The acoustic voice quality index, version 2.06 and 3.01, for the Persian-speaking population

The Rapidly Evolving Scenario of Acoustic Voice Analysis in Otolaryngology

The field of voice analysis has experienced significant transformations, evolving from basic perceptual assessments to the incorporation of advanced digital signal processing and computational tools. This progression has facilitated a deeper understanding of the complex dynamics of vocal function, particularly through the use of acoustic voice analysis within a multidimensional evaluation framework. Traditionally, voice analysis relied on parameters such as fundamental frequency, jitter, shimmer, and noise-to-harmonic ratio, which, despite their utility, have faced criticism for variability and lack of robustness. Recent developments have led to a shift toward more reliable metrics such as cepstral measures, which offer improved accuracy in voice quality assessments. Furthermore, the integration of multiparametric constructs underscores a comprehensive approach to evaluating vocal quality, blending sustained vowels, and continuous speech analyses. Current trends in clinical practice increasingly favor these advanced measures over traditional parameters due to their greater reliability and clinical utility. Additionally, the emergence of artificial intelligence (AI), particularly deep learning, holds promise for revolutionizing voice analysis by enhancing diagnostic precision and enabling efficient, non-invasive screening methods. This shift toward AI-driven approaches signifies a potential paradigm change in voice health, suggesting a future where AI not only aids in diagnosis but also the early detection and treatment of voice-related pathologies.

Validation of the Acoustic Voice Quality Index Version 03.01 in Turkish

OBJECTIVES

The aim of this study was to validate the Acoustic Voice Quality Index (AVQI) version 3.01 in the Turkish-speaking population.

MATERIALS AND METHODS

Concatenated voice samples of the sustained vowel [a:] and continuous speech were collected from 127 dysphonic and 128 normophonic participants. The auditory-perceptual evaluation was performed by five experienced raters using the Grade parameter of the Grade, Roughness, Breathiness, Asthenia, Strain scale. Rater reliability, concurrent validity, diagnostic accuracy, and differences between normophonic and dysphonic groups were analyzed for the AVQI version 3.01.

RESULTS

The number of syllables for the standardized reading text with the concatenation of the voiced parts lasting around 3 seconds (mean = 3.84 seconds) was 36. The intraclass correlation coefficient (ICC) values of intra-rater reliability of G scores of five raters were excellent (mean ICC = 0.934), and of inter-rater reliability, they varied between moderate and excellent (mean ICC = 0.786). AVQIv3 demonstrated a high diagnostic accuracy with area under receiver-operating characteristic curve = 0.906 in identifying disrupted versus normal voice quality. With sensitivity of 80% and specificity of 94%, AVQIv3 = 2.345 was the cutoff point that differentiated most accurately between normophonic and dysphonic voices in Turkish.

CONCLUSION

AVQIv3 is an ecologically valid tool for objective differentiation between dysphonic and normal voices in the Turkish language.

Cross-Cultural Adaptation, Validation, and Diagnostic Accuracy of the Voice Fatigue Handicap Questionnaire-Persian Version

OBJECTIVE

The current study aimed to determine the psychometric characteristics of a translated version of the Voice Fatigue Handicap Questionnaire in Persian by examining the validity, reliability, and diagnostic accuracy using data collected from people with and without dysphonia.

STUDY DESIGN

Cross-sectional study.

METHOD

The original questionnaire was translated from Italian to Persian using the International Quality of Life Assessment criteria. The translated version was completed by 122 people with dysphonia and 49 people without dysphonia. The validity, reliability, and diagnostic accuracy of the Voice Fatigue Handicap Questionnaire Persian-version were evaluated. A panel of five voice-specializing Speech and Language Pathologists and 20 native Persian speakers (with dysphonia) in a pilot study confirmed the translated version for content and face validity, respectively. The internal consistency was evaluated by Cronbach's alpha and McDonald omega coefficients. The intraclass correlation coefficient was used to examine the test-retest reliability. For discriminant validity, the mean total and subscale scores of respondents with and without dysphonia were compared through independent t tests. Finally, sensitivity, specificity, and ideal cut-off value were determined using the receiver-operating characteristic curve.

RESULTS

Cronbach's alpha coefficient was 0.965 for the total score (functional: α = 0.883, emotional: α = 0.944, physical: α = 0.917). Also, the McDonald omega coefficient was 0.966 for the total score (functional: ω = 0.889, emotional: ω = 0.933, physical: ω = 0.920). The intraclass correlation coefficient for measuring the test-retest reliability was 0.971 for the total score (functional: ICC=0.937, emotional: ICC=0.954, physical ICC=0.976). The results of the independent samples t tests indicated that the dysphonia group obtained significantly higher mean scores (total and subscale scores) than the group without dysphonia. The cutoff value of 13.5 was determined based on the optimal balance of sensitivity (0.992) and specificity (0.918).

CONCLUSION

The Voice Fatigue Handicap Questionnaire-Persian version is a valid and reliable questionnaire to identify individuals at high risk of vocal fatigue and subsequent dysphonia.

Validation of the Acoustic Voice Quality Index and the Acoustic Breathiness Index in the Persian Language

OBJECTIVES/HYPOTHESIS

This study aimed to validate the acoustic voice quality index version 03.01 (AVQIv3) and the acoustic breathiness index (ABI) in the Persian language.

METHODS

Six judges assessed the severity degree of the abnormal overall voice quality (hoarseness) and breathiness from continuous speech (cs) and sustained vowel (sv) in 136 voices samples of dysphonic and 45 vocally healthy participants. Firstly, the time length of cs and sv was balanced out for a higher level of ecological validity. Secondly, the concurrent validity and diagnostic accuracy were statistically analyzed with the Spearman rank-order correlation, and the receiver operating characteristics, likelihood ratio, and Youden index.

RESULTS

There was substantial inter-rater reliability between judges regarding hoarseness and breathiness. Twenty syllables were identified as the standardized number of syllables for the cs part. Sufficient correlations were found between AVQI and hoarseness (rs = 0.74), and between ABI and breathiness (rs = 0.74), respectively. The thresholds of 1.63 (sensitivity of 73.2% and specificity of 91%) and 2.97 (sensitivity of 70% and specificity of 87%) yielded the highest level of diagnostic findings for AVQI and ABI, respectively.

CONCLUSION

The AVQIv3 and ABI are reliable indices to quantify the abnormal overall voice quality and breathiness in the Persian language.