Severity Of Voice Quality Research Articles

Comparative Analysis of Two Methods of Perceptual Voice Assessment

The primary aim was to compare two methods for perceptual evaluation of voice - paired comparison (PC) and visual analog scale (VAS) ratings. Secondary aims were to assess the correspondence between two dimensions of voice- overall severity of voice quality and resonant voice, and to investigate the influence of rater experience on perceptual rating scores and rating confidence scores. Experimental design. Voice samples from six children (pre and post therapy) were rated by 15 Speech-Language Pathologists specialized in voice. Raters completed four tasks corresponding to the two rating methods and voice qualities: PC-severity, PC-resonance, VAS-severity, and VAS-resonance. For PC tasks, raters chose the better of two voice samples (better voice quality or better resonance, depending on the task) and indicated the degree of confidence in each choice. Rating and confidence score were combined to produce a number on a 1-10 scale (PC-confidence adjusted). VAS ratings involved rating voices on a scale for degree of severity and resonance, respectively. PC-confidence adjusted and VAS ratings were moderately correlated for overall severity and also vocal resonance. VAS ratings were normally distributed and had greater rater consistency than PC-confidence adjusted ratings. VAS scores reliably predicted binary PC choices (choice of voice sample only). Overall severity and vocal resonance were weakly correlated and rater experience was not linearly related to rating scores or confidence. Results suggest that the VAS rating method holds advantages over PC, including normally distributed ratings, superior consistency of ratings, and the ability to provide more finely grained detail regarding the auditory perception of voice. Overall severity and vocal resonance were not redundant in the current data set, suggesting that resonant voice and overall severity are not isomorphic. Finally, the number of years of clinical experience was not linearly related to perceptual ratings or rating confidence.

Individual Voice Dimensions' Prediction of Overall Dysphonia Severity on Two Auditory-Perceptual Scales.

Auditory-perceptual evaluation of dysphonic voice is an essential clinical activity that characterizes the nature of dysphonia and aids in planning its clinical management. Although there are multidimensional acoustic measures that correlate well with overall severity ratings, they tend to include measures that have only small or moderate correlations with individual voice characteristics frequently perceptually measured (e.g., breathiness or roughness). Given this difference between perceptual and acoustic measures, it is unclear how much individual voice characteristics contribute to a listener's perception of overall severity of dysphonia. The purpose of this study was to explore individual voice characteristics' relative contribution to the rating of overall dysphonia severity and to explore sex-related differences. Two hundred ninety-six voice samples were accessed from the Perceptual Voice Qualities Database. Roughness, breathiness, asthenia, strain, pitch, and loudness ratings from the Grade, Roughness, Breathiness, Asthenia, Strain and Consensus Auditory-Perceptual Evaluation of Voice scales were used to predict overall voice quality severity in linear regression with bootstrapped coefficients. Roughness, breathiness, and strain were the strongest predictors of overall severity. Asthenia and, to a lesser extent, pitch were also significant predictors of overall severity. Loudness was not a significant predictor. There were several sex-related differences noted, as well as differences related to the scale used. Breathiness, roughness, and strain were all important predictors of overall severity for all regressions. Clinicians should be aware of scale-related differences if they are using auditory-perceptual measures to choose voice therapy targets. Analyses accounting for perceptual strategy differences were recommended for future studies.

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.

The effect of the auditory signal on videolaryngostroboscopy ratings and interpretation

ObjectiveThe primary aim of this study was to examine the effect of the videolaryngostroboscopic auditory signal on videolaryngostroboscopy (VLS) ratings and interpretation in normophonic and dysphonic speakers. Study DesignProspective repeated measures design MethodEight speech-language pathologists evaluated rigid VLS exams obtained from 12 dysphonic speakers with vocal fold pathology and 4 normophonic speakers with normal VLS exams. VLS exams were evaluated with the auditory signal present and absent with a washout period between rating sessions. VLS measures were obtained using the Voice-vibratory Assessment of Laryngeal Imaging (VALI) and a 100mm visual analog scale (VAS). The effects of the auditory signal and its interaction with voice quality severity on 9 VLS ratings, diagnostic billing codes, and treatment recommendations were examined. ResultsThere was no effect of auditory information on VLS measures or overall severity of laryngeal function evaluated using the VAS (ps > 0.05). There was a main effect of auditory information and a significant interaction with voice quality severity for only one VLS measure (non-vibrating portion-left) evaluated using the VALI (P = 0.05). Post-hoc analysis for this rating showed significant increases (t-test adjusted P < 0.05) when voice quality severity was moderate-severe (M = 4.8%; SD = 1.65%) and auditory information was present. Agreement in individual clinician's selection of diagnostic codes (73%) and treatment recommendations (65.6%) when auditory cues were present and absent was moderate to high. ConclusionThe presence of the videolaryngostroboscopic auditory signal had a minimal effect on VLS ratings, treatment recommendations, or diagnostic billing codes.

Epidemiological Patterns and Treatment Outcomes in a Private Practice Community Voice Clinic

Voice therapy is administered by speech-language pathologists in multiple practice settings, including private practice community voice clinics. However, the evidence for diagnosis patterns and voice treatment outcomes in community voice clinics is very limited. The purpose of this study was to extend knowledge from a previous investigation by assessing the epidemiological patterns of patient referrals to a private practice community voice clinic across a 4-year period (50 months) and to measure the effectiveness of treatment outcomes for patients who were followed up with voice therapy in the same setting. Retrospective case series. Consecutive patient records from November 2014 through January 2019 were reviewed. Patients were grouped into seven categories of distinctive diagnoses. Descriptive data for each group were extracted to determine epidemiological patterns of disorder diagnosis, voice handicap, voice quality severity, age, and gender. For patients who completed at least three treatment sessions, pre- and posttreatment measurements of two assessments, the Voice Handicap Index (VHI) and the Acoustic Voice Quality Index (AVQI), were extracted and compared using a multivariate analysis of variance. Records from 454 consecutive patient referrals over a 50-month time period were reviewed. The most frequent diagnoses were multifactorial etiologies or those with only a few cases, categorized collectively as an "other" diagnosis category. Diagnoses of nonspecific dysphonia and mid-membranous lesions were also common. Consensus Auditory Perceptual Evaluation of Voice-scale scores were not different among disorders; however, group differences were found for VHI and AVQI. Treatment data were available for 292 patients, with 47 of those patients completing at least three treatment sessions and with data for pre- and posttreatment VHI and AVQI. A mixed multivariate analysis of variance showed a significant effect of treatment (Wilks' Lambda=0.42, F[2]=27.58, P < 0.001, ƞp²=0.58), where both AVQI and VHI improved significantly across the pre- to posttreatment measurements. Patient characteristics and diagnosis patterns across a 50-month period were similar when compared to a previous study that investigated epidemiological patterns in this clinic across 28 months. Voice therapy administered in this community voice clinic to patients with varied diagnoses was found to be effective based on changes in VHI and AVQI measurements.

Vocal Function Differences Before and After Sorority Recruitment

Participation in sorority recruitment often results in acute vocal impairment. The purpose of this investigation was to characterize the extent to which voice function and laryngeal appearance may be altered by participation in this social phenomenon. Using a within-participant repeated measures design, nine women participating as sorority recruiters completed the study protocol. The following data were collected at two time points, immediately before and after the completion of two weeks of sorority recruitment: stroboscopic laryngeal imaging, vocal acoustic measures, and perceptual measures of vocal effort and voice quality. Perceived phonatory effort and overall severity of voice quality were significantly impaired following sorority recruitment. All participants had evidence of mucosal changes in the form of one or more the following: observed edema, erythema, increased vascularity, glottic margin changes. No significant differences in acoustic measures were identified. Increased perceived vocal effort, increased overall severity ratings of voice quality, and deleterious vocal fold tissue changes observed support the hypothesis that the acute vocal loading that is characteristic of the sorority recruitment process contributes to a decline in voice function in the short term. Acoustic measures taken either lacked the sensitivity for the perceived decline in voice function or the participants, who were otherwise healthy, managed to adapt the acoustic signal to the tissue changes observed. The extent to which these acute changes may be mitigated with vocal hygiene and voice training is an area for future study.

Voice quality severity and responsiveness to levodopa in Parkinson’s disease

The effect of levodopa on perceptual and acoustic measures of voice quality was examined in fifty-one individuals with Parkinson’s disease (IWPD). IWPDs produced prolonged vowels while on and off levodopa. Acoustic measures included jitter, shimmer, harmonic-to-noise ratio, cepstral peak prominence and the Acoustic Voice Quality Index. A perceptual measure of overall voice quality was obtained from 3 listeners. When the IWPDs were examined as a group, no significant difference was found between on and off levodopa conditions. In contrast, when IWPDs were split into two groups based on voice quality severity, a significant group-by-medication state interaction emerged. In addition, there was a significant correlation (r = .55) between the magnitude of levodopa-related improvement in perceived voice quality and voice quality severity. In contrast, levodopa-related improvement in voice quality was not correlated with duration of disease or levodopa use. Results do not support the hypothesis of reduced levodopa-responsiveness to voice symptoms as disease duration increases. Instead, the results suggest that the magnitude of the levodopa response may increase with increasing severity of the voice quality symptoms. These results suggest that the severity of speech and voice symptoms needs to be given greater consideration in future studies of levodopa effectiveness in IWPDs.

The Acoustic Voice Quality Index Version 03.01 for the Japanese-speaking Population

We aimed to determine the most appropriate syllable number for analyzing the Acoustic Voice Quality Index for the Japanese-speaking population (AVQIv3-JP) and to validate AVQIv3-JP using the determined syllable number. First, we counted how many syllables should be included in each continuous speech (CS) sample to achieve time-balanced analysis between CS and sustained vowel samples using our previous dataset including 336 CS samples with 58 syllables. From the descriptive statistics of the counted syllable numbers, the most appropriate syllable number was identified. Subsequently, we performed validation procedures of AVQIv3-JP using our latest dataset including 455 recordings. Thirty Japanese syllables were judged to be the most appropriate syllable number. The concurrent validity of the AVQIv3-JP using 30 syllables was confirmed by Spearman's rho of 0.873. Subsequently, the receiver operating characteristic analysis demonstrated the excellent discriminative capability of AVQIv3-JP, showing the area under the curve of 0.915. The AVQIv3's original threshold of 2.43 in the Dutch language corresponded to sensitivity and specificity of 64.6% and 97.3%, respectively. In the present study, a threshold of 1.41 achieved the best accuracy with balanced sensitivity and specificity of 84.4% and 85.6%, respectively. Furthermore, the 95th percentile of the control participants exhibited a threshold of 2.06, showing sensitivity and specificity of 72.1% and 93.8%, respectively, as well as reasonable positive and negative likelihood ratios of 11.7 and 0.298, respectively. The AVQIv3 using 30 Japanese syllables is a reliable measurement tool for estimating the severity of voice quality and detecting abnormal voices.

The effect of visual feedback and training in auditory-perceptual judgment of voice quality

The aim of the present investigation was to evaluate the effect of visual feedback on rating voice quality severity level and the reliability of voice quality judgment by inexperienced listeners. For this purpose two training programs were created, each lasting 2 hours. In total 37 undergraduate speech–language therapy students participated in the study and were divided into a visual plus auditory-perceptual feedback group (V + AF), an auditory-perceptual feedback group (AF), and a control group with no feedback (NF). All listeners completed two rating sessions judging overall severity labeled as grade (G), roughness (R), and breathiness (B). The judged voice samples contained the concatenation of continuous speech and sustained phonation. No significant rater reliability changes were found in the pre- and posttest between the three groups in every GRB-parameter (all p > 0.05). There was a training effect seen in the significant improvement of rater reliability for roughness within the NF and AF groups (all p < 0.05), and for breathiness within the V + AF group (p < 0.01). The rating of the severity level of roughness changed significantly after the training in the AF and V + AF groups (p < 0.01), and the breathiness severity level changed significantly after the training in the V + AF group (p < 0.01). The training of V + AF and AF may only minimally influence the reliability in the judgment of voice quality but showed significant influence on rating the severity level of GRB parameters. Therefore, the use of both visual and auditory anchors while rating as well as longer training sessions may be required to draw a firm conclusion.

Influence of Consonant Voicing Characteristics on Sentence Production in Abductor Versus Adductor Spasmodic Dysphonia

This study evaluated the hypotheses that sentence production by speakers with adductor (AD) and abductor (AB) spasmodic dysphonia (SD) may be differentially influenced by consonant voicing and manner features, in comparison with healthy, matched, nondysphonic controls. This was a prospective, single blind study, using a between-groups, repeated measures design for the independent variables of perceived voice quality and sentence duration. Sixteen subjects with ADSD and 10 subjects with ABSD, as well as 26 matched healthy controls produced four short, simple sentences that were systematically loaded with voiced or voiceless consonants of either obstruant or continuant manner categories. Experienced voice clinicians, who were "blind" as to speakers' group affixations, used visual analog scaling to judge the overall voice quality of each sentence. Acoustic sentence durations were also measured. Speakers with ABSD or ADSD demonstrated significantly poorer than normal voice quality on all sentences. Speakers with ABSD exhibited longer than normal duration for voiceless consonant sentences. Speakers with ADSD had poorer voice quality for voiced than for voiceless consonant sentences. Speakers with ABSD had longer durations for voiceless than for voiced consonant sentences. The two subtypes of SD exhibit differential performance on the basis of consonant voicing in short, simple sentences; however, each subgroup manifested voicing-related differences on a different variable (voice quality vs sentence duration). Findings suggest different underlying pathophysiological mechanisms for ABSD and ADSD. Findings also support inclusion of short, simple sentences containing voiced or voiceless consonants as part of the diagnostic protocol for SD, with measurement of sentence duration in addition to judments of voice quality severity.

The Relationship Between Perception of Vocal Effort and Relative Fundamental Frequency During Voicing Offset and Onset

In this study, the authors aimed to determine the relationship between relative fundamental frequency (RFF) and listener perception of vocal effort in individuals with varying degrees of vocal hyperfunction. Thirty women diagnosed with voice disorders commonly associated with vocal hyperfunction and 10 healthy women provided speech samples that were used to obtain parameters of RFF. Twelve listeners judged the speech samples for overall severity and vocal effort (VE) using rating scales. Significant but relatively weak negative correlations were found between perceptual measures and offset RFF parameters. Although offset RFF was increased in healthy participants relative to speakers with voice disorders, no differences were seen in RFF as a function of severity of VE in individuals with voice disorders. Although a statistically significant correlation between offset RFF and VE was found, examination of data as a function of both VE and health status indicated that RFF more accurately classifies the presence of a voice disorder than does severity of voice quality or VE. There is a need for further research to investigate the clinical utility of RFF measures for assessment of rehabilitation progress.

Tracking voice change after thyroidectomy: application of spectral/cepstral analyses

This study evaluates the utility of perioperative spectral and cepstral acoustic analyses to monitor voice change after thyroidectomy. Perceptual and acoustic analyses were conducted on speech samples (sustained vowel /ɑ/ and CAPE-V sentences) provided by 70 participants (36 women and 34 men) at four study time points: prior to thyroid surgery and 2 weeks, 3 months and 6 months after thyroidectomy. Repeated measures analyses of variance focused on the relative amplitude of the dominant harmonic in the voice signal (cepstral peak prominence, CPP), the ratio of low-to-high spectral energy, and their respective standard deviations (SD). Data were also examined for relationships between acoustic measures and perceptual ratings of overall severity of voice quality. Results showed that perceived overall severity and the acoustic measures of the CPP and its SD (CPPsd) computed from sentence productions were significantly reduced at 2-week post-thyroidectomy for 20 patients (29% of the sample) who had self-reported post-operative voice change. For this same group of patients, the CPP and CPPsd computed from sentence productions improved significantly from 2-weeks post-thyroidectomy to 6-months post-surgery. CPP and CPPsd also correlated well with perceived overall severity (r = −0.68 and −0.79, respectively). Measures of CPP from sustained vowel productions were not as effective as those from sentence productions in reflecting voice deterioration in the post-thyroidectomy patients at the 2-week post-surgery time period, were weaker correlates with perceived overall severity, and were not as effective in discriminating negative voice outcome (NegVO) from normal voice outcome (NormVO) patients as compared to the results from the sentence-level stimuli. Results indicate that spectral/cepstral analysis methods can be used with continuous speech samples to provide important objective data to document the effects of dysphonia in a post-thyroidectomy patient sample. When used in conjunction with patient's self-report and other general measures of vocal dysfunction, the acoustic measures employed in this study contribute to a complete profile of the patient's vocal condition.

Multiparametric Evaluation of Dysphonic Severity

In recent years, the multiparametric approach for evaluating perceptual rating of voice quality has been advocated. This study evaluates the accuracy of predicting perceived overall severity of voice quality with a minimal set of aerodynamic, voice range profile (phonetogram), and acoustic perturbation measures. One hundred and twelve dysphonic persons (93 women and 19 men) with laryngeal pathologies and 41 normal controls (35 women and six men) with normal voices participated in this study. Perceptual severity judgement was carried out by four listeners rating the G (overall grade) parameter of the GRBAS scale. The minimal set of instrumental measures was selected based on the ability of the measure to discriminate between dysphonic and normal voices, and to attain at least a moderate correlation with perceived overall severity. Results indicated that perceived overall severity was best described by maximum phonation time of sustained /a/, peak intraoral pressure of the consonant-vowel /pi/ strings production, voice range profile area, and acoustic jitter. Direct-entry discriminant function analysis revealed that these four voice measures in combination correctly predicted 67.3% of perceived overall severity levels.