Acoustic Voice Quality Index - AVQI para o português brasileiro: análise de diferentes materiais de fala

Immediate effect of inspiratory exercise with exerciser and respiratory encourager in women without vocal complaints

PURPOSE

To evaluate the immediate effect of the inspiratory exercise with a booster and a respiratory exerciser on the voice of women without vocal complaints.

METHODS

25 women with no vocal complaints, between 18 and 34 years old, with a score of 1 on the Vocal Disorder Screening Index (ITDV) participated. Data collection was performed before and after performing the inspiratory exercise and consisted of recording the sustained vowel /a/, connected speech and maximum phonatory times (MPT) of vowels, fricative phonemes and counting numbers. In the auditory-perceptual judgment, the Vocal Deviation Scale (VSD) was used to verify the general degree of vocal deviation. Acoustic evaluation was performed using the PRAAT software and the parameters fundamental frequency (f0), jitter, shimmer, harmonium-to-noise ratio (HNR), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI) and Acoustic Breathiness Index (ABI). To measure the aerodynamic measurements, the time of each emission was extracted in the Audacity program. Data were statistically analyzed using the Statistica for Windows software and normality was tested using the Shapiro-Wilk test. To compare the results, Student's and Wilcoxon's t tests were applied, adopting a significance level of 5%.

RESULTS

There were no significant differences between the results of the JPA and the acoustic measures, in the pre and post inspiratory exercise moments. As for the aerodynamic measures, it was possible to observe a significant increase in the value of the TMF /s/ (p=0.008).

CONCLUSION

There was no change in vocal quality after the inspiratory exercise with stimulator and respiratory exerciser, but an increase in the MPT of the phoneme /s/ was observed after the exercise.

Perceptual-Auditory and Acoustic Analysis of Breathiness in Cis and Transgender Men and Women

OBJECTIVE

To verify breathiness in the cisgender and transgender men and women's voices, compare values of acoustic and perceptual indicators of breathiness and fundamental frequency (f0) between groups, and compare them between the voices attributed as female and male.

STUDY DESIGN

Cross sectional retrospective study.

METHODS

The study was approved by the Research Ethics Committee (4,937,140). Sustained vowel /a/ and continuous speech recordings of 21 cisgender men (CISM), 31 transgender men (TM), 32 cisgender women (CISW), and 31 transgender women (TW) were analyzed. Three judges conducted a perceptive-auditory analysis regarding the degree breathiness, using a visual analog scale, and attributed gender (female or male). The ABI (Acoustic Breathiness Index) was extracted using the PRAAT software (6.1.16). The f0, Harmonic-Noise Ratio (HNR), Voice Turbulence Index (VTI), and Soft Phonation Index (SPI) were analyzed using the Multi-Dimensional Voice Program (KayPentax).

RESULTS

The ABI value for CISM was lower than for TM and CISW. CISW had a higher f0 than; TM had a higher f0 than CISM; and TW had a higher f0 than CISM. The groups did not differ for HNR and VTI. Regarding the SPI, CISM had higher values than CISW. Regarding the auditory perception, TM presented more intense breathiness than CISM in the vowel. Regarding gender attribution by voice, the voices CISM and CISW were 100% identified as male and female. On the other hand, in the vowel analysis, 45.2% of the TM voices were perceived as female, and 59.4% of TW voices as male.

CONCLUSION

Breathiness occurs differently between groups and the voices perceived as male and female. Even when TM is submitted to the use of testosterone and undergoes vocal changes, the transglottal airflow remains, which is a female characteristic of phonation.

Resonant Voice: Perceptual and Acoustic Analysis After an Intensive Lessac Kinesensic Training Workshop

OBJECTIVE

To investigate whether actors' and actresses' voices post an Intensive Lessac Kinesensic Training Workshop - ILKTW can be perceptually identified as more resonant, and to assess if the Acoustic Voice Quality Index (AVQI), the Acoustic Breathing Index (ABI), and their acoustic measures are able to indicate the classified voices as more resonant.

METHODS

Eight vocally healthy English first-language actors and actresses, participants of the same ILKTW, were asked to sustain the vowel /a/ and to read a piece of the Rainbow Passage, pre and postworkshop, at a self-selected habitual frequency and intensity. The readings were divided into initial and final parts, both with 34 syllables, and combined with the vowel /a/ (3s). The pre and postworkshop recordings (pairs of the initial and final parts followed by the /a/ vowel) of each participant were randomly presented to a voice expert who rated the samples as more resonant or similar. The same samples were analyzed using the AVQI and ABI scripts.

RESULTS

87,5% of the initial parts and 100% of the final in postworkshop were rated by the voice expert as more resonant. Tilt was higher for the postworkshop initial parts (P = 0.036), but a correlation with the perceptual rating wasn't found. HNR was higher (P = 0.018) and jitter was lower (P = 0.017) for the postworkshop final parts. The statistical analysis comparing the perceptive and acoustic data for the final samples couldn't be applied.

CONCLUSION

It seems that the ILKTW has a positive impact on the development of a resonant voice and that the perceptual auditory rating was more effective to describe resonant voices than the AVQI, ABI, and its acoustic measures.

What is the Effect of CPAP Treatment With Humidifier on Vocal Quality?

OBJECTIVE

Evaluate vocal quality in patients with OSA before and after continuous use of CPAP with a humidifier using subjective patient perception and clinical assessment. The hypothesis was that CPAP treatment with a humidifier would benefit voice quality.

STUDY DESIGN

Randomized, sham-controlled, blinded clinical trial.

METHODS

Forty-three natal males with obstructive sleep apnea for whom CPAP treatment was recommended following polysomnography were randomized into two therapy groups: CPAP and Sham-CPAP. Participants completed questionnaires on voice use, a voice self-assessment with the ten-item vocal handicap index (VHI-10), and complementary questionnaires: the Epworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), reflux symptoms index (LPRSI) and oral dryness visual analog scale (DRY). Their voices were recorded at three different times: before CPAP therapy, and after 3 and 6 months of continuous CPAP use. The acoustic voice quality index (AVQI), and an auditory-perceptual judgment (APJ) were also applied before and after the CPAP and Sham treatments.

RESULTS

After 6 months of treatment, the CPAP group presented improvements in their sleep patterns; however, no statistically significant differences were observed between the groups in respect of the results of the voice-related questionnaires, the AVQI values, and the APJ of the voice quality. All of the participants had some degree of vocal deviation at baseline.

CONCLUSIONS

CPAP therapy with a humidifier did not improve vocal quality as evaluated by the clinician or patient self-assessment. However, it did not have any significant negative effects on voice quality, so can be considered safe to use in male OSA patients.

Dynamic vocal analysis: vocal functionality evaluation

Dynamic vocal analysis (DVA) is an auditory-perceptual and acoustic vocal assessment strategy that provides estimates on the biomechanics and aerodynamics of vocal production by performing frequency and intensity variation tasks and using voice acoustic spectrography. The objective of this experience report is to demonstrate the use of DVA in the assessment of vocal functionality of dysphonic and non-dysphonic individuals, with a special focus on the laryngeal musculature. Phonatory tasks consisted of sustained vowel, "a" or "é", and/or connected speech, in three intensities (habitual, soft, and loud) and three frequencies (habitual, high, and low), as well as ascending and descending glissando. The adjustments of the laryngeal and paralaryngeal muscles can be inferred from the different DVA tasks. The main characteristics of the laryngeal muscles analyzed are control of glottic adduction, stretching, and shortening of the vocal folds; the main characteristics of the paralaryngeal musculature are mainly related to the vertical laryngeal position in the neck. While the sustained vowel evaluates the vocal functionality with a focus on the larynx, connected speech allows the evaluation of the articulatory adjustments employed. An acoustic spectrographic software can be used to visualize the performance of such tasks. The clinical application of the DVA will be exemplified using acoustic spectrography plates from normal and dysphonic voices, taken from a voice bank. Individuals who perform the DVA tasks in a balanced way, with adequate vocal quality and without phonatory effort, demonstrate good vocal functionality. On the other hand, difficulties in performing these tasks with worsening vocal quality and/or increased muscle tension may be indications of altered vocal functionality.

Acoustic measurements of CPPS and AVQI pre and post speech therapy

PURPOSE

To compare the acoustic measurements of Cepstral Peak Prominence-Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) at pre- and post-voice therapy times.

METHODS

This is a before and after intervention study, with retrospective data collection. Twenty-two subjects with a mean age of 49.9 years participated in the study. The vocal therapy occurred between the years 2016 to 2019 in a teaching clinic, and the subjects had vocal samples collected before and after the therapeutic processes. CPPS and AVQI data extractions were performed during pre- and post-therapy. In order to characterize the sample, auditory-perceptual evaluation (APE) regarding the overall degree of vocal deviation at pre- and post-therapy moments was performed. The data were analyzed statistically.

RESULTS

The APE data indicated a decrease in the median values of overall vocal deviation degree at the post-therapy stage for both the vowel (p=0.00) and number (p=0.00) samples. The average CPPS for the vowel was 14.53 pre-therapy and 16.37 post-therapy (p=0.01); for the number emission, it was 8.22 pre-therapy and 9.06 post-therapy (p=0.02), there was a difference in the CPPS of the vowel and numbers indicating vocal improvement at post-therapy. The average AVQI was 2.27 pre-therapy and 1.54 post-therapy (p=0.05). There was an improvement in the AVQI results, with borderline p-value.

CONCLUSION

Vocal therapy produced changes in the general degree of vocal deviation, as well as in CPPS and AVQI measurements, and the results at the post-therapy moment are similar to those of vocally healthy individuals.

Acoustic measurements of CPPS and AVQI pre and post speech therapy

PURPOSE

To compare the acoustic measurements of Cepstral Peak Prominence-Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) at pre- and post-voice therapy times.

METHODS

This is a before and after intervention study, with retrospective data collection. Twenty-two subjects with a mean age of 49.9 years participated in the study. The vocal therapy occurred between the years 2016 to 2019 in a teaching clinic, and the subjects had vocal samples collected before and after the therapeutic processes. CPPS and AVQI data extractions were performed during pre- and post-therapy. In order to characterize the sample, auditory-perceptual evaluation (APE) regarding the overall degree of vocal deviation at pre- and post-therapy moments was performed. The data were analyzed statistically.

RESULTS

The APE data indicated a decrease in the median values of overall vocal deviation degree at the post-therapy stage for both the vowel (p=0.00) and number (p=0.00) samples. The average CPPS for the vowel was 14.53 pre-therapy and 16.37 post-therapy (p=0.01); for the number emission, it was 8.22 pre-therapy and 9.06 post-therapy (p=0.02), there was a difference in the CPPS of the vowel and numbers indicating vocal improvement at post-therapy. The average AVQI was 2.27 pre-therapy and 1.54 post-therapy (p=0.05). There was an improvement in the AVQI results, with borderline p-value.

CONCLUSION

Vocal therapy produced changes in the general degree of vocal deviation, as well as in CPPS and AVQI measurements, and the results at the post-therapy moment are similar to those of vocally healthy individuals.

Mapping of the characteristics in the CoDAS journal publications in the voice area: a scoping review

PURPOSE

To map and describe the characteristics present in the publications of the CoDAS journal in the voice segment.

RESEARCH STRATEGIES

The research was carried on the Scielo database using the descriptor voice.

SELECTION CRITERIA

CoDAS publications in the field of voice.

DATA ANALYSIS

Specific data collected according to delineation, summarized by descriptive analysis and analyzed in narrative format.

RESULTS

Studies published in 2019 and with cross-sectional delineation were more frequent. The most frequent result in the cross-sectional studies was the vocal self-assessment. Most intervention studies were of immediate single-session-only effect. The most frequent procedures in the validation studies were translation and transcultural adaptation.

CONCLUSION

There was a gradual increase in the number of publications of voice studies, though these had heterogeneous characteristics.

Meta-Analysis on the Validity of the Acoustic Voice Quality Index

BACKGROUND

Acoustic measurements are useful tools to objectively measure overall voice quality. The Acoustic Voice Quality Index (AVQI) has shown to be a valid multiparametric tool to objectify dysphonia severity. The increasing number of validity studies investigating AVQI's validity demands a comprehensive synthesis of the available outcomes.

OBJECTIVE OF REVIEW

The aim of the present meta-analysis is to quantify the evidence for the diagnostic accuracy of the AVQI, including its sensitivity, specificity and likelihood ratio statistics, and its concurrent validity and sensitivity to changes in auditory-perceptual voice quality ratings.

TYPE OF REVIEW

Meta-analysis SEARCH STRATEGY: MEDLINE, EMBASE, the Cochrane library and Web of Science were searched from 2010 till April 2021 with an additional manual search, using keywords related to AVQI and common terminologies of validity outcomes. Studies considering the clinical validity of AVQI (ie, diagnostic accuracy, concurrent validity and sensitivity to change), using auditory-perceptual voice quality evaluation as reference, were included.

EVALUATION METHOD

The Preferred Reporting Items for Systematic reviews and Meta-Analyses of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines were used. Quality assessment of included studies was conducted using the QUADAS-2 tool. For the diagnostic accuracy of AVQI, the pooled sensitivity, specificity and likelihood ratio statistics were determined using a summary receiver operating characteristic approach. Weighted correlation coefficient measures (rW¯) were used to assess the concurrent validity and sensitivity to change.

RESULTS

A total of 198 studies were screened and 33 articles were included. In total, voice samples of 11447, 10272, and 367 different subjects were considered for analysis of diagnostic accuracy, concurrent validity and change responsiveness, respectively. Satisfying diagnostic accuracy results were found with a pooled sensitivity of 0.83 (95% CI: 0.82-0.83), a pooled specificity of 0.89 (95% CI: 0.88-0.90), a pooled positive LR of 7.75 (95% CI: 6.04-9.95), a pooled negative LR of 0.20 (95% CI: 0.16-0.23), and a pooled diagnostic odds ratio of 47.13 (95% CI: 34.82-63.79). Summary receiver operating characteristic curve analysis showed an excellent AUC value of 0.937 and Q* index of 0.874. Strong correlations of rW¯ = 0.838 for concurrent validity and rW¯ = 0.796 for sensitivity to change were found.

CONCLUSIONS

Our results confirm the general clinical utility of the AVQI as a robust and valid objective measure for evaluating overall dysphonia severity across languages and study methods.

[Validation of the Acoustic Voice Quality Index in the Russian language]

THE AIM

Of this study was to validate the Acoustic Voice Quality Index (AVQI) in Russian language and determine threshold values to differentiate normal and dysphonic voices in russophone population.

MATERIALS AND METHODS

41 recordings of patients with laryngeal hemiplegia and hemiparesis appeared after thyroid carcinomas' surgical treatment and laryngeal cancer from the Tomsk Cancer Research Institute were used, as well as 10 new recordings of normophonic people, composing a control group. Voice samples included the first quatrain of the poem «Sail» written by M.Yu. Lermontov, and sustained vowel «a». Four specialists who work with voice disorders (three speech-language pathologists and one phoniatrist) rated degree of dysphonia for all voice sample. Moreover, the AVQI was calculated for each sample.

RESULTS

There was a statistically significant correlation between auditory-perceptual assessment and the AVQI (r=0.74), this confirms that AVQI is effective in evaluating voice disorders. The group of people with normal voice had relatively low values of AVQI, whereas the group of patients with laryngeal diseases had relatively high values. Analysis of ROC-curve showed that AVQI has excellent diagnostic accuracy to differentiate normal and dysphonic voices (AUC=0.966).

CONCLUSIONS

The AVQI is the excellent tool for objective assessment of voice disorders in the Russian population/.

The cepstral spectral index of dysphonia, the acoustic voice quality index and the acoustic breathiness index as novel multiparametric indices for acoustic assessment of voice quality

PURPOSE OF REVIEW

The objective assessment of voice quality using acoustic measures is an important pillar of voice diagnostics. This article reviews three recent acoustic measures and their clinical use in phoniatrics and laryngology.

RECENT FINDINGS

Two acoustic parameters, the cepstral spectral index of dysphonia (CSID) and the acoustic voice quality index (AVQI), have gained importance as validated multiparametric indices in the objective assessment of hoarseness because they include both continuous speech and sustained vowels. The acoustic breathiness index (ABI), another multiparametric index, assesses breathiness admixture during phonation and identifies it robustly, unaffected by other characteristics of dysphonia such as roughness.

SUMMARY

Acoustic measurements are useful diagnostic tools when used correctly with an appropriate recording system, consideration of environment and use of software programs. CSID, AVQI and ABI objectively improve the detection of voice quality abnormalities. In addition to their proven validity, their application is simple and their usability for clinicians is high.

Validation of the acoustic breathiness index to the Brazilian Portuguese language

OBJECTIVE

To assess the concurrent validity and the diagnostic accuracy of the Acoustic Breathiness Index (ABI) in Brazilian Portuguese.

METHODS

The counting numbers 1-20 and the vowel /a/ of 150 subjects were recorded (37 vocally healthy and 113 with dysphonia). The analyzed samples were the counting number 1-11 and 3 s of the sustained vowel. Nine voice specialists performed the perceptual judgment of the degree of breathiness. The Spearman Correlation and the receiver operating characteristic (ROC) curve were used to assess ABI's concurrent validity and diagnosis accuracy.

RESULTS

Results from five listeners were chosen for the study analyses due to moderate and substantial intra-rater reliability (Cohen's Kappa values = 0.520-0.772) and moderate inter-rater reliability (Fleiss Kappa = 0.353). The ABI presented a high concurrent validity (r = 0.746); 55.6% of the breathiness vocal deviation can be explained by the acoustic analysis (r² = 0.556). The ROC curve presented good diagnostic accuracy (85.2%). At a threshold of 2.94, the sensitivity was 75.3% and the specificity was 93.4%.

CONCLUSION

The ABI is a valid tool for screening and patient's follow-up regarding breathy vocal qualities in the Brazilian Portuguese language.

Does the Combination of Glottal and Supraglottic Acoustic Measures Improve Discrimination Between Women With and Without Voice Disorders?

AIM

To analyze the accuracy of traditional acoustic measurements (F0, perturbation, and noise) and formant measurements in discriminating between women with and without voice disorders, and with different laryngeal disorders.

STUDY DESIGN

A descriptive, cross-sectional, and retrospective.

METHOD

Two hundred and sixty women participated. All participants recorded the spoken vowel /Ɛ/ and underwent laryngeal visual examination. Acoustic measures of the mean and standard deviation of the fundamental frequency (F0), jitter, shimmer, glottal-to-noise excitation ratio, and the values of the first three formants (F1, F2, and F3) were obtained.

RESULTS

Individual acoustic measurements did not demonstrate adequate (<70%) performance when discriminating between women with and without voice disorders. The combination of the standard deviation of the F0, shimmer, glottal-to-noise excitation ratio, F1, F2, and F3 showed acceptable (>70%) performance in classifying women with and without voice disorders. Individual measures of jitter as well as F1 and F3 demonstrated acceptable (>70%) performance when distinguishing women with different laryngeal diagnoses, including without voice disorders (healthy larynges), Reinke's edema, unilateral vocal fold paralysis, and sulcus vocalis. The combination of acoustic measurements showed excellent (>80%) performance when discriminating women without voice disorder from those with Reinke's edema (mean of F0, F1, and F3) and with sulcus vocalis (mean of F0, F1, and F2).

CONCLUSIONS

Individual formant and traditional acoustic measurements do not demonstrate adequate performance when discriminating between women with and without voice disorders. However, the combination of traditional and formant measurements improves the discrimination between the presence and absence of voice disorders and differentiates several laryngeal diagnoses.

Accuracy of Acoustic Voice Quality Index and Its Isolated Acoustic Measures to Discriminate the Severity of Voice Disorders

OBJECTIVE

To evaluate the Acoustic Voice Quality Index (AVQI) and its isolated acoustic measures accuracy in discriminating voices with different degrees of deviation.

METHODS

Two hundred and fifty-eight voice samples (160 dysphonic; 98 vocally healthy). Information regarding acoustic analysis and overall degree of deviation (G) were considered. The acoustic analysis consisted of the AVQI total score and its isolated acoustic measures: smoothed cepstral peak prominence (CPPs); harmonic-to-noise ratio (HNR); shimmer local and dB (Shim, ShdB); the general slope of the spectrum (Slope) and tilt of the regression line through the spectrum (Tilt). The auditory-perceptual judgment was the median G score of five voice specialists (Cohen's = 0.605-0.773; Fleiss = 0.370). Quadratic discriminant analysis and accuracy, sensitivity, and specificity of performance measures were used to investigate the discriminatory power of these measures.

RESULTS

AVQI presented acceptable accuracy to differentiate voices with no vocal deviation and with vocal deviation (73.9%) and among the degrees of deviation (mild vs. moderate = 70.49%; mild vs. moderate = 71.39%; moderate vs. severe = 87.5%). No isolated acoustic measurement was consistent with differentiating voice quality among all degrees of deviation. A combination of five acoustic measures (CPPs, HNR, ShdB, Slope, Tilt) had the highest accuracy to differentiate between healthy and deviated voice (75.55%). Shimmer was more accurate to discriminate between voices with mild, moderate, and severe deviation; almost all isolated acoustic measurements were accurate to discriminate voices with moderate and severe deviation. The combination of acoustic measures presented higher accuracy (mild vs. moderate = 70.21%-74.29%; mild vs. moderate = 71.53%-76.11%; moderate vs. severe = 86%-95.50%).

CONCLUSION

AVQI is an accepted tool to discriminate among different degrees of vocal deviation, and more accurate between voices with moderate and severe deviations. Isolated acoustic measures perform better when discriminating voices with a higher degree of deviation. A combination of acoustic parameters, with the same weight, is more accurate to discriminate different degrees of deviation, however, not consistent.

Performance of Different Acoustic Measures to Discriminate Individuals With and Without Voice Disorders

The goal of this study is to compare and combine different acoustic features in discriminating subjects with and without voice disorders. A database of 484 adult patients participated in the research. All subjects recorded a sustained vowel /Ɛ/ and underwent a laryngoscopic examination of the larynx. From the results of the laryngeal examination performed by a physician and the auditory-perceptual judgment performed by a Speech-Language Pathologist, the subjects were allocated to the group with (n = 52) and without (n = 432) voice disorder. Four types of acoustic features were used: traditional measures, cepstral measures, nonlinear measures, and recurrence quantification measures. Recordings comprised the emission of the vowel /ε/. Quadratic discriminant analysis was used as classifier. Individual features in the context of traditional, cepstral, and recurrence quantification measures achieved an acceptable performance of ≥70%. Combination of measures improved the classifier performance. The best classification result (86.43% accuracy) was obtained by combining traditional linear and recurrence quantification measures. Results shown that Traditional, Cepstral, and recurrence quantification measures are promising features that capture meaningful information about voice production, which provides good classification performances. The findings of this study can be used to develop a computational tool for voice disorders diagnosis and monitoring.

Influence of the Voice Sample Length in Perceptual and Acoustic Voice Quality Analysis

OBJECTIVE

To analyze the variations that different voice sample length (VSL) has on the perceived degree of voice quality deviation and on the Acoustic Voice Quality Index (AVQI) accuracy.

METHODS

Voices of 71 subjects (53 dysphonic; 18 vocally health) were recorded: numbers 1-20 (42 syllables) + vowel/a/. Three different VSL were edited: VSL_long, 1-20 + 3 seconds vowel/a/; VSL_cust, customized length, were voiced-segments of the continuous speech had the same length of the vowel (mean = 18.73 syllables corresponding to 3 seconds of only-voiced segments) + 3 seconds vowel/a/; VSL_short, 1-10 (15 syllables) + 3 seconds vowel/a/. Three voice specialists perceptually judged the overall voice quality (G); 3 sessions were performed to evaluate each VSL variant. AVQI's precision and Spearman correlation were assessed.

RESULTS

The intra-rater reliability was "almost perfect" (kappa >0.826) for all evaluators in VSL_short; "substantial" (0.684) and "almost perfect" (0.897) in VSL_cust and "fair" (0.447) to "almost perfect" (1.000) in VSL_long. The inter-rater reliability was "moderate" (0.554) for VSL_long, "substantial" (0.622 and 0.618) for VSL_cust and VSL_short. The Gmean and AVQI_mean were perceived as more severe for longer samples and less severe for shorter samples. Considering the AVQI, VSL_short (r = 0.665) presented the higher correlation. VSL_cust presented the best area under the ROC curve (0.821). VSL_long and VSL_cust specificity was 100%, VSL_short specificity was 75%; higher sensitivity was observed for VSL_short (74%).

CONCLUSION

The voice quality outcomes changes for different VSLs. Longer VSLs seem to be perceived as more deviated, shorter VSLs seem to be more reliable and have better correlation with the acoustic analysis. The AVQI best accuracy was found at a customized length. Thus, to increase the voice analysis reliability, standardized procedure must be followed, including a precise speech material control allowing comparison among clinics and voice-centers.

GALP Qualifier Scale: Initial Considerations to Classify a Voice Problem

OBJECTIVE

To propose a single qualifier scale for voice problems based on the International Classification of Functioning, Disability, and Health (ICF) that classifies a voice problem considering its multidimensionality.

METHOD

A multicultural database was analyzed (280 subjects). The analyzed information was: the perceptual judgment of the overall voice quality (G); the acoustic analysis (A) with the Acoustic Voice Quality Index; the laryngeal diagnosis (L) and the patient self-assessment (P) using the Voice Handicap Index. The variables were categorized. A 2-step cluster analysis was performed to define groups with common characteristics.

RESULTS

A 7-point qualifier scale, the GALP, was defined to generally classify levels of voice problems considering 4 dimensions of the voice evaluation. Each level of voice problem, that is, no problem, mild, moderate, severe, or complete voice problem, has its own possible outcome for G, A, L, and P that will change, or not, the overall level of voice problem. The extremes of the scale represent "no problem" at all when all parameters are normal, and "complete problem" when all parameters are altered. The 3 levels in between were defined by the cluster analysis (mild, moderate, and severe problem) and change according to the outcome of each evaluation (G, A, L, and P). Thus, changes in one parameter alone may or not contribute to the change of the level of voice problem. Also, there are 2 categories for cases that do not fit the classification (not specified) and for which some of the variables are missing (not applicable).

CONCLUSION

The GALP scale was proposed to classify the level of voice problem. This approach considers important dimensions of voice evaluation according to the ICF. It is a potential tool to be used by different professionals, with different assessment procedures, and among different populations, clinicians, and study centers.

A Case of Specificity: How Does the Acoustic Voice Quality Index Perform in Normophonic Subjects?

The acoustic voice quality index (AVQI) is a multiparametric tool based on six acoustic measurements to quantify overall voice quality in an objective manner, with the smoothed version of the cepstral peak prominence (CPPS) as its main contributor. In the last decade, many studies demonstrated its robust diagnostic accuracy and high sensitivity to voice changes across voice therapy in different languages. The aim of the present study was to provide information regarding AVQI’s and CPPS’s performance in normophonic non-treatment-seeking subjects, since these data are still scarce; concatenated voice samples, consisting of sustained vowel phonation and continuous speech, from 123 subjects (72 females, 51 males; between 20 and 60 years old) without vocally relevant complaints were evaluated by three raters and run in AVQI v.02.06. According to this auditory-perceptual evaluation, two cohorts were set up (normophonia versus slight perceived dysphonia). First, gender effects were investigated. Secondly, between-cohort differences in AVQI and CPPS were investigated. Thirdly, with the number of judges giving G = 1 to partition three sub-levels of slight hoarseness as an independent factor, differences in AVQI and CPPS across these sub-levels were investigated; for AVQI, no significant gender effect was found, whereas, for CPPS, significant trends were observed. For both AVQI and CPPS, no significant differences were found between normophonic and slightly dysphonic subjects. For AVQI, however, this difference did approach significance; these findings emphasize the need for a normative study with a greater sample size and subsequently greater statistical power to detect possible significant effects and differences.