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

Effectiveness of Thymepearls After Vocal Loading in Professional Voice Users: A Randomized Placebo-Controlled Double-Blind Clinical Trial

OBJECTIVES

Professional voice users depend on their voice for optimal performance of their profession. The aim of this study was to find out to what extent sucking a placebo and thyme represent an improvement of the voice in professional voice users after vocal loading.

METHODS

A randomized placebo-controlled clinical double-blind study was conducted with four measurement moments: a premeasurement, immediately after the vocal loading, after the subsequent ingestion of the "thymepearl" (TP) in the experimental group and in the control group the placebo, and after a half-hour break. Finally, 18 subjects were considered, 9 participants in each group.

RESULTS

No significant differences in the objective measurements of both groups could be observed. However, significant improvements in subjective measures (perceptions of dry mouth and feeling of hoarseness) could be observed after vocal loading by sucking the thymepearls in direct comparison to the placebo.

CONCLUSIONS

Sucking the TP can improve subjective sensation after vocal loading compared with placebo, but no differences are seen on objective vocal measures.

A Retrospective Study of Acoustic Measures of Glottal Stop Production to Assess Vocal Function in Unilateral Vocal Fold Paresis/Paralysis Patients

PURPOSE

The aim of this study was to determine (a) diagnostic accuracy of acoustic measures of glottal stop production (GSP; intensity differences, slopes, complete voicing cessation) to distinguish between unilateral vocal fold paresis/paralysis (UVFP) patients and controls; (b) if acoustic measures of GSP significantly correlated with an acoustic measure of voice disorder severity, acoustic voice quality index (AVQI); and (c) if acoustic measures from another type of voicing cessation, voiceless consonant production, also significantly differed between groups.

METHOD

Ninety-seven patients with unilateral paresis/paralysis and 35 controls with normal laryngostroboscopic signs produced two sets of five repeated [i] and four repeated [isi]. Tokens were randomized by type between groups and analyzed blinded using a customized Praat program that computed intensity differences and slopes between vowel maxima and glottal stop minima for inter-[i] tokens and vowel maxima and voiceless consonant minima for intra-[isi] tokens. The number of voicing cessations for inter-[i] tokens was obtained.

RESULTS

Onset and offset intensity differences and number of voicing cessations from inter-[i] tokens had the greatest areas under the curve (.854, .856, and .835, respectively). Correlation coefficients were significant (p < .01) between AVQI and all GSP acoustic measures with weak/medium effect sizes. No significant differences were found between controls and participants with UVFP for acoustic measures from intra-[isi].

CONCLUSIONS

Acoustic GSP measures demonstrated good diagnostic accuracy and some relationship to severity of voice disorder. No significant differences in acoustic measures for medial voiceless fricative consonants between controls and participants with UVFP suggested that voicing cessation for voiceless fricatives differs from voicing cessation for GSP.

A Cepstral Peak Prominence (CPP) Voice Analysis in Iranian Post-lingual Deaf Adult Cochlear Implant Users

OBJECTIVE

In standardized connected speech samples, cepstral peak prominence (CPP) and smoothed CPP (CPPS) have been described as accurate parameters to evaluate voice quality. Lack of normal auditory feedback in post-lingually deaf CI users might influence tuning the acoustic parameters in speech production. Based on shreds of evidence, normal hearing results in suitable vocal control through the sensory-motor linkage. The main aim of the present study was to compare the cepstral values between the Iranian cochlear implant group and normal peers.

METHOD

Persian CAPE-V sentences were recorded from 30 CI users and 30 healthy speakers (mean age=36.7 years, SD=13.5, range=18-60 years). Thirteen /a/vowels were extracted manually from syllables. Each subject phonated sustained /a/vowel for 5 seconds. PRAAT was used to calculate CPP and CPPS. To compare two age- and gender-matched groups, the independent sample t-test was applied. Then, ANCOVA was used to assess the impact of demographic factors on cepstral scores in CI participants.

RESULTS

Significant differences between the CI group and normal peers were discovered based on CPP and CPPS in both tasks (reading sentences and sustained vowel) (P < 0.05). Overall, CI users showed higher cepstral values. The implanted ear and prosthesis model had no significant impact on both CPP and CPPS (P ≥ 0.8).

CONCLUSION

Higher CPP and CPPS values in the CI users might be due to increased phonatory instability and spectral noise, with the possibility of decreased vocal control and its quality. The outcome suggests that CI group uses a different voice control strategy. These findings should be kept in mind for intervention methods, especially by assessing vocal characteristics and considering the voice quality in adult CI users.

Observations and Considerations for Implementing Remote Acoustic Voice Recording and Analysis in Clinical Practice

OBJECTIVES/HYPOTHESIS

Remote voice recording and acoustic analysis allow for comprehensive voice assessment and outcome tracking without the requirements of travel to the clinic, in-person visit, or expensive equipment. This paper delineates the process and considerations for implementing remote voice recording and acoustic analysis in a high-volume university voice clinic.

STUDY DESIGN

Clinical Focus.

METHODS

Acoustic voice recordings were attempted on 108 unique patients over a 6-month period using a remote voice recording phone application. Development of the clinical process including determining normative data in which to compare acoustic results, clinician training, and clinical application is described. The treating Speech Language Pathologists (SLPs) were surveyed 2 months after implementation to assess ease of application, identify challenges and assess implementation of potential solutions.

RESULTS

Of 108 unique patients, 83 patients were successful in completing the process of synchronous remote acoustic voice recording in conjunction with their SLP clinician. The process of downloading the application, setting up, and obtaining voice recordings was most commonly 10-20 minutes according to the 8 SLPs surveyed. Challenges and helpful techniques were identified.

CONCLUSIONS

Remote acoustic voice recordings have allowed SLPs to continue to complete a comprehensive voice evaluation in a telepractice model. Given emerging knowledge about the viability of remote voice recordings, the success in obtaining acoustic data remotely, and the accessibility of a low-cost app for SLPs makes remote voice recordings a viable option to facilitate remote clinical care and research investigation.

The Efficacy of the NHS Waterpipe in Superficial Hydration for People With Healthy Voices: Effects on Acoustic Voice Quality, Phonation Threshold Pressure and Subjective Sensations

OBJECTIVES

This study examined the efficacy of the NHS waterpipe as a superficial hydration treatment in voice production in healthy young women.

STUDY DESIGN

This is a prospective, single-blind, within- and between-subject experimental design.

METHODS

Thirty six female university students (mean age 24.6 years, range 19-45 years) were recruited to the study. Participants were randomized to two experimental groups (E1 and E2) and a control group. E1 underwent hydration treatment with the NHS waterpipe filled with 0.9% saline that was immersed in a cup of heated water. E2 underwent a similar treatment but without heated immersion. The control group received no treatment. Acoustic Voice Quality Index (AVQI v03.01) and its subparameters, phonation threshold pressure, self-perceived phonatory effort and sensation of throat dryness was measured at three time points (before the intervention and immediately and 15 minutes after it).

RESULTS

The Tilt of the AVQI's subparameters increased significantly in the E1 (P = 0.027) and E2 groups (P = 0.027) after the intervention. Furthermore, the E1 group had significantly lower harmonics-to-noise-ratio values at the third measurement point compared to the E2 group (P = 0.023). These findings may result from fluid transported to the vocal fold level. The sensations of throat dryness decreased in the E1 (P = 0.001) and E2 groups (P < 0.0005) after the intervention. Perceived phonatory effort decreased statistically significantly at the final measurement point in the E1 (P = 0.002) and E2 (P = 0.031) groups. No variables changed in the control group.

CONCLUSIONS

The waterpipe seems to be efficient in hydrating vocal folds on single use. It seems to be more efficient when employed with a hot water bath, albeit slightly impairing some acoustic values in the short term. Without the heated fluid, it still seems to decrease sensations of throat dryness and affect acoustic voice quality. The waterpipe does not seem to have an effect on phonation threshold pressure, and it seems to lower self-perceived effort just as efficiently whether the waterpipe is employed using a hot water bath or not. Further research is needed to prove the efficacy of long-term usage and usage with voice patients.

Extrinsic Laryngeal Muscle Tension in Primary Muscle Tension Dysphonia with Shear Wave Elastography

OBJECTIVES

It has been assumed that patients with primary muscle tension dysphonia (pMTD) have more extrinsic laryngeal muscle (ELM) tension, but tools to study this phenomenon lack. Shear wave elastography (SWE) is a potential method to address these shortcomings. The objectives of this study were to apply SWE to the ELMs, compare SWE measures to standard clinical metrics, and determine group differences in pMTD and typical voice users before and after vocal load.

METHODS

SWE measurements of the ELMs from ultrasound examinations of the anterior neck, supraglottic compression severities from laryngoscopic images, cepstral peak prominences (CPP) from voice recordings, and self-perceptual ratings of vocal effort and discomfort were obtained in voice users with (N = 30) and without (N = 35) pMTD, before and after a vocal load challenge.

RESULTS

ELM tension significantly increased from rest-to-voiced conditions in both groups. However, the groups were similar in their ELM stiffness levels at SWE at baseline, during vocalization, and post-vocal load. Levels of vocal effort and discomfort and supraglottic compression were significantly higher and CPP was significantly lower in the pMTD group. Vocal load had a significant effect on vocal effort and discomfort but not on laryngeal or acoustic patterns.

CONCLUSION

SWE can be used to quantify ELM tension with voicing. Although the pMTD group reported significantly higher levels of vocal effort and vocal tract discomfort and, on average, exhibited significantly more severe supraglottic compression and lower CPP values, there were no group differences in levels of ELM tension using SWE.

LEVEL OF EVIDENCE

2 Laryngoscope, 133:3482-3491, 2023.

Smartphone-Based Voice Wellness Index Application for Dysphonia Screening and Assessment: Development and Reliability

OBJECTIVE

This study aimed to develop a Voice Wellness Index (VWI) application combining the acoustic voice quality index (AVQI) and glottal function index (GFI) data and to evaluate its reliability in quantitative voice assessment and normal versus pathological voice differentiation.

STUDY DESIGN

Cross-sectional study.

METHODS

A total of 135 adult participants (86 patients with voice disorders and 49 patients with normal voices) were included in this study. Five iOS and Android smartphones with the "Voice Wellness Index" app installed were used to estimate VWI. The VWI data obtained using smartphones were compared with VWI measurements computed from voice recordings collected from a reference studio microphone. The diagnostic efficacy of VWI in differentiating between normal and disordered voices was assessed using receiver operating characteristics (ROC).

RESULTS

With a Cronbach's alpha of 0.972 and an ICC of 0.972 (0.964-0.979), the VWI scores of the individual smartphones demonstrated remarkable inter-smartphone agreement and reliability. The VWI data obtained from different smartphones and a studio microphone showed nearly perfect direct linear correlations (r = 0.993-0.998). Depending on the individual smartphone device used, the cutoff scores of VWI related to differentiating between normal and pathological voice groups were calculated as 5.6-6.0 with the best balance between sensitivity (94.10-95.15%) and specificity (93.68-95.72%), The diagnostic accuracy was excellent in all cases, with an area under the curve (AUC) of 0.970-0.974.

CONCLUSION

The "Voice Wellness Index" application is an accurate and reliable tool for voice quality measurement and normal versus pathological voice screening and has considerable potential to be used by healthcare professionals and patients for voice assessment.

It Sounds like It Feels: Preliminary Exploration of an Aeroacoustic Diagnostic Protocol for Singers

To date, no established protocol exists for measuring functional voice changes in singers with subclinical singing-voice complaints. Hence, these may go undiagnosed until they progress into greater severity. This exploratory study sought to (1) determine which scale items in the self-perceptual Evaluation of Ability to Sing Easily (EASE) are associated with instrumental voice measures, and (2) construct as proof-of-concept an instrumental index related to singers' perceptions of their vocal function and health status. Eighteen classical singers were acoustically recorded in a controlled environment singing an /a/ vowel using soft phonation. Aerodynamic data were collected during a softly sung /papapapapapapa/ task with the KayPENTAX Phonatory Aerodynamic System. Using multi and univariate linear regression techniques, CPPS, vibrato jitter, vibrato shimmer, and an efficiency ratio (SPL/PSub) were included in a significant model (p < 0.001) explaining 62.4% of variance in participants' composite scores of three scale items related to vocal fatigue. The instrumental index showed a significant association (p = 0.001) with the EASE vocal fatigue subscale overall. Findings illustrate that an aeroacoustic instrumental index may be useful for monitoring functional changes in the singing voice as part of a multidimensional diagnostic approach to preventative and rehabilitative voice healthcare for professional singing-voice users.

Reliability of Universal-Platform-Based Voice Screen Application in AVQI Measurements Captured with Different Smartphones

The aim of the study was to develop a universal-platform-based (UPB) application suitable for different smartphones for estimation of the Acoustic Voice Quality Index (AVQI) and evaluate its reliability in AVQI measurements and normal and pathological voice differentiation. Our study group consisted of 135 adult individuals, including 49 with normal voices and 86 patients with pathological voices. The developed UPB "Voice Screen" application installed on five iOS and Android smartphones was used for AVQI estimation. The AVQI measures calculated from voice recordings obtained from a reference studio microphone were compared with AVQI results obtained using smartphones. The diagnostic accuracy of differentiating normal and pathological voices was evaluated by applying receiver-operating characteristics. One-way ANOVA analysis did not detect statistically significant differences between mean AVQI scores revealed using a studio microphone and different smartphones (F = 0.759; p = 0.58). Almost perfect direct linear correlations (r = 0.991-0.987) were observed between the AVQI results obtained with a studio microphone and different smartphones. An acceptable level of precision of the AVQI in discriminating between normal and pathological voices was yielded, with areas under the curve (AUC) displaying 0.834-0.862. There were no statistically significant differences between the AUCs (p > 0.05) obtained from studio and smartphones' microphones. The significant difference revealed between the AUCs was only 0.028. The UPB "Voice Screen" application represented an accurate and robust tool for voice quality measurements and normal vs. pathological voice screening purposes, demonstrating the potential to be used by patients and clinicians for voice assessment, employing both iOS and Android smartphones.

Longitudinal Vocal Outcomes and Voice-Related Quality of Life After Selective Bilateral Laryngeal Reinnervation: A Case Study

PURPOSE

Bilateral vocal fold paralysis (BVFP) is a severe disorder that can result in respiratory, swallowing, and voice-related problems. Most surgical treatments do not restore laryngeal function and often need to compromise voice quality to preserve respiratory function. Laryngeal reinnervation (LR) may offer a solution to this problem, but literature on longitudinal outcomes of this procedure is scarce. This study aims to report the longitudinal vocal outcomes of BVFP after LR and subsequent voice therapy.

METHOD

The case of a 23-year-old man with BVFP after a traumatic dissection of both recurrent laryngeal nerves is described. Selective bilateral LR of both adductors and abductors was performed 5 months after the onset of BVFP. Voice therapy was provided after the LR procedure. Multidimensional voice assessments, including acoustic, perceptual, and patient-reported outcome measures (PROMs), were conducted 2, 5, 6.5, 8, and 31 months after LR.

RESULTS

An improvement of vocal capabilities and voice quality was noticed 6.5 months after LR, after 4.5 months of voice therapy, with normative values after 2.5 years. PROMs showed an improvement of voice-related quality of life, but some limitations to activities of daily living were still present. Inspiratory arytenoid abduction was not observed on laryngeal videostroboscopic findings in this patient, but tracheostomy was not required.

CONCLUSIONS

Voice therapy after LR helps establish healthy and efficient voice use without increasing compensatory hyperfunctional behavior. More research is needed to examine potential merits of voice therapy in the rehabilitation of vocal and respiratory functions after LR.

Outcomes of Cricothyroid Visor Maneuver (CVM) for Treatment of Vocal Polyp: A Case Report

OBJECTIVE

The aim of the study is the clinical investigation of a patient with a vocal fold polyp, and the visual, acoustical, perceptual, and self-report changes before and after using the cricothyroid visor manoeuvre (CVM).

DESIGN

A 48-year-old female university professor, gynecologist, and obstetrician with a history of laryngopharyngeal reflux and a left vocal polyp participated. Treatment was provided in 10 sessions. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the effects of the two-treatment program. Also, laryngoscopic images, perceptions by the patient about her voice quality and quality of life before and after therapy were assessed.

RESULTS

Improvements in acoustic parameters were obtained especially in perturbation and CCPS parameters. The overall voice quality scores on the CAPE-V were moderate before therapy and became mild after therapy. Laryngoscopy images demonstrated improvement in the glottis closure configuration in two phases (open and close) in pre- and post- CVM therapy and a decrease in polyp size. The patient had improvement in VAS, IVQLP, and VRQOL scores.

CONCLUSION

The CVM therapy used in the study resulted in positive changes in acoustic and perceptual-auditory aspects of voice production, self-report, and QOL for the patient. The CVM approach appears to have been effective for this case in decreasing the polyp size or its regression or for vocal adaptation.

An iOS-based VoiceScreen application: feasibility for use in clinical settings-a pilot study

OBJECTIVES

To elaborate the application suitable for smartphones for estimation of Acoustic Voice Quality Index (AVQI) and evaluate its usability in the clinical setting.

METHODS

An elaborated AVQI automatization and background noise monitoring functions were implemented into a mobile "VoiceScreen" application running the iOS operating system. A study group consisted of 103 adult individuals with normal voices (n = 30) and 73 patients with pathological voices. Voice recordings were performed in the clinical setting with "VoiceScreen" app using iPhone 8 microphones. Voices of 30 patients were recorded before and 1 month after phonosurgical intervention. To evaluate the diagnostic accuracy differentiating normal and pathological voice, the receiver-operating characteristic statistics, i.e., area under the curve (AUC), sensitivity and specificity, and correct classification rate (CCR) were used.

RESULTS

A high level of precision of AVQI in discriminating between normal and dysphonic voices was yielded with corresponding AUC = 0.937. The AVQI cutoff score of 3.4 demonstrated a sensitivity of 86.3% and specificity of 95.6% with a CCR of 89.2%. The preoperative mean value of the AVQI [6.01(SD 2.39)] in the post-phonosurgical follow-up group decreased to 2.00 (SD 1.08). No statistically significant differences (p = 0.216) between AVQI measurements in a normal voice and 1-month follow-up after phonosurgery groups were revealed.

CONCLUSIONS

The "VoiceScreen" app represents an accurate and robust tool for voice quality measurement and demonstrates the potential to be used in clinical settings as a sensitive measure of voice changes across phonosurgical treatment outcomes.

Effect of Gender on Acoustic Voice Quality Index 02.03 and Dysphonia Severity Index in Indian Normophonic Adults

Acoustic Voice Quality Index and Dysphonia Severity Index are the two most widely used multiparametric objective measures that can successfully quantify voice quality. Latoszek et al. (2019) reported that gender had no influence on both AVQI and DSI in Dutch population. However, there is a lack of research focussed on investigating the gender effect on both DSI and AVQI and on investigating the relationship between DSI and AVQI in the Indian adult population. The present study is aimed to investigate the effect of gender on DSI and AVQI and to explore the relation between the two in the Indian adult population. 138 normophonic individuals (74 females and 64 males) were considered as participants. The phonation of /a/ and reading samples were considered as stimuli for extracting AVQI analysed using AVQI script version 02.03. The raw values of MPT, highest frequency, lowest intensity, and Jitter% were obtained from VRP module and MDVP module of Computerized Speech Lab to calculate the DSI. The results revealed that gender has significant effect on CPPs, HNR and TiltLTAS, ShimLocal, ShimdB, MPT, F0-High and Jitter%. While the overall AVQI, DSI, SlopeLTAS and I-Low were independent of gender effect. To conclude, the present study provides the reference data for AVQI v.2.03 and DSI for healthy Indian adults and discusses the influence of gender on AVQI, DSI and their constituent parameters.

Voice Quality in Telephone Interviews: A preliminary Acoustic Investigation

OBJECTIVES

To investigate the impact of standardized mobile phone recordings passed through a telecom channel on acoustic markers of voice quality and on its perception by voice experts in normophonic speakers.

METHODS

Continuous speech and a sustained vowel were recorded for fourteen female and ten male normophonic speakers. The recordings were done simultaneously with a head-mounted high-quality microphone and through the telephone network on a receiving smartphone. Twenty-two acoustic voice quality, breathiness and pitch-related measures were extracted from the recordings. Nine vocologists perceptually rated the G, R and B parameters of the GRBAS scale on each voice sample. The reproducibility, the recording type, the stimulus type and the gender effects, as well as the correlation between acoustic and perceptual measures were investigated.

RESULTS

The sustained vowel samples are damped after one second. Only the frequencies between 100 and 3700Hz are passed through the telecom channel and the frequency response is characterized by peaks and troughs. The acoustic measures show a good reproducibility over the three repetitions. All measures significantly differ between the recording types, except for the local jitter, the harmonics-to-noise ratio by Dejonckere and Lebacq, the period standard deviation and all six pitch measures. The AVQI score is higher in telephone recordings, while the ABI score is lower. Significant differences between genders are also found for most of the measures; while the AVQI is similar in men and women, the ABI is higher in women in both recording types. For the perceptual assessment, the interrater agreement is rather low, while the reproducibility over the three repetitions is good. Few significant differences between recording types are observed, except for lower breathiness ratings on telephone recordings. G ratings are significantly more severe on the sustained vowel on both recording types, R ratings only on telephone recordings. While roughness is rated higher in men on telephone recordings by most experts, no gender effect is observed for breathiness on either recording types. Finally, neither the AVQI nor the ABI yield strong correlations with any of the perceptual parameters.

CONCLUSIONS

Our results show that passing a voice signal through a telecom channel induces filter and noise effects that limit the use of common acoustic voice quality measures and indexes. The AVQI and ABI are both significantly impacted by the recording type. The most reliable acoustic measures seem to be pitch perturbation (local jitter and period standard deviation) as well as the harmonics-to-noise ratio from Dejonckere and Lebacq. Our results also underline that raters are not equally sensitive to the various factors, including the recording type, the stimulus type and the gender effects. Neither of the three perceptual parameters G, R and B seem to be reliably measurable on telephone recordings using the two investigated acoustic indexes. Future studies investigating the impact of voice quality in telephone conversations should thus focus on acoustic measures on continuous speech samples that are limited to the frequency response of the telecom channel and that are not too sensitive to environmental and additive noise.

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 Acoustic Breathiness Index (ABI) in the South Indian Population

BACKGROUND

Acoustic Breathiness Index (ABI) is an acoustic model which equates to the auditory-perceptual (A-P) measure of breathiness. Globally, ABI has been validated in multiple languages. To date, empirical studies validating ABI in the South Indian population have not been carried out. Moreover, there is only minimal evidence on the impact of language and gender on ABI.

OBJECTIVES

This study attempted to validate ABI in languages of Malayalam and Kannada with "B" and "G" of GRBAS. The authors also examined the influence of language and gender on ABI.

METHODS

The authors retrospectively analyzed a dataset consisting of 160 voice samples (91 normophonic and 69 dysphonic). Five speech-language pathologists perceptually evaluated these samples on the GRBAS scale. PRAAT software was used to calculate ABI for each voice sample. The authors also determined the effects of language and gender on ABI. Following this, ABI's concurrent validity and diagnostic accuracy were examined relating to "B" and "G" of the GRBAS scale.

RESULTS

The judges reached a moderate agreement on the perceptual evaluation of voice quality. The authors observed neither language nor gender differences in ABI. The concurrent validity of ABI was strong (r = 0.761) when correlated against "B". Further, evaluations revealed that an ABI value of >3.66 could distinguish between breathy and non-breathy voice samples with an area under the curve of 0.816 (Sensitivity = 61.73%; Specificity = 94.93%). On the other hand, the concurrent validity of ABI in correlation with "G" did not yield the optimal result.

CONCLUSIONS

ABI is a valid acoustic tool for identifying breathiness in the languages of Malayalam and Kannada. ABI correlates better with "B" than "G" on the GRBAS scale. ABI is independent of language and gender.

Acoustic Voice Quality Index (AVQI) in the Measurement of Voice Quality: A Systematic Review and Meta-Analysis

INTRODUCTION

Acoustic Voice Quality Index (AVQI) is a multiparametric construct of voice quality recognized for its clinical and research applications around the globe. This study aimed to review the validity and diagnostic accuracy of AVQI (v02&03) and determine the effects of age and gender.

METHODS

This is a systematic review and meta-analysis registered with the PROSPERO registry. The authors searched two databases (PubMed and Cochrane Library database) for relevant studies. Studies selected for the systematic review were grouped based on study objectives. To determine the quality of the selected studies, the authors utilized the QUADAS-2 tool.

RESULTS

Meta-analysis of seven studies on AVQIv02 revealed a diagnostic threshold ranging from 2.72 to 3.33 for AVQIv02. In comparison, eight studies investigating AVQIv03 suggested a diagnostic threshold ranging from 1.33 to 3.15 for AVQIv03. Altogether, these studies demonstrated a pooled sensitivity and specificity of 0.85 and 0.92 for AVQIv02 and 0.82 and 0.92 for AVQIv03. The Area under the Curve was slightly better for AVQIv03 (0.94) than AVQIv02 (0.92). Three studies investigating the effect of age and gender on AVQI had a consensus that AVQI is independent of gender. However, findings were contradictory about the impact of age on AVQI.

CONCLUSIONS

AVQI is found to be a valid tool for the assessment of voice quality. AVQIv03 is slightly better than AVQIv02 in its diagnostic accuracy. AVQI is independent of gender. Because of the contradictory evidence, additional research on the effects of age on AVQI is necessary.

Choral Conductors Vocal Loading in Rehearsal Simulation Conditions

OBJECTIVES

Choir conductors represent a profession with an intensive vocal load. The present study aims to investigate the impact of 40 minutes vocal loading tasks on fundamental frequency (F0), jitter (Jitt), shimmer (Shim), median cepstral peak prominence (CPPs), and CPPs standard deviation in specific acoustic conditions.

METHOD

Eighteen amateur choir conductors (13 female, five male) participated in the study. The vocal loading experiment was organized in rooms where each conductor usually had choir rehearsals. The vocal loading experiment included vocal warm-up, singing, and loud reading. The STIPA test signal provided the background noise with 60 dBA @ 1m during the singing and reading tasks. The F0, Jitt, Shim, CPPs, and CPPs SD were extracted before and after vocal loading by the Vocal Holter Med (VHM) device. Additionally, Acoustic Voice Quality Index (AVQI) was estimated for participants, and all of them completed the Voice Handicap Index-30 (VHI-30) and the Singing Voice Handicap Index (SVHI). Finally, reverberation time (T30) was measured in each rehearsal room.

RESULTS

A statistically significant decrease of CPPs SD by 0.1 dB was observed in male conductors. Associations between CPPs SD and VHI-30 (r = 0.789, P = 0.001) were found in female conductors, and between Jitt and SVHI (r = 0.9, P = 0.037) in male conductors. Female conductors with higher total score of SVHI demonstrated increase of postloading F0 (r = 0.612, P = 0.026).

CONCLUSIONS

Forty-minute vocal loading tasks that included warm-up, intensive singing, and loud reading did not significantly impact vocal parameters in female and male conductors. In addition, the rehearsal room volume and length of reverberation time did not affect obtained vocal parameters after vocal loading.

Accuracy of Acoustic Voice Quality Index Captured With a Smartphone - Measurements With Added Ambient Noise

OBJECTIVE

To evaluate the accuracy of Acoustic Voice Quality Index (AVQI) measures obtained from voice recordings simultaneously using oral and smartphone microphones in a sound-proof room, and to compare them with AVQIs obtained from the same smartphone voice recordings with added ambient noise.

METHODS

A study group of 183 subjects with normal voices (n = 86) and various voice disorders (n = 97) was asked to read aloud a standard text and sustain the vowel /a/. The controlled ambient noise averaged at 29.61 dB SPL was added digitally to the smartphone voice recordings. Repeated measures analysis of variances (ANOVA) with Greenhouse-Geiser correction was used to evaluate AVQI changes within subjects. To evaluate the level of agreement between AVQI measurements obtained from different voice recordings Bland-Altman plots were used.

RESULTS

Repeated measures ANOVA showed that differences among AVQI results obtained from voice recordings done with oral studio microphone, recordings done with a smartphone microphone, and recordings done with a smartphone microphone with added ambient noise were not statistically significant (P = 0.07). No significant systemic differences and acceptable level of random errors in AVQI measurements of voice recordings made with oral and smartphone microphones (including added noise) were revealed.

CONCLUSION

The AVQI measures obtained from smartphone microphones voice recordings with experimentally added ambient noise revealed an acceptable agreement with results of oral microphone recordings, thus suggesting the suitability of smartphone microphone recordings performed even in the presence of acceptable ambient noise for estimation of AVQI.

Are Acoustic Markers of Voice and Speech Signals Affected by Nose-and-Mouth-Covering Respiratory Protective Masks?

Background

Worldwide use of nose-and-mouth-covering respiratory protective mask (RPM) has become ubiquitous during COVID19 pandemic. Consequences of wearing RPMs, especially regarding perception and production of spoken communication, are gradually emerging. The present study explored how three prevalent RPMs affect various speech and voice sound properties.

Methods

Pre-recorded sustained [a] vowels and read sentences from 47 subjects were played by a speech production model (‘Voice Emitted by Spare Parts’, or ‘VESPA’) in four conditions: without RPM (C1), with disposable surgical mask (C2), with FFP2 mask (C3), and with transparent plastic mask (C4). Differences between C1 and masked conditions were assessed with Dunnett's t test in 26 speech sound properties related to voice production (fundamental frequency, sound intensity level), voice quality (jitter percent, shimmer percent, harmonics-to-noise ratio, smoothed cepstral peak prominence, Acoustic Voice Quality Index), articulation and resonance (first and second formant frequencies, first and second formant bandwidths, spectral center of gravity, spectral standard deviation, spectral skewness, spectral kurtosis, spectral slope, and spectral energy in ten 1-kHz bands from 0 to 10 kHz).

Results

C2, C3, and C4 significantly affected 10, 15, and 19 of the acoustic speech markers, respectively. Furthermore, absolute differences between unmasked and masked conditions were largest for C4 and smallest for C2.

Conclusions

All RPMs influenced more or less speech sound properties. However, this influence was least for surgical RPMs and most for plastic RPMs. Surgical RPMs are therefore preferred when spoken communication is priority next to respiratory protection.

Validation and Test-Retest Reliability of Acoustic Voice Quality Index Version 02.06 in the Turkish Language

OBJECTIVES

The aim of the present study was to investigate the validity (both concurrent and diagnostic) and test-retest reliability of Acoustic Voice Quality Index (AVQI) version 2 (AVQI 02.06) in Turkish speaking population.

MATERIALS AND METHODS

Two hundred and fifty five native Turkish subjects with normal voices (n = 128) and with voice disorders (n = 127) were asked to sustain the vowel [a:] and read aloud the Turkish phonetically balanced text. To determine the test-retest reliability of AVQI, 20 dysphonic (ie, around 15% of the group), and 20 normophonic (ie, around 15% of the group) were reassessed 15 minutes after the first AVQI determination. A three middle seconds of sustained vowel [a:] and a sentence with 25 syllables was concatenated, and AVQI analysis was conducted. The auditory-perceptual evaluation was performed by five experienced raters with Grade (G) from GRBAS Protocol.

RESULTS

There was a statistically significant correlation between AVQI scores and auditory-perceptual evaluation of overall voice quality (r_s = 0.717, P < 0.001). AVQI gave a threshold of 2.98 for the dysphonic voice. The values of intraclass correlation coefficient with two-way mixed-effects model, single-measures type, absolute agreement definition showed an excellent test-retest reliability for AVQI in Turkish language (intraclass correlation coefficient = 0.986).

CONCLUSION

AVQI v.02.06 is a valid and robust tool in differentiating dysphonic and normal voice, and has excellent test-retest reliability in Turkish language.

An evaluation of Short-term Treatment Outcomes of Cricothyroid Visor Maneuver: A Proof-of-Concept Pilot Study

INTRODUCTION

Muscle tension dysphonia (MTD) is used as a clinical and diagnostic descriptive label for a diverse range of vocal fold behaviors caused by increased tension of the (para) laryngeal musculature. These increased tension can occur in the cricothyroid muscle and in the ''visor'' mechanism, contributing to voice problems. The main goal of this study is to determine whether a new method, the cricothyroid visor maneuver (CVM), is an effective method for improving quality and other aspects of the MTD patients' voices.

METHOD(S)

Eighty-eight adult female patients participated in this quasiexperimental study. One group consisted of 30 MTD patients (mean age 28.7 ± 4.95 years) for whom manual circumlaryngeal therapy (MCT) was provided. The other group consisted of 30 MTD patients (mean age 28.9 ± 5.1 years) who received CVM. Also, 28 adult females with MTD (mean age 28.60 ± 4.56 years), who were on the clinic's waiting list, served as a control group and did not receive any treatment. Treatment was provided in a single 30-minute session. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the short-term effects of the two treatment programs. Also, perceptions of patients' about their voice quality before and after therapy were assessed by visual analogue scale.

RESULTS

Perceptually, Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) ratings improved in all patients with both treatment methods. Acoustically, with CVM, harmonic-to-noise ratio and Cepstral Peak Prominence increased and perturbation (jitter and shimmer) measures decreased and there was not significant change in MCT and control groups. Visual analogue scale showed that feelings of patients improved after therapy in both treatment methods, with higher scores for patients receiving CVM in comparison to the MCT method.

DISCUSSION

These results suggest that CVM can be an effective method for voice rehabilitation in patients with MTD and manipulation of Cricothyroid muscle and ''visor'' mechanism can lead to marked voice improvement.