Differences in acoustic and perceptual parameters of the voice between elderly and young women at habitual and high intensity

Consensus for voice quality assessment in clinical practice: guidelines of the European Laryngological Society and Union of the European Phoniatricians

INTRODUCTION

To update the European guidelines for the assessment of voice quality (VQ) in clinical practice.

METHODS

Nineteen laryngologists-phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected.

RESULTS

Of the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases.

CONCLUSION

The ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach.

The Effect of Mandarin Vowels on Acoustic Analysis: A Prospective Observational Study

OBJECTIVES

Although vowels are of interest for acoustic analysis in clinics, there is no consensus regarding the effect of vowel selection on acoustic perturbation parameters. This study aimed to reveal the effects of Mandarin vowels on acoustic measurements.

STUDY DESIGN

A prospective observational study.

METHODS

This prospective observational study enrolled normal phonation Mandarin speakers at the Otolaryngology Department of the Eye & ENT Hospital affiliated with Fudan University from December 2020 to August 2021. This study recruited 107 normal-voiced Mandarin speakers (59 women and 49 men) with a median age of 26 (22, 33) years old. The objective measures included traditional acoustic parameters (fundamental frequency, harmonic-to-noise ratio, percent jitter, and percent shimmer) and cepstral analysis (smoothed cepstral peak prominence) of six Mandarin vowels (ɑ /a/, o /o/, e /ɤ/, i /i/, u /u/, ü /y/).

RESULTS

The acoustic analysis revealed no significant differences in the fundamental frequency among vowels. The low vowel /a/ had the highest values for percent jitter and percent shimmer and the lowest harmonic-to-noise ratio value. The back vowel /u/ had the lowest cepstral measures (P < 0.05).

CONCLUSIONS

The acoustic analysis significantly varied across the different Mandarin vowels, and these differences must be considered for the effective clinical application of objective evaluations.

Many Changes in Speech through Aging Are Actually a Consequence of Cognitive Changes

Background: During aging, changes in human speech may arise because of the neurophysiological deterioration associated with age, or as the result of an impairment in the cognitive processes underlying speech production. Some speech parameters show specific alterations under the presence of dementia. The objective of our study is to identify which of these parameters change because of age, cognitive state, or the interaction of both. Methods: The sample includes 400 people over 55 years old, who were divided into four groups, according to their age. The cognitive state of the participants was assessed through the MMSE test and three ranks were stablished. Gender was also considered in the analysis. Results: Certain temporal, fluency, rhythm, amplitude and voice quality parameters were found to be related to the cognitive state, while disturbance parameters changed due to age. Frequency parameters were exclusively influenced by gender. Conclusions: Understanding how speech parameters are specifically affected by age, cognitive state, or the interaction of both, is determinant to advance in the use of speech as a clinical marker for the detection of cognitive impairments.

A Field-Based Approach to Establish Normative Acoustic Data for Healthy Female Voices

Purpose The primary aim of this study was to obtain high-quality acoustic normative data in natural field environments for female voices. A secondary aim was to examine acoustic measurement variability in field environments. Method This study employed a within-subject repeated-measures experimental design that included 45 young female adults with normal voices. Participants were stratified by age (18-23, 24-29, and 30-35 years). After initial evaluation and instruction, participants completed voice recordings during seven consecutive days using a standard protocol, including both connected speech and sustained vowels. Thirty-two cepstral-, spectral-, and time-based acoustic measures were acquired using Praat and the Analysis of Dysphonia in Speech and Voice. Results Among the 958 total recordings, greater than 90% satisfied inclusion criteria based on protocol compliance, peak clipping, and signal-to-noise ratio. Significant differences were observed for age (p < .05). For 19 acoustic measures, values improved significantly as signal-to-noise ratio increased. Cepstral- and spectral-based measures demonstrated less measurement variability as compared with time-based measures. Conclusions With adequate training, field audio recordings represent a viable option for clinical voice management. The significant age effects observed in this study support the need for more specific criteria when collecting and applying normative data. Cepstral- and spectral-based measures demonstrated the least measurement variability. This study provides additional evidence for multiparameter acoustic voice measurement, specifically toward ecologically valid sampling in natural environments. Future studies should expand on these findings in other populations with normal and disordered voices.

Comparing Individuals through the Speech Recognition Test Applied to Regional Live Voice and Recorded Speeches from Paraná State in Five Brazilian Counties

Introduction  Speech tests such as logoaudiometry measure the ability to perceive and recognize oral sounds. The Speech Recognition Index (SRI) is one of the speech tests adopted in clinical routine; it uses standardized live voice and recorded speeches. The live voice speech method can be influenced by intra and interspeaker variability, as well as by regionalism variability, whereas recorded tests show consistency in their presentation.

Objective  Analyzing results of the SRI test applied to live voice and recorded speeches from Paraná State, in different Brazilian counties.

Method  The sample comprised 125 individuals, 25 from each county (Rio de Janeiro, Florianópolis, Porto Alegre, Salvador and Curitiba), from both sexes, in the age group 20 to 70 years; the SRI was applied in both techniques.

Results  The recorded speech method showed prevalence of hit improvement in Rio de Janeiro (40%), Salvador, Porto Alegre and Florianópolis (28%). Individuals from Salvador and Florianópolis subjected to the recorded speech method showed better results in the left ear. Individuals from Rio de Janeiro and Porto Alegre showed satisfactory results in both ears, whereas those from Curitiba did not show statistically significant difference between the left and the right ear.

Conclusion  The recorded CD application method showed prevalence of hit improvement (%) in the SRI responses in comparison to the live voice speech technique in most of the studied counties. According to the hit rate measured in the herein investigated counties, Rio de Janeiro showed the best results in the recorded speech method.

Phonotherapeutic Intervention in Patients With Mucosal Leishmaniasis Sequelae

PURPOSE

To characterize the voice before and after speech-language intervention, with Humming nasal sound in patients with sequelae Mucosal Leishmaniasis (ML) and Cutaneous Leishmaniasis (CL).

METHODS

Collection of phonation /a:/ from 44 patients with ML and CL for perceptual voice analysis and computed acoustic. The Wilcoxon nonparametric test and Fisher's exact test were used, with significance level of 5%.

RESULTS

It was observed, prespeech therapy, that 27.7% of participants with ML presented asthenic vocal quality, and for the acoustics characteristics there was a statistically significant result for measures of frequency, frequency disturbance, noise, and subharmonic measurements, indicating phonatory instability, weakness, and noise emission giving the emission a feeling of vocal weakness. After therapy, the subharmonic segment measurements for the group with ML, showing reduction noise emission. Patients with CL had more grade 1 instability (36.4%), indicating tremor in vocal tract structures. After speech therapy, this group presented a reduction in the degree of roughness and reduction of the frequency disturbance measures, indicating a decrease in tension in the larynx and pharynx.

CONCLUSION

Even after completing treatment for LM, patients may experience vocal changes due to the sequelae of the disease, like vocal alterations due to nasal lesions or in other locations that interfere in the correct vocal emission. As for participants with CL, no vocal changes would be expected, since these patients present thorax, leg and arm lesions that would not cause problems for the voice. Nevertheless, the two groups of participants presented vocal changes to different degrees before vocal therapy. However, it was observed that patients with ML present vocal alterations with more severe degrees. After the speech-language intervention, the participants of both groups showed vocal improvement, but the group with CL presented more vocal benefits, possibly due to the previous vocal alterations not being so severe.

Effects of age on the amplitude, frequency and perceived quality of voice

The manner and extent to which voice amplitude and frequency control mechanisms change with age is not well understood. The related question of whether the assessment of one's own voice evolves with age, concomitant with the acoustical changes that the voice undergoes, also remains unanswered. In the present study, we characterized the aging of voice production mechanisms (amplitude, frequency), compared the aging voice in different experimental contexts (vowel utterance, connected speech) and examined the relationship between voice self-assessment and age-related voice acoustical changes. Eighty healthy adults (20 to 75 years old) participated in the study, which involved computation of several acoustical measures of voice (including measures of fundamental frequency, voice amplitude, and stability) as well as self-assessments of voice. Because depression is frequent in older adults, depression and anxiety scores were also measured. As was expected, analyses revealed age effects on most acoustical measures. However, there was no interaction between age and the ability to produce high/low voice amplitude/frequency, suggesting that voice amplitude and frequency control mechanisms are preserved in aging. Multiple mediation analyses demonstrated that the relationship between age and voice self-assessment was moderated by depression and anxiety scores. Taken together, these results reveal that while voice production undergoes important changes throughout aging, the ability to increase/decrease the amplitude and frequency of voice are preserved, at least within the age range studied, and that depression and anxiety scores have a stronger impact on perceived voice quality than acoustical changes themselves.