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Acoustic Voice Quality Index is a six-variable acoustic model for the multiparametric measurement developed by Maryn et al. Studies have provided evidence regarding the practical usefullness, internal consistency, external validity, diagnostic accuracy, and responsiveness to change of AVQI. Recently, researchers have been exploring the utility of AVQI in classifying the voice severity. The aim of the present study was to determine the diagnostic accuracy of the AVQI v.02.03 in discriminating across the perceptual levels of dysphonia severity in 18-40 years age range in Kannada speaking population; and to develop an application to depict the AVQI based severity of dysphonia. For the study, 163 individuals in normophonic and 134 individuals in dysphonic group were considered in the age range of 18-40 years. All participants were native speakers of Kannada language. The sustained vowel /a/ and reading of standard Kannada passage were considered as stimuli for extracting AVQI analysed using AVQI script version 02.03. The AVQI cut-off values obtained were 2.50 (A ROC =0.894; Sensitivity= 84.7%; Specificity= 83.1%), 4.17 (A ROC =0.953; Sensitivity= 84.4%; Specificity= 88.5%) and 6.23 (A ROC =1.000; Sensitivity= 100%; Specificity= 100%) for normal vs. mild, mild vs. moderate and moderate vs. severe respectively. A user friendly application was developed which provides a simplified output for AVQI cut-off values which can be comprehendible by patients with voice disorder/ non-professionals and health professionals., Competing Interests: Declaration of Competing Interest We declare no conflict of interest in the paper titled “A comprehensive application for grading severity of voice based on Acoustic Voice Quality Index v.02.03.”, (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Childhood and adolescence are essential stages in the development of voice and speech quality; therefore, it is essential to understand the vocal changes that occur during this period. Frequency-based measurement methods like cepstral measurements stand out among the methods described, which are able to identify f o and estimate the periodicity and noise in the acoustic wave without establishing individual cycles of the sound wave., Methods: Two hundred seventy-one recordings (128 female and 131 male) from children and adolescents aged 5 to 18 years with no vocal complaints were analyzed. Three speech-language pathologists assessed the vocal quality and determined as appropriate for the age. The recordings were divided into six age groups (G1:5-7; G2:8-9; G3:10-11; G4:12; G5:13-15 and G6:16-18 years old). Sustained production of the vowel /a/ were inspected and edited using the PRAAT software. Then, it was extract de Cepstrum Peak Prominence Smoothed (CPPS) using a script in the same software. A Two-way ANOVA was applied to investigate the effect of sex, age and sex*age interaction, followed by Bonferroni's correction for each gender separately. Finally, the Student's t test for independent samples was performed to compare genders within each age group., Results: Male children and adolescents from G5 and G6 had higher CPPS measures than G1, G2 and G3 (P ≤ 0.001). In addition, G6 also had higher values than G4 (P ≤ 0.001). There was no difference between age groups in the female group. In turn, sex differences were reported from 12 years of age onwards, with higher CPPS values found for male participants compared to female participants (P ≤ 0.01)., Conclusion: Vocal changes that usually occur from childhood to adolescence are reflected in the acoustic CPPS measure in males, resulting in higher values in the 13 to 18 years old. On the other hand, no changes in CPPS values were observed in the age groups of female participants. Males have higher CPPS values than females and that sex differences are reported after 12 years of age., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Face masks have become important after the pandemic, but the change in voice when wearing a face mask is still unclear. The study investigated the effect of face masks on the acoustic and perceptual characteristics of voice quality associated with young and older Chinese adults., Methods: Voice samples of the sustained vowel /a/ and continuous speech produced by 44 older and 61 young adults with and without an ASTM level-3 surgical face mask were recorded and analyzed. Perceptual and acoustic parameters including mean fundamental frequency (F0) and intensity, perturbation measures (jitter and shimmer), harmonic-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPs), and long-term average spectrum (LTAS) measures were obtained and compared., Results: When comparing masked to unmasked voices, for both male and female speakers, F0 and intensity showed no significant changes, except for F0 of continuous speech, which increased significantly. Meanwhile, perturbation measures such as jitter and shimmer were reduced, while HNR and CPPs increased. In addition, LTAS measures included low-frequency mean spectral energy (MSE), high-frequency MSE, and spectral tilt (ST), which were different. For perceptual measures, the overall grade of dysphonia, and roughness were reduced, except for the breathiness among older male speakers, while the other vocal qualities were not changed. Between young and older speakers, significant differences in shimmer, CPPs, and perceived breathiness among male speakers, and low-frequency MSE among female speakers were found., Conclusion: Wearing a surgical mask appeared to change the perceived voice quality. This is supported by the change in perturbation and LTAS measures, and HNR and CPPs values. In addition, some differences between young and older adults were observed. Oral Communication effectiveness may be affected when wearing surgical masks due to changes in voice quality. Additionally, clinicians need to exercise hightened caution in evaluating the voice quality of clients when wearing face masks., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To identify the accuracy and cut-off values of the cepstral peak prominence (CPP) and cepstral peak prominence-smoothed (CPPS) obtained from different speech tasks, to identify dysphonic voices in Brazilian Portuguese speakers, and to verify the correlation between these measures and the overall severity of dysphonia (OS)., Method: In a study with 376 subjects-277 with dysphonia and 99 controls-we recorded four speech tasks and assessed OS with a visual analog scale. We extracted CPP and CPPS from these recordings and analyzed them using receiver operating characteristic curves to determine cut-off values and other performance metrics (area under curve, accuracy, sensitivity, specificity, predictive values, and likelihood ratios)., Results: CPP values below 28.15 dB (sustained vowel [Ɛ]), 28.77 dB (sustained vowel [a]), 28.58 dB (all Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) sentences), and CPPS values below 16.42 dB (sustained vowel [Ɛ]), 17.02 dB (sustained vowel [a]), and 11.30 dB (all CAPE-V sentences) are indicative of the presence of dysphonia. CPP VE , CPP VA , CPP CAPE-V , CPP VS , CPPS VE , CPPS VA , CPPS Count , CPPS CAPE-V e CPPS VS , and CPPS VS can explain the variability of OS from 19% to 57.9%., Conclusions: The cut-off values for CPP VE , CPP VA, CPP CAPE-V , CPPS VE, CPPS CAPE-V, and CPPS VA obtained from Praat software can be used as a reference for the clinical voice assessment of Brazilian Portuguese speakers in the respective speech tasks. Analysis of the correlation coefficients of the cepstral measures investigated provided us with a predictive model of OS perception based on each measure/speech task., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The Coronavirus Disease 2019 (COVID-19) is an ongoing global pandemic and wearing face mask is recommended across the globe to break the transmission chain of infection. The masks available in the market are of different types and materials and tend to alter the voice characteristics of the speaker. This can therefore impair optimal communication and the present study is a systematic review exploring the effect of various masks on voice production parameters., Study Design: Systematic review., Materials and Methods: The titles and abstracts screening was carried out for the inclusion of articles using eight electronic databases spanning the period from 1st January 2020 to 30th April 2021. 10 articles (8 published & 2 in pre-print) that met the inclusion criteria were considered for this systematic review and the pooled age range was 18 -69 years., Results: Three primary studies from the USA, 2 each from Australia & Italy, one each from Brazil, China, and Germany were found to have investigated the influence of wearing N95, KN95, surgical and fabric masks on voice related measures. The users significantly reported vocal fatigue, discomfort, and also perceived voice problems. Attenuation of speech sound amplitude was highest for the transparent mask followed by cloth mask, N95, KN95, and surgical mask., Conclusion: The World Health Organization (WHO) has been repeatedly endorsing the need to use a face mask in the current COVID-19 pandemic. However, for an unintruded voice production, the surgical mask is recommended for everyone, including healthcare professionals when they are not in close contact with patients, and not involved in aerosol-generating procedures. For teachers, doing direct teaching (offline classes), 'surgical mask' can reduce the vocal load of teachers, smoothen the teacher-student interaction and thereby facilitate better learning by the students. Additionally, it would be useful to protect oneself from the risk of developing voice problems by following standard vocal healthcare tips., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To compare the outcomes of bi-weekly voice therapy (BWVT) with weekly voice therapy on perception, acoustics, and quality of life for individuals with muscle tension dysphonia (MTD)., Methods: Thirty participants with MTD were enrolled either BWVT (40 min/session, two sessions per week for 4 weeks) or weekly voice therapy (40 min/session, once a week for 8 weeks). Auditory perceptual ratings, acoustic parameters, and the Mandarin version of the voice-related quality of life questionnaire (MV-RQOL) scores were statistically analyzed before and after treatment., Results: There were significant improvements in the voice qualities such as overall grade, roughness, asthenia, and strain in both groups after treatment. Acoustics analyses showed that fundamental frequency, speaking fundamental frequency, jitter, shimmer, and cepstral peak prominence significantly improved in both groups after treatment. For the MV-RQOL questionnaire scores, the result also demonstrated that both groups felt significant improvements in voice-related quality of life after treatment. However, there were no significant differences between the two groups of treatment effects., Conclusions: Patients with MTD can restore voice qualities and quality of life if they are able to complete a full course of voice therapy, regardless of the intensity of voice therapy. However, if they can receive the BWVT, they would be able to regain their voice faster. The results of this study can be provided as a reference for clinicians when treating patients with MTD., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The voice quality of patients with Coronavirus Disease 2019 (COVID-19) seems to be affected due to lower and upper respiratory involvement. Patient-based voice assessment scales are important clinical measures to diagnose voice disorders and monitor treatment outcomes in COVID-19 patients. This study compared vocal fatigue between COVID-19 patients and those with normal voices. Furthermore, the relationship between vocal fatigue and acoustic voice parameters of COVID-19 patients was evaluated., Methods: This cross-sectional study enrolled 30 laboratory-confirmed patients with COVID-19 (18 males and 12 females) and 30 healthy individuals with normal voices (14 males and 16 females) to compare their respiratory or phonatory parameters. The Persian versions of the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) and the vocal fatigue index (VFI) were conducted before and after reading the text. The Jitter, shimmer, maximum phonation time, and harmonic-to-noise ratio (HNR) were analyzed by Praat software based on the recorded voices of CAPE-V tasks. The acoustic assessment and VFI questionnaire results were compared between COVID-19 patients and the control group., Results: There were significant differences between COVID-19 patients and their healthy counterparts in all VFI subscales (P < 0.001). Moreover, after reading the text, we found significant differences between the two groups regarding Jitter, shimmer, and HNR of /a/ and /i/ vowels (P < 0.05). Our findings also indicated a significant correlation between symptom improvement with rest and acoustic parameters in all tasks, except the Jitter of /a/ before reading the text., Conclusion: Patients with COVID-19 showed significantly more vocal fatigue than people with normal voices after reading the text. Moreover, there was a significant relationship between Jitter, shimmer, and HNR and the tiredness of voice and physical discomfort subscales of VFI., Competing Interests: DECLARATION OF COMPETING INTEREST The authors have no conflicts of interest to declare., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To examine the effects of short-term and long-term engagement with structured choral singing on vocal function and quality of life outcomes in older adults., Methods: Two groups of older adult singers over 55 years, one with fewer than 4 semesters and one with 4 or more semesters singing in a chorale, were assessed at 3 time points: baseline, after 1 semester of singing, and either after 1 semester of rest or after 1 semester of rest and 1 semester more of singing. Acoustic and aerodynamic measures, voice-related quality of life ratings, and measures of singing accuracy were obtained. Percent change between time points were calculated to determine three outcomes: improvement, lack of change, or worsening of measures across time., Results: Long-term average spectrum (LTAS), difference in first and second harmonics and estimated subglottic pressure were significantly more likely to improve after a semester of singing with less experience singers, and LTAS continued to improve after a semester of rest. Flow was significantly more likely to improve with more singing experience after a semester of singing. Aerodynamic variables consistently changed in more experienced singers and improvement was maintained over the three visits. No significant changes occurred over time for singing accuracy for any singer type. Self-perception of singing voice continued to improve with more singing experience., Conclusions: This study demonstrated that for older adults in good health, regular singing provided a mechanism for maintaining speaking voice over time., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The knowledge about the age effects in speech acoustics is still disperse and incomplete. This study extends the analyses of the effects of age and gender on acoustics of European Portuguese (EP) oral vowels, in order to complement initial studies with limited sets of acoustic parameters, and to further investigate unclear or inconsistent results. A database of EP vowels produced by a group of 113 adults, aged between 35 and 97, was used. Duration, fundamental frequency (f0), formant frequencies (F1 to F3), and a selection of vowel space metrics (F1 and F2 range ratios, vowel articulation index [VAI] and formant centralization ratio [FCR]) were analyzed. To avoid the arguable division into age groups, the analyses considered age as a continuous variable. The most relevant age-related results included: vowel duration increase in both genders; a general tendency to formant frequencies decrease for females; changes that were consistent with vowel centralization for males, confirmed by the vowel space acoustic indexes; and no evidence of F3 decrease with age, in both genders. This study has contributed to knowledge on aging speech, providing new information for an additional language. The results corroborated that acoustic characteristics of speech change with age and present different patterns between genders., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To analyze the performance of 10 different machine learning (ML) classifiers for discrimination between dysphonic and non-dysphonic voices, using a variance threshold as a method for the selection and reduction of acoustic measurements used in the classifier., Method: We analyzed 435 samples of individuals (337 female and 98 male), with a mean age of 41.07 ± 13.73 years, of which 384 were dysphonic and 51 were non-dysphonic. From the sustained /ε/ vowel sample, 34 acoustic measurements were extracted, including traditional perturbation and noise measurements, cepstral/spectral measurements, and measurements based on nonlinear models. The variance method was used to select the best set of acoustic measurements. We tested the performance of the best-selected set with 10 ML classifiers using precision, sensitivity, specificity, accuracy, and F1-Score measurements. The kappa coefficient was used to verify the reproducibility between the two datasets (training and testing)., Results: The naive Bayes (NB) and stochastic gradient descent classifier (SGDC) models performed best in terms of accuracy, AUC, sensitivity, and specificity for a reduced dataset of 15 acoustic measures compared to the full dataset of 34 acoustic measures. SGDC and NB obtained the best performance results, with an accuracy of 0.91 and 0.76, respectively. These two classifiers presented moderate agreement, with a Kappa of 0.57 (SGDC) and 0.45 (NB)., Conclusion: Among the tested models, the NB and SGDC models performed better in discriminating between dysphonic and non-dysphonic voices from a set of 15 acoustic measures., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

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., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To verify the validity in the internal consistency in the spectrographic analysis protocol (SAP)., Material and Methods: Thirty-nine students of the Speech-Language Pathology graduate program and 38 speech-language pathologists, specialized in voice, participated in the study. The participants made visual inspections of 10 spectrograms and marked the items of the SAP. For analysis of the internal consistency in the SAP, the exploratory factor analysis (EFA) and confirmatory factor analysis were performed., Results: Most items showed corrected item-total correlation above 0.3, indicating that the items have a good relationship with each other and with the SAP as a whole. Six items presented values below the average, suggesting the exclusion of these from the construct. However, three of these were maintained because they were judged as important parameters in clinical practice, requiring the training of judges when using the SAP to properly understand the items. The EFA regrouped the previous domains of the SAP into three factors. All items presented a factor load above 0.4, suggesting the retention of all, except for the items previously indicated, for exclusion. The confirmatory factor analysis corroborated with the EFA and its indexes., Conclusion: The SAP has good internal consistency. All items have a good degree of relationship with each other and contribute positively to the protocol as a whole. The final version of the SAP, at this stage, has 15 items (from the 25 items of the initial SAP version), distributed among three domains., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to determine the feasibility of altering speech breathing patterns and dysphonia severity through training increased levels of lung volume use during speech. It was hypothesized that respiratory-based training would increase lung volume levels during speech as well as improve acoustic voice measures, and that the addition of laryngeal-based treatment would further improve voice acoustics by treatment completion., Method: A multiple baseline, single subject design was replicated over six participants with primary muscle tension dysphonia as a preliminary investigation of novel respiratory treatment methods. Following four baseline probes (1-4), two phases of treatment were implemented over 6 weeks. Respiratory lung volume-based training (RLVT) and subsequent performance was probed at sessions 5 to 7 and laryngeal-based training was added to the RLVT and probed at sessions 8 to 10. Visual biofeedback was used during RLVT to assist the motor learning process. Respiratory outcome measures of lung volume initiation, termination and excursion were objectively measured using respiratory plethysmography (InductoTrace), and cepstral and spectral-based acoustic measures were also determined at each time point., Results: All participants showed improvement in one or more respiratory measures as well as reduced acoustic dysphonia severity following phase 1 of RLVT alone. Two participants achieved further marked improvement in acoustic voice measures after laryngeal-based training was added in phase 2 of treatment, but this was generally also accompanied by further improvement or stabilization of respiratory measures., Conclusion: Results from this preliminary study support the feasibility of RLVT for improving speech breathing behavior, and suggest that RLVT alone can improve objectively measured dysphonia severity., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Semioccluded vocal tract (SOVT) exercises are routinely included in many voice therapy programs because they have been shown to improve acoustic, aerodynamic, and patient-reported voice outcomes. One limitation of the traditional SOVT exercise is that the nature of phonation through straws or semioccluded oral postures allows only for single phoneme production. A variably occluded facemask (VOFM) allows for use of articulated connected speech beyond the production of single phonemes, while still providing occlusion and, presumably, the vocal efficiency benefits that arise from it. This study reports on the effect of time duration of phonation with a variably occluded facemask on voice outcomes in patients with voice disorders., Design: Prospective, randomized cohort study., Methods: Fifteen patients with voice disorders phonated for 5 minutes through a VOFM with diameter openings of 3.2, 6.4, and 9.6 mm. Acoustic and aerodynamic voice measures were collected before and after each occlusion trial. These results were compared to a historical patient group that received the same phonation training for 2 minutes., Results: Positive effect sizes were found for acoustic and aerodynamic improvements for all patients for at least one occlusion diameter. Effect sizes for aerodynamic outcomes were greater in the 5-minute conditions for both the 9.6- and 6.4-mm occlusions than the 2-minute condition. Effect sizes for acoustic outcomes were greater in the 5 minute than 2-minute trial for the 9.6- and 6.4-mm occlusion diameter, but greater in the 2 minute than 5-minute trial for 3.2-mm diameter., Discussion: This study provides evidence that all three occlusion sizes may elicit beneficial changes for different patients; however, 5 minutes of phonation into a facemask with end occlusion of 6.4-mm diameter results in improved acoustic and aerodynamic voice outcomes for many patients with voice disorders. Future studies should further explore phonatory physiologic changes of the VOFM in a larger sample of patients and translate effects into clinical treatment for patients with voice disorders., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to characterize the acoustic and aerodynamics of the voice of young men with prelingual deafness after cochlear implantation (CI) to provide a theoretical basis for their rehabilitation after CI., Methods: The CI group included 17 young men with prelingual deafness who implanted cochlear at 18-24 years old. The control group included 17 normally hearing young men at the same age. The 10-item Voice Handicap Index, acoustic parameters, and aerodynamic parameters were evaluated., Results: For the acoustic parameters, the F0, SDF0, and Jitter of the CI group were higher than those of the Control group, and these differences were statistically significant. Additionally, The difference in mean shimmer and mean NHR values between the CI group and the Control group was not statistically significant For the aerodynamic parameters, the subglottal pressure and aerodynamic power of the CI group were significantly higher than those of the Control group, whereas the MPT was significantly shorter., Discussion: Due to excessive stress on the laryngeal muscle and limited pneumo-phono-articulatory coordination, the young men in the CI group had a thin voice and poor voice control and muscle coordination, and they exhibited excessive laryngeal resistance. We propose that after CI, in addition to regular hearing and speech rehabilitation, voice training is also extremely important for prelingually deaf young men., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: One of the presumed etiologies of primary muscle tension dysphonia (MTD) is a respiratory-phonatory disruption resulting in poor phonatory airflow in speech; however, few data exist on the differences between vocally healthy adults and patients diagnosed with MTD. The goal of this study was to compare aerodynamic and acoustic measures of self-perceived vocally healthy adults with patients diagnosed with MTD., Study Design: Retrospective, observational, matched cohort study., Methods: Vocally healthy adults age 19-60 years were matched on age, gender, and body mass index (BMI) to patients diagnosed with MTD. Recorded samples of the first four sentences of The Rainbow Passage were analyzed for between-group differences in the following acoustic and aerodynamic dependent measures in connected speech: mean airflow during voicing, breath number, reading passage duration, inspiratory and expiratory durations, phonation time, inspiratory and expiratory volumes, cepstral peak prominence (CPP), CPP standard deviation (CPP SD), low to high ratio (L/H ratio), L/H ratio SD, CPP Fo, CPP Fo SD, cepstral spectral index of dysphonia, and dB sound pressure level (SPL)., Results: One hundred and seventy participants were studied; 85 patients diagnosed with primary MTD and 85 vocally healthy control participants. The two groups differed significantly in mean SPL, duration of the reading passage, and inspiratory and expiratory airflow duration (P ≤ 0.003). No significant differences were observed between the groups on any other phonatory aerodynamic or acoustic measure. Mean SPL, duration of the reading passage, and inspiratory and expiratory airflow durations were lower and longer, respectively, in patients with MTD. Ranges and standard deviations were greater for all aerodynamic and acoustic measurements in patients with MTD., Conclusion: Large variability in aerodynamic and acoustic measurements were observed in patients with primary MTD with no salient differences at the group level compared to vocally healthy participants. Individual phonatory aerodynamic and acoustic profiles should be used when setting goals for patient treatment plans and to track response to treatment for patients with MTD. Taken in its entirety, connected speech from patients diagnosed with MTD essentially reflect normal acoustic and aerodynamic values., (Copyright © 2020. Published by Elsevier Inc.)

Objectives: Investigate the relationships between the Voice Handicap Index, laryngeal electromyography, and objective acoustic voice testing in order to determine the utility of these measures in the management of vocal fold movement disorders., Methods: A retrospective review of patients who had completed a Voice Handicap Index-10 (VHI-10) questionnaire, laryngeal electromyography (LEMG), and objective acoustic measurements (including jitter, relative average perturbation, shimmer, noise-to-harmonic ratio, and standard deviation of fundamental frequency). All three tests had been completed within 30 days of the initial evaluation. All patients' results for acoustic measures were recorded as standard deviations from the norm. LEMG results were converted to grade of paresis (mild, moderate, severe) based on the muscle with the lowest recruitment. Spearman correlation coefficients were calculated to determine the relationship between these three parameters., Results: A total of 313 subjects were included in the analysis. VHI-10, LEMG (grade of paresis), and objective acoustic measures were, at best, weakly correlated. VHI-10 was better correlated than LEMG to each acoustic parameter including the average acoustic scores; however, the highest correlation observed only reached ρ = 0.349 (P < 0.001). The acoustic variables that correlated best with VHI-10 and LEMG were the standard deviation of the fundamental frequency (ρ = 0.349, P < 0.001) and shimmer (ρ = 0.207, P < 0.001), respectively., Conclusion: This study demonstrates that these measures are, at best, weakly associated. VHI-10 correlated better than LEMG (grade of paresis) to each acoustic voice analysis parameter. However, the maximum correlation coefficient observed was 0.349. Therefore, VHI-10 scores and objective voice acoustic measurements are not useful for predicting the severity of vocal fold movement disorders. Moreover, a given severity of paresis can have different effects on voice handicap and acoustic output in different individuals., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Acoustic parameters are widely used as voice quality therapeutic outcomes in many laryngological diseases. The aim of this study is to explore the impact of changes in the nature and duration of the analyzed time interval and the vowel choice on the significance of the acoustic measurements used as therapeutic outcomes in two different diseases., Study Design: A prospective case series., Material and Methods: From September 2013 to January 2018, patients with laryngopharyngeal reflux (LPR) disease were recruited and treated with pantoprazole, diet, and behavioral changes for 3 months. The reflux symptom index and reflux finding score were used for both diagnosis and assessment of treatment effectiveness. Simultaneously, patients with early idiopathic Parkinson's disease (IPD) were enrolled and benefited from a levodopa challenge test. An Iowa Oral Performance Instrument was used for objective outcomes in the assessment of levodopa effectiveness on muscular strength of IPD patients. Acoustic measurements were performed in both groups pre- and postmedication intake at different time intervals, including the "most stable" time intervals of 1 second, 2 seconds, 3 seconds, 4 seconds, and 5 seconds and a 1 second-time interval positioned at mid-production. We also measured acoustic parameters on the entire signal of three vowels and on the signal of each vowel being taken separately., Results: A total of 80 LPR and 19 IPD patients met our inclusion criteria and completed the study protocol. LPR and IPD patients had significant clinical improvements throughout treatment, according to reflux symptom index, reflux finding score, and Iowa Oral Performance Instrument scores. The acoustic analysis revealed that acoustic parameters significantly improved from pre- to post-treatment and varied across methods used for measurement. The duration and position of the analyzed time interval in the production and the vowel on which the acoustic measures were made yielded considerable differences in the results., Conclusion: Depending on the time interval over which the acoustic parameters are measured, the clinically demonstrated effect of the medication may or may not be statistically demonstrated irrespective of the disease. According to the results of this study and regarding the lack of standardization of acoustic measurement methods, a line of thought is proposed to bypass the interval selection problem., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The purpose of this study was to comprehensively evaluate voice and speech changes in one healthy 30-year-old transgender male undergoing testosterone therapy for transition. Testing occurred at three timepoints before cross-sex hormone therapy and every 2 weeks thereafter for 1 year. Data collected included measures of acoustics, aerodynamics, and laryngeal structure and function via flexible laryngoscopy. Analysis included acoustic correlates of pitch, loudness, voice quality, and vocal tract length, as well as perceptual measures of voice quality and gender. Speaking fundamental frequency (f o ) lowered from 183 Hz to 134 Hz. Phonatory frequency range (ie, minimum and maximum singing range) shifted from a range of D#3-E6 to a range of A2-A5. Perceptual measures of voice quality indicated no negative changes. Naïve listeners reliably rated the participant's speech samples as male after 37 weeks on testosterone. Few studies document in detail the variety of voice changes that occur during cross-sex hormone therapy, focusing instead on f o alone. This study adds to the literature a comprehensive case study of speech and voice changes experienced by one transmasculine participant undergoing testosterone therapy., (Copyright © 2019. Published by Elsevier Inc.)

Objectives: The purpose of this preliminary study was to determine the aerodynamic and acoustic effects of the low mandible maneuver (LMM) as compared to normal voice production., Methods: Ten participants with normal voice characteristics who were nonsingers produced sustained vowel and repeated syllable utterances during two different speaking conditions: using the LMM and using normal phonation posture. The LMM involves a wider vocal tract configuration with a lowered and relaxed jaw position. Acoustic recordings and analyses were performed to determine formants 1 and 2 (F1 and F2) and sound pressure level. Aerodynamic data were collected and analyzed to investigate the effects of the LMM on mean peak pressure, mean airflow, aerodynamic power, aerodynamic efficiency, and aerodynamic resistance., Results: Participants showed greater aerodynamic efficiency, mean peak pressure, and sound pressure level during the LMM condition as compared to normal phonation. The LMM vocal tract configuration changes were also associated with a lowering of F1 and F2 relative to normal voice production., Conclusions: The lowering of the mandible and increased oral area that occurred during the LMM increased vocal efficiency and sound output without significant change to parameters that can be associated with increased vocal effort. These changes in filter configuration were associated with changes in vocal tract resonances. The LMM was readily learned and implemented by healthy participants in this study, and may have utility for singers in training as well as people with hyperfunctional voice disorders., (Copyright © 2018. Published by Elsevier Inc.)

Introduction: The ability to perform acoustic inspection of data and to correlate the results with perceptual and physiological aspects facilitates vocal behavior analysis. The singing voice has specific characteristics and parameters that are involved during the phonation mechanism, which may be analyzed acoustically., Objective: To describe and analyze the fundamental frequency and formants in pitch variation in the /a/ vowel in sopranos., Methods: The sample consisted of 30 female participants between the ages of 20 to 45 years without vocal complaints. All sustained vowel sounds were recorded with the /a/ vowel sustained for 5 seconds, with three replications at low (C4-261 Hz), medium (Eb4-622 Hz), and high (Bb4-932 Hz) frequencies that were comfortable for the voice classification. In total, 90 samples were analyzed with digital extraction of the fundamental frequency (f0) and the first five formants (F1, F2, F3, F4, and F5) and manual confirmation. The middle segment was considered for analysis, whereas the onset and offset segments were not considered. Subsequently, FFT (fast Fourier transform) plots, LPC (linear predictive coding) graphs, and tube diagrams were created. The Shapiro-Wilks test was applied for adherence and the Friedman test was applied for comparison of paired samples., Results: For vocalizations at low and medium pitches, higher values were observed for the first five formant frequencies than for the f0 value. Overlaying the LPC and FFT graphs revealed a similarity between F1 and F2 at the two pitches, with clustered harmonics in the F3, F4, and F5 region in the low pitch. At the medium pitch, there was similarity between F3 and F4, an F5 peak, and tuned harmonics. However, in the high-pitch vocalizations, there was an increase in the F2, F3, F4, and F5 values in relation to f0, and there was similarity between them along with synchrony between f0 and F1, H2 and F2, H3 and F3, H4 and F4, and H5 and F5., Conclusions: Pitch changes indicate differences in the behavior of the fundamental frequency and sound formants in sopranos. The comparison of the sustained vowels sounds in f0 at the three pitches revealed specific vocal tract changes on the LPC curve and FFT harmonics, with an extra gain range at 261 Hz, synchrony between peaks of formants and harmonics at 622 Hz, and equivalence of f0 and F1 at 932 Hz., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The objective of this study was to analyze the accuracy of recurrence quantification measurements (RQMs) in discriminating between individuals with and without voice disorders. This study consisted of a total of 541 recorded voice samples from normal and dysphonic subjects. All subjects recorded a sustained vowel /Ɛ/ and underwent a laryngoscopic examination of the larynx. Twelve RQMs and three parameters related to the topology of the phonatory system were extracted from the samples, for a total of 15 measures. The classification used quadratic discriminant analysis and includes the measures of accuracy, sensitivity, and specificity. Single measurements such as Shannon's entropy, average diagonal length, and transitivity had only acceptable performance ratings (≥70%) in discriminating between individuals with and without voice disorders. The combination of the parameters average diagonal length, Shannon's entropy, trapping time, length of the longest vertical line, tau, imbedding dimension, neighborhood radius, and transitivity produced the highest accuracy in discrimination (83.27%). Therefore, the performance of RQMs related to the formation of diagonal lines in classifying individuals with and without voice disorders was acceptable at ≥70%. A combination of RQMs showed good performance in discriminating between the study groups, with higher sensitivity and specificity., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: To study the usefulness of voice quality as therapeutic outcome in laryngopharyngeal reflux disease., Material and Methods: A total of 80 patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, diet, and lifestyle recommendations for 3 months. The therapeutic effectiveness was assessed with RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability (GRBASI); aerodynamic and a panel of acoustic measurements before and after treatment. A correlation analysis between symptoms, videolaryngostroboscopic signs, and acoustic measurements was conducted., Results: Compared to baseline, means of RSI, RFS, Voice Handicap Index, perceptual dysphonia, and roughness significantly decreased. Significant improvements of phonatory quotient, percent jitter, percent shimmer, Relative Average Perturbation, Pitch Perturbation Quotient, Phonatory F0 Range, Amplitude Perturbation Quotient, smooth Amplitude Perturbation Quotient, and Peak-to-Peak Amplitude Variation were found at the end of treatment. Studies of correlation did not identify relevant correlation between videolaryngostroboscopic signs, especially vocal folds edema, and objective voice quality evaluations., Conclusion: Voice quality assessments can help to better understand voice disorders and can be used as indicators of the treatment effectiveness in patients with laryngopharyngeal reflux-related symptoms., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of the current study is to determine the relation of frailty syndrome to acoustic measures of voice quality and voice-related handicap., Methods: Seventy-three adults (52 community-dwelling participants and 21 assisted living residents) age 60 and older completed frailty screening, acoustic assessment, cognitive screening, and the Voice Handicap Index-10 (VHI-10). Factor analysis was used to consolidate acoustic measures. Statistical analysis included multiple regression, analysis of variance, and Tukey post-hoc tests with alfa of 0.05., Results: Montreal Cognitive Assessment (MoCA) and exhaustion explained 28% of the variance in VHI-10. MoCA and sex explained 27% of the variance in factor 1 (spectral ratio), age and MoCA explained 13% of the variance in factor 2 (cepstral peak prominence for speech), and slowness explained 10% of the variance in factor 3 (cepstral peak prominence for sustained /a/). There were statistically significant differences in two measures across frailty groups: VHI-10 and MoCA. Acoustic factor scores did not differ significantly among frailty groups (P > 0.05)., Conclusions: Voice-related handicap and cognitive status differed among robust and frail older adults, yet vocal function measures did not. The components of frailty most related to VHI-10 were exhaustion and weight loss rather than slowness, weakness, or inactivity. Based on these findings, routine screening of physical frailty and cognition are recommended as part of a complete voice evaluation for older adults., (Copyright © 2018 The Voice Foundation. All rights reserved.)

Objective: To investigate the usefulness of voice quality assessment as a treatment outcome in responder and nonresponder patients with laryngopharyngeal reflux (LPR)., Material and Methods: Eighty clinically diagnosed LPR patients with reflux finding score (RFS) > 7 and reflux symptom index (RSI) > 13 were treated with pantoprazole, lifestyle changes, and diet recommendations for three months. RSI; RFS; Voice Handicap Index; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; aerodynamic and acoustic measurements were assessed at baseline and after treatment. These data were analyzed and compared with regard to the clinical evolution of patients (responder versus nonresponder). Patients who significantly improved RSI ≤ 13 and RFS ≤ 7 after treatment were considered as responder. Nonresponders were defined as patients with RSI > 13 and/or RFS > 7 at the end of treatment. Studies of correlation between the adherence to the diet regimen and the evolution of both signs and symptoms and between videolaryngostroboscopic signs; blinded Grade, Roughness, Breathiness, Asthenia, Strain, and Instability; and acoustic measurements were conducted., Results: Significant improvements in RSI, RFS, Voice Handicap Index, perceptual voice quality (dysphonia and roughness), and some fundamental frequency and intensity perturbation cues (phonatory fundamental frequency range, percent jitter, pitch perturbation quotient, relative average perturbation, percent shimmer, smoothed amplitude perturbation quotient, amplitude perturbation quotient, and peak-to-peak amplitude variation) were mainly identified after treatment in responder patients. The clinical and voice quality improvements of nonresponder patients were lower; highlighting a similar evolution of symptoms, signs, and voice quality. The correlation analysis revealed significant relationships between the adherence to lifestyle changes and diet recommendations and the improvement of symptoms and substantial correlations between breathiness and fundamental frequency perturbation parameters., Conclusion: Voice quality assessments can be used as indicators of the treatment effectiveness in patients with LPR. Voice quality improvement seems to be consistently associated with clinical improvement., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Sixty to 90% of patients with idiopathic Parkinson disease (IPD) developed early dysphonia and subtle speech impairment, which is usually related to orofacial muscular dysfunctions. The aim of this preliminary study is to assess the usefulness of voice quality and orofacial strength (involved in speech) as outcome of levodopa challenge test used for the IPD diagnosis., Material and Methods: A total of 20 patients with early IPD were recruited and evaluated for clinical findings (Hoehn and Yahr scale), voice handicap index, maximal phonation time, phonation quotient, percent jitter, percent shimmer, noise-to-harmonic ratio, and orofacial muscular strength (Iowa Oral Performance Instrument) at baseline, throughout the levodopa challenge test and after therapeutic stabilization., Results: The intake of a standardized dose of levodopa (levodopa challenge test) significantly improved phonation quotient and percent shimmer. We did not find similar improvement after medical stabilization of patients (based on levodopa medication) despite an improvement of Hoehn and Yahr mean score. The intake of levodopa significantly improved cheeks and lips strength involved in speech quality both along the challenge test and after the therapeutic stabilization., Conclusions: These preliminary findings support a differential impact of levodopa on voice and speech functions in early diagnosed IPD and a mismatch between the clinical examination, orofacial strength, and voice quality improvements once the patient is medically stabilized., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Voice is produced by the vibration of the vocal folds expressed by its fundamental frequency (Hz), whereas the formants (F) are fundamental frequency multiples, indicating amplification zones of the vowels in the vocal tract. We have shown that lifetime isolated growth hormone deficiency (IGHD) causes high pitch voice, with higher values of most formant frequencies, maintaining a prepuberal acoustic prediction. The objectives of this work were to verify the effects of the therapy with a semi-occluded vocal tract (SOVTT) and choir training on voice in these subjects with IGHD. We speculated that acoustic vocal parameters can be improved by SOVTT or choir training., Study Design: This is a prospective longitudinal study without control group., Methods: Acoustic analysis of isolated vowels was performed in 17 adults with IGHD before and after SOVTT (pre-SOVTT and post-SOVTT) and after choir training (post training), in a 30-day period., Results: The first formant was higher in post training compared with the pre-SOVTT (P = 0.009). The second formant was higher in post-SOVTT than in pre-SOVTT (P = 0.045). There was a trend of reduction in shimmer in post-choir training in comparison with pre-SOVTT (P = 0.051), and a reduction in post-choir training in comparison with post-SOVTT (P = 0.047)., Conclusions: SOVTT was relevant to the second formant, whereas choir training improved first formant and shimmer. Therefore, this speech therapy approach was able to improve acoustic parameters of the voice of individuals with congenital, untreated IGHD. This seems particularly important in a scenario in which few patients are submitted to growth hormone replacement therapy., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to examine the perceptual structure and acoustic characteristics of speech of patients with adductor spasmodic dysphonia (ADSD) in Mandarin., Study Design: Case-Control Study MATERIALS AND METHODS: For the estimation of dysphonia level, perceptual and acoustic analysis were used for patients with ADSD (N = 20) and the control group (N = 20) that are Mandarin-Chinese speakers. For both subgroups, a sustained vowel and connected speech samples were obtained. The difference of perceptual and acoustic parameters between the two subgroups was assessed and analyzed., Results: For acoustic assessment, the percentage of phonatory breaks (PBs) of connected reading and the percentage of aperiodic segments and frequency shifts (FS) of vowel and reading in patients with ADSD were significantly worse than controls, the mean harmonics-to-noise ratio and the fundamental frequency standard deviation of vowel as well. For perceptual evaluation, the rating of speech and vowel in patients with ADSD are significantly higher than controls. The percentage of aberrant acoustic events (PB, frequency shift, and aperiodic segment) and the fundamental frequency standard deviation and mean harmonics-to-noise ratio were significantly correlated with the perceptual rating in the vowel and reading productions., Conclusions: The perceptual and acoustic parameters of connected vowel and reading in patients with ADSD are worse than those in normal controls, and could validly and reliably estimate dysphonia of ADSD in Mandarin-speaking Chinese., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This study compared whispering attempts by adults using tracheoesophageal (TE) speech with those by adults with a larynx. Comparisons were based on listener judgments, visual-perceptual assessment of spectrograms, and measures of the acoustic signal., Study Design: This was a prospective, cross-sectional study., Methods: Seventeen TE and 10 laryngeal speakers produced sentences in a whisper and in their spoken voice. Listeners judged sentences as whispered or spoken. Judges signal-typed the spectrograms based on presence-absence of a "voicing bar." Speaking rate, articulation rate, percent pause, and dB sound pressure level were measured., Results: Twenty-nine percent of TE speakers were perceived to be whispering on whisper attempts; most others were perceived to be using spoken voice while attempting to whisper. Spectrograms of TE whispering were most often categorized as "mostly voiced." Speaking and articulation rates were slower for TE speakers. There was a significantly greater reduction in speaking rate from spoken to whisper for the TE group. Percent pause did not differ significantly between groups and speaking mode. TE speakers had a significantly smaller difference in dB sound pressure level between spoken and whisper modes., Conclusions: Some individuals using TE speech can whisper based on auditory-perceptual judgment, but most were perceived to be speaking during these attempts. The fact that some TE participants could whisper indicates the behavior is possible and might be considered a therapeutic target if it is of importance to an individual. The percentage of TE speakers who can learn to whisper, and the optimal training approach, are yet to be determined., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to characterize changes in the voice and vowel articulation of prelingually deaf children after cochlear implantation., Methods: In this study, the patient group included 30 prelingually deaf children who underwent unilateral cochlear implantation at 4-6 years of age. The control group included normally hearing children of the same age. All deaf children had follow-ups before cochlear implantation and at 1, 3, 6, 12, and 24 months after implantation. The acoustic parameters, aerodynamic parameters, and vowel formants were measured in the patient group and compared with those of the control group., Results: All acoustic parameters, aerodynamic parameters, and vowel formants differed significantly between normally hearing children and prelingually deaf children. For prelingually deaf children, all of the above parameters gradually decreased after cochlear implantation. Furthermore, the acoustic parameters Jitter and Shimmer were significantly reduced as early as 6 months, whereas the fundamental frequency, the standard deviation of fundamental frequency, estimated subglottal pressure, aF1, iF2, and uF2 were significantly altered 12 months after implantation. However, statistically significant differences in these parameters were not observed between 12 and 24 months after cochlear implantation., Conclusion: After cochlear implantation, prelingually deaf children established auditory feedback and improved voice control and vowel production., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Although a variety of therapeutic techniques have been suggested for patients with unilateral adductor vocal fold paralysis (UAVFP), they were not aimed specifically at determining the efficacy of early intervention for these patients. The purposes of this study are to explore a protocol of voice therapy and to investigate its efficacy in voice therapy for patients with early UAVFP. A 12-week planned voice therapy protocol, including vocal function exercise, hard attack, and resonance voice therapy, was given to 10 patients within 6 months of initial diagnosis. Additionally, nine patients diagnosed with UAVFP within 6 months served as controls., Methods: Multidimensional evaluations of voice function were obtained for statistical analyses., Results: Compared to a control group, the experimental group receiving voice therapy exhibited significant improvement in the following: (1) glottal closure; (2) voice quality of grade, breathiness, monotone, and resonance; (3) acoustic measurements of jitter, shimmer, and noise-to-harmonic ratio; (4) aerodynamics measurements of maximum phonation time, phonation threshold pressure, and phonation quotient; and (5) Voice Handicap Index of functional subscale., Conclusion: This prospective study established an effective protocol of early intervention of voice therapy in patients with UAVFP and demonstrated its efficacy in data on laryngeal physiology, voice quality, voice stability, voice efficiency, and communication function., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: The use of frequency-based analysis as an accurate method of voice analysis motivated us to evaluate the voice qualities of healthy versus dysphonic Iranian people., Methods: Two hundred normal and dysphonic participants aged between 20 and 50 years in either gender were divided into four different equal groups. For the tasks, 5-second prolongation of vowel /a/ and a sample of reading text were used for the analysis. "Speech Tool" software was employed for Cepstral peak prominence (CPP) and cepstral peak prominence-smoothed (CPPS) analyses. The t test and Mann-Whitney U test were used for statistical analysis., Results: Significant differences between the dysphonic and controls were discovered based on CPP and CPPS in the reading tasks (males and females) and CPPS in the sustained vowel (males and females). Nevertheless, the two male groups showed no differences in the sustained vowel in CPP. Moreover, significantly lower CPP and CPPS were observed in the sustained vowel and reading tasks for the dysphonic females compared to the control group and either group of males., Discussion and Conclusion: In spite of the different characteristics of consonant-vowel contexts in Persian language, the results of this study suggested that both CPP and CPPS are appropriate to differentiate between normal and dysphonic voices in connected speech and CPPS is promising for sustained phonation in Persian. The results of this research also suggested that the male group in the normal and dysphonic samples had better CPP and CPPS values., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aims to build an excised anterior glottic web (AGW) model and study the basic voice-related mechanisms of the AGW through investigating the acoustic, aerodynamic, and vibratory properties., Study Design and Methods: Overall, four conditions were tested for each of the eight canine larynges used. At baseline, 10%, 20%, and 33% occlusion (as determined by the placement of the suture), acoustic, aerodynamic, and high-speed video data were collected while each larynx was phonated in a soundproof booth., Results: The phonation threshold pressure (PTP) and the phonation threshold flow significantly increased as percent occlusion increased (P < 0.001). There were significant increases in jitter % and shimmer % from baseline group to AGW model groups at PTP, 1.25 PTP, and 1.5 PTP (P = 0.039, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P = 0.001, respectively). The fundamental frequency significantly increased as percent occlusion increased at all given pressures (P < 0.001). Correlation dimension (D2) was significantly higher in the AGW model groups than in the baseline group at PTP, 1.25 PTP, and 1.5 PTP (P = 0.002, P < 0.001, P = 0.01, respectively). High-speed videos revealed that, the left phase shift in the AGW model groups compared with the baseline at 1.25 PTP was significant (P = 0.027) and right phase shift at 1.5 PTP (P < 0.001)., Conclusions: We presented an anatomically similar model of a type 1 AGW and confirmed its validity through aerodynamic, acoustic, and high-speed video analysis in our study. We observed and investigated the glottic web movement, which may be a new explanation for the pathologic voice-related mechanism of AGW., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of our study was to investigate the short- and long-term effects of tonsillectomy on voice performance in adults., Study Design: Prospective cohort study., Materials and Methods: This study was conducted between January 2013 and June 2015. A total of 26 adults who had tonsillectomy due to chronic tonsillitis or recurrent acute tonsillitis were included in the study. The voice performances of the participants were analyzed with objective and subjective methods before surgery, and 1 and 3 months after surgery. An acoustic voice analysis (fundamental frequency [F0], jitter %, shimmer %) was performed for objective analysis, and Voice Handicap Index survey was used for subjective analysis of the voice. Preoperative F0, jitter %, shimmer %, and Voice Handicap Index values were compared with the values obtained 1 and 3 months after surgery., Results: Impairment of voice performance was determined when preoperative and postoperative first month F0, jitter %, and shimmer % values were compared. Three months after surgery, those values were found similar to the preoperative values., Conclusion: Tonsillectomy affects voice performance negatively in adults in short term; however, it does not affect voice performance in long term after surgery., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The study aimed to explore the impact of the selection of the analyzed time interval on the significance of acoustic measurements used to investigate laryngopharyngeal reflux (LPR) treatment efficacy, and based on these results to develop an alternative statistical approach in data analysis focusing on individual patient vocal behavior., Study Design: This is a prospective case series., Methods: From September 2013 to July 2015, 41 patients with a reflux finding score (RFS) > 7 and a reflux symptom index (RSI) > 13 were enrolled and treated with pantoprazole 20 mg twice daily and diet behavioral changes for 3 months. Voice recordings were performed at baseline and after 3 months of treatment. Most stable time intervals of 1, 2, 3, 4, and 5 seconds, and a 1-second time interval positioned at mid-production, were subjected to acoustic analysis. Based on the latter, we developed an "informativeness coefficient" for each acoustic parameter that aimed at assessing its sensitivity to clinical resolution in the case of LPR disease., Results: Significant clinical improvement (RSI and RFS) was observed after treatment (P < 0.05). The acoustic analysis revealed that acoustic parameters significantly improving from pre- to posttreatment varied across time intervals. The duration and the position of the analyzed time interval in the production yielded considerable differences in the results. Analysis of the informativeness coefficient indicated that jitter, jitter percent, relative average perturbation (RAP), pitch perturbation quotient (PPQ), shimmer (ShdB), shimmer percent (Shim), amplitude perturbation quotient (APQ), and smoothed amplitude perturbation quotient (sAPQ) were the indices most sensitive to medical treatment efficacy, with a coefficient ranging from 75.86% to 86.21%., Conclusions: Depending on the selection of the time interval over which the acoustic parameters are measured, the potential effect of the treatment may or may not be statistically demonstrated. Future studies are needed to establish standardized methodological procedures for acoustic data analysis., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To characterize the vocal quality and acoustic parameters of voices of air traffic controllers (ATCs) without any vocal complaints before and after a shift., Method: The voices of a group of 45 ATCs were recorded before and after a 2-hour shift, regardless of their operational position or number of previously worked shifts; both genders were included, participants had a mean age of 25 years, and they had a mean length of occupational experience of 4 years and 2 months. Each of these professionals was recorded phonating a sustained /a/ vowel and counting from 1 to 20, and the recordings were acoustically analyzed using the Praat software. A perceptual-auditory analysis of the recordings was then performed by three speech therapists specializing in voice, who evaluated the characteristics of each emission using a visual analog scale (VAS). The acoustic analysis was performed on the sustained /a/ vowel. The measures of intensity; frequency; maximum phonation time (MPT); and the first, second, third, and fourth formants were considered in this analysis., Results: There were no significant differences between the random pre- and postshift samples, either in the acoustic or in the perceptual-auditory analysis. The perceptual-auditory analysis revealed that 44% (n = 20) of ATCs showed alterations in vocal quality during the sustained /a/ vowel emission, and this dysphonia was also observed in connected speech in 25% (n = 5) of this group., Conclusion: Perceptual-auditory analysis of the /a/ vowel revealed that a high percentage of ATCs had vocal alterations (44%), even among a group of subjects without vocal complaints., (Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

To evaluate voice of Iranian patients with Parkinson's disease (PD) and find any relationship between motor disabilities and acoustic voice parameters as speech motor components. We evaluated 27 Farsi-speaking PD patients and 21 age- and sex-matched healthy persons as control. Motor performance was assessed by the Unified Parkinson's Disease Rating Scale part III and Hoehn and Yahr rating scale in the "on" state. Acoustic voice evaluation, including fundamental frequency (f0), standard deviation of f0, minimum of f0, maximum of f0, shimmer, jitter, and harmonic to noise ratio, was done using the Praat software via /a/ prolongation. No difference was seen between the voice of the patients and the voice of the controls. f0 and its variation had a significant correlation with the duration of the disease, but did not have any relationships with the Unified Parkinson's Disease Rating Scale part III. Only limited relationship was observed between voice and motor disabilities. Tremor is an important main feature of PD that affects motor and phonation systems. Females had an older age at onset, more prolonged disease, and more severe motor disabilities (not statistically significant), but phonation disorders were more frequent in males and showed more relationship with severity of motor disabilities. Voice is affected by PD earlier than many other motor components and is more sensitive to disease progression. Tremor is the most effective part of PD that impacts voice. PD has more effect on voice of male versus female patients., (Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the voice changes after narrow-margin endoscopic partial laryngectomy in subjects with T1N0M0 glottic cancer., Study Design: Uncontrolled retrospective comparison of preoperative and postoperative mean phonation time; fundamental frequency, jitter, shimmer, and noise-to-harmonic ratio; and voice-related quality of life (V-RQOL) survey scores., Methods: Seventeen adults diagnosed with T1N0M0 glottic cancer who underwent narrow-margin endoscopic partial laryngectomy were included. All subjects had preoperative and postoperative acoustic evaluation and V-RQOL scores. Subjects were separated into three groups based on age and depth of resection. Group A (mean age, 52 years) consisted of seven subjects who underwent superficial resection (superficial layer of lamina propria) and were younger than 60 years. Group B (mean age, 76 years) consisted of six subjects who were older than 60 years and underwent superficial resection (superficial layer of lamina propria). The four subjects in group C were older than 60 years and underwent deep resection (into the vocal ligament and/or into the thyroarytenoid muscle)., Results: There was a statistically significant improvement in V-RQOL in group A. The acoustic measures did not change after surgery (no P<0.05)., Conclusion: For early-stage cancer, patients younger than 60 years and superficial resection of cancer are predictive for better voice., (Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This pilot study examined voice outcomes and patient perceptions after intensive voice therapy for vocal fold nodules via telepractice., Study Design: Pilot, within-subjects experimental trial., Methods: Participants included 10 women diagnosed with bilateral vocal fold nodules who received intensive voice treatment via a free videoconferencing platform Skype, (Microsoft Corp., Redmond, WA). All participants completed one vocal hygiene session in person, followed by eight sessions of therapy via telepractice over 3 weeks. Before and immediately after treatment, patients attended a clinic in person to complete perceptual, stroboscopic, acoustic, and physiological assessments of vocal function. Analyses were performed by a speech-language pathologist and an otolaryngologist independent to and blinded to the study. Participants also completed the Voice Handicap Index and a telepractice satisfaction questionnaire, or an anticipated satisfaction questionnaire, before and after the treatment., Results: Significant improvements were found in perceptual, vocal fold function, acoustic, and physiological parameters as well as nodule sizes and patient perceptions of voice-related quality of life post-treatment. Participants were highly positive about their first experience with telepractice. Results were similar to those from a separate study investigating the effects of an intensive voice therapy delivered in conventional face-to-face (FTF) format., Conclusions: This study is consistent with possible benefits of telepractice in the delivery of intensive treatment for vocal fold nodules. Pending final verification with a FTF comparison group, telepractice could be recommended as an alternate treatment modality for patients with vocal fold nodules., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives/hypothesis: This article aims to establish correlations between acoustic and audio-perceptual measures using the GRBAS scale with respect to four different voice analysis software programs., Study Design: Exploratory, transversal., Methods: A total of 90 voice records were collected and analyzed with the Dr. Speech (Tiger Electronics, Seattle, WA), Multidimensional Voice Program (Kay Elemetrics, NJ, USA), PRAAT (University of Amsterdam, The Netherlands), and Voice Studio (Seegnal, Oporto, Portugal) software programs. The acoustic measures were correlated to the audio-perceptual parameters of the GRBAS and rated by 10 experts., Results: The predictive value of the acoustic measurements related to the audio-perceptual parameters exhibited magnitudes ranging from weak (R(2)a=0.17) to moderate (R(2)a=0.71). The parameter exhibiting the highest correlation magnitude is B (Breathiness), whereas the weaker correlation magnitudes were found to be for A (Asthenia) and S (Strain). The acoustic measures with stronger predictive values were local Shimmer, harmonics-to-noise ratio, APQ5 shimmer, and PPQ5 jitter, with different magnitudes for each one of the studied software programs., Conclusions: Some acoustic measures are pointed as significant predictors of GRBAS parameters, but they differ among software programs. B (Breathiness) was the parameter exhibiting the highest correlation magnitude., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the perceptual, physiological, acoustic, and aerodynamic outcomes of patients with vocal nodules following intensive voice treatment compared with traditional voice treatment., Study Design: Pragmatic randomized clinical trial., Methods: Fifty-three women diagnosed with bilateral vocal nodules participated in the study. Voice recordings, stroboscopic recordings, acoustic, and aerodynamic assessments were made before voice treatment, after vocal hygiene education, and immediately postvoice treatment. All participants completed one session of vocal hygiene and eight sessions of direct voice therapy, however the delivery of the treatment between the two groups differed in treatment intensity., Results: Physiological improvements were observed after vocal hygiene alone, whereas physiological, perceptual, and acoustic parameters all improved to some degree in both treatment groups immediately posttreatment. There were no differences in the extent of change observed between the two groups at any point following treatment., Conclusions: The investigation provided initial evidence that individuals with vocal nodules are able to recover voice function, vocal health, and vocal communication through intensive voice treatment. The results suggest comparable positive perceptual, physiological, and acoustic outcomes from intensive voice therapy compared with traditional voice therapy. Further investigation is required to determine the long-term effects of intensive treatment., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To analyze the accuracy of recurrence measurements, both isolated and combined, to assess the intensity of vocal disorders in children., Method: A total of 93 children of both sexes (48 girls and 45 boys), aged between 3 and 10 years, participated. The vocal-deviation intensity was evaluated by the consensus of three speech therapists from the pronunciation of vowel /ε/ using the visual analog scale. In the acoustic analysis, eight recurrence plot characteristics were evaluated and extracted with neighborhood radius values that maintained the recurrence rate at 1%, 2%, 3%, 4%, and 5%. The classification was performed using quadratic discriminant analysis applied for individual and combined measurements. The performance was evaluated by measuring the accuracy, which related the cases correctly classified to all the analyzed cases., Results: In the classification cases concerning individual measure performance, the trapping time and maximum length of the diagonal lines showed the best classification potential to discriminate between healthy and disturbed voices, with accuracy rates above 80%. In the healthy and mild deviation cases, the trend (TREND) measure was also relevant. For the mild versus moderate deviation classification, the best performance was obtained by the TREND measure (85.00% ± 7.64%). A gain was obtained in the classification rate when the measures of recurrence were combined, reaching an accuracy of 95.00% ± 5.00%, for discriminating between healthy voices and those with mild deviation., Conclusions: The measures of recurrence, either alone or combined, may be useful in detecting healthy and disturbed voices and in differentiating the intensity of vocal disorders in children., (Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To correlate change in Voice Handicap Index (VHI)-10 scores with corresponding voice laboratory measures across five voice disorders., Study Design: Retrospective study., Methods: One hundred fifty patients aged >18 years with primary diagnosis of vocal fold lesions, primary muscle tension dysphonia-1, atrophy, unilateral vocal fold paralysis (UVFP), and scar. For each group, participants with the largest change in VHI-10 between two periods (TA and TB) were selected. The dates of the VHI-10 values were linked to corresponding acoustic/aerodynamic and audio-perceptual measures. Change in voice laboratory values were analyzed for correlation with each other and with VHI-10., Results: VHI-10 scores were greater for patients with UVFP than other disorders. The only disorder-specific correlation between voice laboratory measure and VHI-10 was average phonatory airflow in speech for patients with UVFP. Average airflow in repeated phonemes was strongly correlated with average airflow in speech (r=0.75). Acoustic measures did not significantly change between time points., Conclusions: The lack of correlations between the VHI-10 change scores and voice laboratory measures may be due to differing constructs of each measure; namely, handicap versus physiological function. Presuming corroboration between these measures may be faulty. Average airflow in speech may be the most ecologically valid measure for patients with UVFP. Although aerodynamic measures changed between the time points, acoustic measures did not. Correlations to VHI-10 and change between time points may be found with other acoustic measures., (Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objectives: The purpose of this study was to determine the aerodynamic and acoustic features of speech produced at comfortable, maximal and minimal levels of vocal effort., Study Design: Prospective, quasi-experimental research design., Method: Eighteen healthy participants with normal voice were included in this study. After task training, participants produced repeated syllable combinations at comfortable, maximal and minimal levels of vocal effort. A pneumotachometer and vented (Rothenberg) mask were used to record aerodynamic data, with simultaneous recording of the acoustic signal for subsequent analysis. Aerodynamic measures of subglottal pressure, translaryngeal airflow, maximum flow declination rate (MFDR), and laryngeal resistance were analyzed, along with acoustic measures of cepstral peak prominence (CPP) and its standard deviation (SD)., Results: Participants produced significantly greater subglottal pressure, translaryngeal airflow, and MFDR during maximal effort speech as compared with comfortable vocal effort. When producing speech at minimal vocal effort, participants lowered subglottal pressure, MFDR, and laryngeal resistance. Acoustic changes associated with changes in vocal effort included significantly higher CPP during maximal effort speech and significantly lower CPP SD during minimal effort speech, when each was compared with comfortable effort., Conclusions: For healthy speakers without voice disorders, subglottal pressure, translaryngeal airflow, and MFDR may be important factors that contribute to an increased sense of vocal effort. Changes in the cepstral signal also occur under conditions of increased or decreased vocal effort relative to comfortable effort., (Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)