test, chi square and fisher exact test were used. Ninety-six patients (48 male and 48 female) were included. Males who received surgical management (MS) had significantly higher jitter percent (1.82 ± 1.34) than males who received medical management (MM) (1.16 ± 19.21), P = 0.02. Furthermore, MS had significantly higher relative average perturbation percent (1.06 ± 0.78) than MM (0.68 ± 0.57), P = 0.03. Females who received surgical management had significantly lower shimmer percent (3.74 ± 2.88) than females who received medical management (4.66 ± 2.42), P = 0.01. Univariate significance was found in some female confounding variables. A logistic regression model did not show significance. Males with high jitter percent and relative average perturbation are more likely to receive surgical management for vocal fold masses. Females with lower shimmer percent are more likely to have surgical management of vocal fold masses when compared to the medical management group. Objective voice measures did not show significant predictive value when controlled for confounding variables.

Quality of Voice in Patients With Partial Deafness Before and After Cochlear Implantation

Quality of Voice in Patients With Partial Deafness Before and After Cochlear Implantation

Extreme Vocal Effects Distortion, Growl, Grunt, Rattle, and Creaking as Measured by Electroglottography and Acoustics in 32 Healthy Professional Singers

SummaryVocal effects - also called extreme or extended vocal techniques - with the intention to sound hoarse or rough are widely used as part of many genres and styles of singing, yet scarcely documented in research. Physiological studies detail the involvement of supraglottic structures for the production of vocal effects, yet the acoustic impact of such involvement has not been documented systematically across phonation types. PurposeTo report acoustic measurements and electroglottography-specific measurements for the five rough-sounding vocal effects Distortion, Growl, Grunt, Rattle, and Creaking across phonation types to demonstrate differences between notes with and without vocal effects added. MethodsThirty-two professional singers and singing teachers produced sustained vowels in each of the four vocal modes with alternations of adding and removing the vocal effects. The singers were recorded with a microphone at a constant distance as well as with EGG. ResultsThe vocal effects Distortion, Growl, Grunt, Rattle, and Creaking impact the acoustic spectra in separate and systematic ways across genders and phonation types. Each vocal effect impacted the spectrum in specific and particular frequency regions between 0 and 3.5 KHz as well as in higher partials after 12 kHz with statistical significance. EGG-waveforms were un-impacted by most of the vocal effects produced using supraglottic sound sources, whereas Grunt and Creaking conditions did impact EGG-waveform signals, though not consistently between participants. EGG measures confirmed sustained and unchanged Qx and Fx for most conditions, with statically significant changes in noise measurements Harmonic-to-Noise Ratio, Normalised Noise Energy, Relative Average Perturbation, and Cepstral Peak Prominence, despite Sound Pressure Level differing significantly only for a few specific conditions. Singers scored an average of 5,95 on Voice Handicap Index questionnaires and were all reportedly healthy. ConclusionsVocal effects added to phonation produce specific increases and specific decreases in particular frequency regions in a systematic way and can be produced in a healthy and sustainable manner, as measured by Voice Handicap Index. Vocal effects can be added to different phonation types with differing acoustic output and singers were able to sustain and control involvement of the supraglottic sound source(s) independently of phonation type.

Receiver operating characteristic analysis of acoustic and electroglottographic parameters with different sustained vowels

Objective To examine the power of the parameters obtained from different sustained vowels used in acoustic and electroglottographic (EGG) voice evaluation protocols to discriminate between dysphonic and non-dysphonic voice quality. Methods Sixty non-dysphonic participants and 30 dysphonic participants were included in the study. In addition to the time domain amplitude and frequency perturbation parameters obtained from the sustained phonation of /ʌ/-/ɛ/-/i/-/u/ vowels, several frequency-domain spectral/cepstral parameters and EGG parameters were evaluated. The classification performance of the acoustic and electroglottographic measures was quantified using analysis and receiver operating characteristic (ROC) curve analysis. Results As a result of ROC analysis, the discriminative diagnostic performance (area under the curve, AUC) of the test for low-vowel (/ʌ/-/ɛ/) phonation was higher than values obtained from high-vowel (/i/-/u/) phonation. For /ʌ/ and /ɛ/ sustained vowels, the parameters exhibiting the highest discrimination were fundamental frequency standard deviation (fo/STD), cepstral peak prominence (CPP), relative average perturbation (RAP), pitch perturbation quotient (PPQ), and jitter percent (JITT). In the EGG parameters, on the other hand, average jitter and periodicity parameters obtained from front vowels (/ɛ/-/i/) were found to have higher AUC values compared to back vowels (/ʌ/-/u/). Conclusions In acoustic analyses, /ʌ/ and /ɛ/ sustained vowels give the highest diagnostic performance. In the electroglottographic evaluation, on the other hand, /ɛ/ and /i/ vowels, when the position of the tongue is forward, have better classification performance compared to /ʌ/ and /u/ vowels, when the position of the tongue is back.

Acoustic Measures of Brazilian Transgender Women's Voices: A Case-Control Study.

Objective: This study aims to compare the acoustic vocal analysis results of a group of transgender women relative to those of cisgender women.Methods: Thirty transgender women between the ages of 19 and 52 years old participated in the study. The control group was composed of 31 cisgender women between the ages of 20 and 48 years old. A standardized questionnaire was administered to collect general patient data to better characterize the participants. The vowel /a/ sounds of all participants were collected and analyzed by the Multi-Dimensional Voice Program advanced system.Results: Statistically significant differences between cisgender and transgender women were found on 14 measures: fundamental frequency, maximum fundamental frequency, minimum fundamental frequency, standard deviation of fundamental frequency, absolute jitter, percentage or relative jitter, fundamental frequency relative average perturbation, fundamental frequency perturbation quotient, smoothed fundamental frequency perturbation quotient, fundamental frequency variation, absolute shimmer, relative shimmer, voice turbulence index (lower values in the cases), and soft phonation index (higher values in the cases). The mean fundamental frequency value was 159.046 Hz for the cases and 192.435 Hz for the controls.Conclusion: Through glottal adaptations, the group of transgender women managed to feminize their voices, presenting voices that were less aperiodic and softer than those of cisgender women.

Normative Speech Data in Professional Opera Singers- A Retrospective Study

The purpose of this study was to compare objective voice parameters for the professional opera singer population with KAYPENTAX CSL normative values. Medical records of students at an elite opera conservatory who came into the senior author's (RTS) office for a baseline evaluation were reviewed retrospectively. All subjects had no voice complaint and had not undergone voice surgery. Subjects with vocal fold mass and scar were excluded. All subjects had undergone objective voice measurements by one of three board certified speech-language pathologists using the KAYPENTAX CSL (computerized Speech Lab) protocol. Mean, standard deviation, median and range were compared with normative values provided by KAYPENTAX CSL. Twenty-seven elite opera conservatory students (11 females and 16 males, ages 21-29 years) were included in the study. There were significant differences between singers and normative values of KAYPENTAX CSL. Among men, the jitter, relative average perturbation and noise- to- harmonic ratio among singers were significantly lower than KAYPENTAX CSL normative values. Among the females, the shimmer percent of singers was significantly higher than KAYPENTAX CSL normative values. Our findings indicate that singers may have different normative voice parameters. However, further research is needed to confirm or refute these findings, and similar studies are needed for singers in other genres.

Acoustic, Perceptual, and Laryngoscopic Changes Post Vocal Abuse at a College Fest

College students use their voices at excessively loud intensities and long durations during college fests. The accumulative effect of vocally abusive behaviors in the presence of high ambient noise, poor vocal hygiene, and other environmental factors contribute significantly towards reducing vocal effectiveness in college students. The present study aimed to study the effect of a vocally demanding situation (college Fest) on perceptual and objective voice features of college students. In this study, a total number of 27 undergraduate female students participated in the age range of 18-27 years. Pre-test-post-test research design was applied. Data analysis consisted of video stroboscopic examination, acoustic analysis using the Multi-dimensional voice program (MDVP), and perceptual evaluation with the GRBAS scale. The data obtained were processed using descriptive statistics and non-parametric tests to determine the difference in each measured parameter pre- and postfest. Incomplete glottis closure, asymmetric vibration of vocal folds, and aperiodicity of vocal folds increased significantly postcollege Fest. GRBAS parameters also showed a change from pre Fest scores on grade (hoarseness) increased by 38%, breathiness in 34%, roughness in 26%, Asthenia in 15%, and strain increased in 38% participants. A P-value estimation revealed significantly higher scores in Jitter percent, Shimmer percent, and relative average perturbation than pre-fest scores. The results of the present study indicate a high risk of vocal disorders among college students post Fest. This study suggests a potential unmet need for college students to receive education before cultural events on optimal vocal usage, vocal hygiene, and an appropriate period of vocal rest.

4290 Acoustic screening for the “wet voice” in a canine laryngeal model

OBJECTIVES/GOALS: Early dysphagia detection reduces risk of pulmonary complications, length of hospital stay, and overall healthcare costs. The biggest limitation for early detection has been the lack of a sensitive, reliable, and noninvasive screening tool. The bedside swallow examination may miss silent aspiration in up to 40% of patients. The objective of this study is to evaluate if acoustic parameters can distinguish normal and wet voice in a canine laryngeal model. Ultimately, our goal is to establish whether the sensitivity of the bedside swallow examination can be augmented with the addition of an acoustic screen in humans. METHODS/STUDY POPULATION: Two excised canine larynges were used for laryngeal phonation simulations under six different conditions over 48 hours. Acoustic recordings were obtained while the larynges were in vibration at the phonation threshold pressure. Phonation was recorded under dry conditions and when the laryngeal introitius was covered with low viscosity glycerin (9.5cP) or high viscosity glycerin (950cP), as well as in adducted and abducted conditions. The latter mimics glottic insufficiency seen in presbylarynx or vocal fold paralysis. RESULTS/ANTICIPATED RESULTS: A total of 112 voice samples were generated and analyzed for pitch, sound pressure level (SPL), % shimmer, % jitter, relative average perturbation (RAP), and noise-to-harmonics using PRAAT software. A multivariate regression model showed that pitch, SPL, % shimmer, % jitter and RAP could significantly predict wetness in abducted conditions only. Could you please add numbers and p values? DISCUSSION/SIGNIFICANCE OF IMPACT: This pilot study indicates that classic acoustic perturbation measures distinguish the dry from the wet larynx only in glottic insufficiency condition in an ex vivo canine laryngeal model. Our next step is to study whether non-linear time series analysis and machine learning can differentiate dry and wet phonation in both adducted and abducted conditions in our animal model. CONFLICT OF INTEREST DESCRIPTION: Dr. Anais Rameau is a co-founder and Chief Executive Officer of MyophonX, a wearable device used to restore speech in patients with limited phonation capacity.

Comparison of Habitual and High Pitch Phonation in Teachers With and Without Vocal Fatigue

The main aim of this study was to investigate whether or not high pitch phonation can be used for assessing the vocal loading model. For this purpose, habitual and high pitch phonations were compared between teachers with and without vocal fatigue. Sixty teachers (30 teachers with vocal fatigue and 30 teachers without vocal fatigue) participated in the present study. From both the groups of teachers, habitual and high pitch phonations were recorded. Fundamental frequency measures (mean, minimum, and maximum fundamental frequency), percent Jitter (Jitt), relative average perturbation (RAP), pitch perturbation quotient (PPQ), smoothened pitch perturbation quotient (SPPQ), noise-to-harmonic ratio (NHR), cepstral peak prominence (CPP), and smoothened cepstral peak prominence (CPPS) measurements were extracted from the recorded samples. The different acoustic measurements were compared across the two phonations and two groups of teachers. Significant decrease in mean, minimum, and maximum fundamental frequency values were found in high pitch phonation in teachers with vocal fatigue when compared with teachers without vocal fatigue. However, there was no significant difference between the two groups of participants for any of the acoustic measurements during the habitual phonation. Current results highlight that high pitch phonation may serve as a better sensitive sample than habitual phonation as an indicator to assess vocal fatigue in teachers. Hence, further studies need to be done with different professional voice users to early identify those individuals who are susceptible to develop voice problems.

Respiratory muscle training in stroke patients with respiratory muscle weakness, dysphagia, and dysarthria - a prospective randomized trial.

Objective:To examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional performance, and dysarthria in patients with stroke.Design:Prospective, randomized controlled trial.Setting:Tertiary hospital.Participants:The trial included 21 subjects (12 men, 9 women) aged 35 to 80 years presenting with 6 months history of unilateral stroke, respiratory muscle weakness (≥70% predicted maximal inspiratory pressure (MIP) and/or ≤70% maximal expiratory pressure (MEP)), dysphagia, or dysarthria. These subjects were randomly assigned to the control (n = 10, rehabilitation) and experimental (n = 11, rehabilitation with RMT) groups.Intervention:Inspiratory RMT starting from 30% to 60% of MIP and expiratory RMT starting from 15% to 75% of MEP for 5 days/week for 6 weeks.Main outcome measures:MIP, MEP, pulmonary function, peak cough flow, perception of dyspnea, Fatigue Assessment Scale, Modified Rankin Scale, Brunnstrom stage, Barthel index, Functional Oral Intake Scale (FOIS), and parameters of voice analysis.Results:Significant differences were observed between both groups in terms of MIP, forced vital capacity (FVC), and forced expiratory volume per second (FEV1) of the percentage predicted. Significant difference was found with respect to the change in fatigue, shimmer percent, amplitude perturbation quotient, and voice turbulence index (VTI) according to the acoustic analysis in the RMT group. The FEV1/FVC ratio was negatively correlated with jitter percent, relative average perturbation, pitch perturbation quotient, and VTI; the maximum mid-expiratory flow (MMEF) and MMEF% were also negatively correlated with VTI. Significant differences among participants of the same group were observed while comparing the Brunnstrom stage before and after training of the affected limbs and the Barthel scale and FOIS scores in both the groups.Conclusions:Altogether, 6-week combined inspiratory and expiratory RMT is feasible as adjuvant therapy for stroke patients to improve fatigue level, respiratory muscle strength, lung volume, respiratory flow, and dysarthria.Clinical trial registration number (Clinical Trial Identifier): NCT03491111.

How Does Our Voice Change as We Age? A Systematic Review and Meta-Analysis of Acoustic and Perceptual Voice Data From Healthy Adults Over 50 Years of Age.

Purpose Approximately 30% of adults over the age of 50 years present with altered vocal function. Our understanding of how these changes manifest acoustically and perceptually is derived from relatively modest-sized studies using a diversity of tools. Voice changes can arise from the onset of disease or disorder, but also age-related physiological changes, which may not reflect pathology as such. Here, we bring together data on acoustic, perceptual, and instrumental assessments (electroglottography), with the aim of gaining a better understanding of the changes occurring across these measurement domains. We consider these changes in the context of different acoustic features, software programs, and perceptual protocols. Method Studies of voice function in healthy older adults over the age of 50 years were sought. Literature was systematically searched with 746 abstracts reviewed. Forty-seven studies were included in the review. A meta-analysis of included studies compared voice acoustic parameters between sex and age. Sixteen acoustic parameters collected from 1,475 participants were analyzed in the meta-analysis. These included some previously unpublished analyses using data provided by authors of included studies. Results Data from the systematic review suggest that older individuals are perceived to present with higher overall scores of dysphonia and roughness, breathiness, strain, and instability. Acoustically, males have significantly higher scores on measures of perturbation, including noise-to-harmonic ratio and absolute jitter. The meta-analysis outcomes suggest that participants aged 80-89 years produce significantly higher fundamental frequency, jitter percent, shimmer percent, and shimmer in decibels compared to participants aged 60-69 years and a significant increase in relative average perturbation, jitter percent, and shimmer in decibels compared to participants aged 70-79 years. Limited data were available comparing acoustic measures using the same acoustic software. Conclusions Variations in fundamental frequency and frequency and amplitude perturbation increase as healthy adults age. It was difficult to draw definitive conclusions based on existing literature due to variability in hardware used, limited descriptions of study cohorts, or missing data from statistical analysis. Supplemental Material https://doi.org/10.23641/asha.11868663.

Characteristics of the Voice of Dysphonic School Children from 4:0 to 7:11 Years Old

Childhood dysphonia is frequent and has many origins, with the most common initial symptom being the altered vocal quality. Describe and correlate the auditory-perceptual and acoustic characteristics of the voice, and the maximum phonation time (MPT), of dysphonic schoolchildren from private and public schools from 4:0 to 7:11 years old, female and male. MPT, acoustic (Multi-Dimensional Voice Program Advanced and Real Time Spectrogram), and auditory-perceptual (Consensus Auditory-Perceptual Evaluation of Voice) evaluations of 115 schoolchildren were statistically analyzed. Auditory-perceptual parameters values were classified as mild, and MPT values were reduced, in most children. Fundamental frequency and Jitt values decreased significantly with age; MPT/i/ increased significantly with age. Relative average perturbation, voice turbulence index (VTI), and number of sub-harmonic segments values were significantly higher in 4:0 years old children. The number of unvoiced segments was higher in 6:0 years old children. Shimmer percent was higher in 7:0 years old children. There were negative correlations between the high frequency spectrographic tracing color intensity and the vocal strain; the VTI and the MPT; the degree of unvoiced segments and the MPT. There was a positive correlation between the smoothed pitch period perturbation quotient and the roughness. In dysphonic schoolchildren, auditory-perceptual parameters were moderate, MPT was reduced, several acoustic parameters were altered, and these vocal characteristics improved with age.

Diagnostic Value of Acoustic and Aerodynamic Measurements in Vocal Fold Movement Disorders and their Correlation with Laryngeal Electromyography and Voice Handicap Index

Investigate the relationships between the Voice Handicap Index, laryngeal electromyography, and objective acoustic voice testing in order to determine the utility of these measures in the management of vocal fold movement disorders. A retrospective review of patients who had completed a Voice Handicap Index-10 (VHI-10) questionnaire, laryngeal electromyography (LEMG), and objective acoustic measurements (including jitter, relative average perturbation, shimmer, noise-to-harmonic ratio, and standard deviation of fundamental frequency). All three tests had been completed within 30 days of the initial evaluation. All patients' results for acoustic measures were recorded as standard deviations from the norm. LEMG results were converted to grade of paresis (mild, moderate, severe) based on the muscle with the lowest recruitment. Spearman correlation coefficients were calculated to determine the relationship between these three parameters. A total of 313 subjects were included in the analysis. VHI-10, LEMG (grade of paresis), and objective acoustic measures were, at best, weakly correlated. VHI-10 was better correlated than LEMG to each acoustic parameter including the average acoustic scores; however, the highest correlation observed only reached ρ = 0.349 (P < 0.001). The acoustic variables that correlated best with VHI-10 and LEMG were the standard deviation of the fundamental frequency (ρ = 0.349, P < 0.001) and shimmer (ρ = 0.207, P < 0.001), respectively. This study demonstrates that these measures are, at best, weakly associated. VHI-10 correlated better than LEMG (grade of paresis) to each acoustic voice analysis parameter. However, the maximum correlation coefficient observed was 0.349. Therefore, VHI-10 scores and objective voice acoustic measurements are not useful for predicting the severity of vocal fold movement disorders. Moreover, a given severity of paresis can have different effects on voice handicap and acoustic output in different individuals.

Instrumental Acoustic Voice Characteristics in Adults with Type 2 Diabetes

The objective of this study was to investigate if there are differences in acoustic parameters between diabetic patients and normal controls. A prospective cross-sectional study was performed in 83 diabetic patients and 70 healthy controls. Voice parameters including fundamental frequency (F0), jitter, shimmer, amplitude perturbation quotient, noise-to-harmonic ratio, smoothed amplitude perturbation quotient, and relative average perturbation were analyzed using Computerized Speech Lab with the Multi-Dimensional Voice Program. F0 in female diabetic patients was significantly lower than controls (222.23 ± 27.89 Hz versus 241.08 ± 28.21 Hz, P< 0.01). In female diabetic subgroups with disease duration more than 10 years, poor glycemic control, or neuropathy, the F0 was still significantly lower. Multivariate analysis showed that F0 was significantly associated with diabetes after controlled for age, body mass index, presence of hypertension, and dyslipidemia. (P= 0.022). However, F0 was not able to predict the presence of diabetes as shown by logistic regression analysis (P= 0.243). Voice fundamental frequency is lower in females with diabetes. However, voice fundamental frequency cannot adequately predict the presence of diabetes.