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SUMMARY Objective To determine if auditory-perceptual voice ratings performed using the GRBAS scale correlate with acoustic and aerodynamic measures of voice. A secondary aim was to examine the relationship between GRBAS ratings and patient-reported quality of life scales. Methods GRBAS ratings, acoustic, aerodynamic and patient-reported quality of life ratings were collected from the University of Wisconsin Madison Voice and Swallow Outcomes Database for 508 adults with voice disorders. Acoustic measures included noise to harmonic ratio, jitter%, shimmer%, highest fundamental frequency (F0) of vocal range, lowest F0 of vocal range, maximum phonation time and dysphonia severity index. Aerodynamic measures included phonation threshold pressure, subglottal pressure, mean transglottal airflow and laryngeal airway resistance. Patient-reported quality of life measures included the Vocal Handicap Index (VHI) and Glottal Function Index (GFI). Results GRBAS ratings were significantly correlated with several acoustic and aerodynamic measures, VHI and GFI. The strongest significant correlations for acoustic measures were observed between GRBAS ratings of overall voice quality and perturbation measures (jitter% r = 0.58, shimmer% r = 0.45, noise to harmonic ratio r = 0.36, Dysphonia Severity Index r = -0.56). The strongest significant correlation for aerodynamic voice measures was observed between GRBAS ratings of breathiness and transglottal airflow (r = 0.23), subglottal pressure (r = 0.49), and phonation threshold pressure (r = 0.26). GRBAS ratings were also significantly correlated with both VHI and the GFI scales. R values were higher for the VHI, but remained largely in low range for both scales. Conclusions Although GRBAS ratings were significantly correlated with multiple objective voice and patient related quality of life ratings, r values were low. These findings support the need for multiple voice measures when performing voice evaluations as no single voice measure was highly correlated with voice quality as measured by the GRBAS scale.

The aim of our study is to evaluate objective and subjective vocal outcomes in patients undergoing vagus nerve stimulation (VNS) therapy for drug-resistant epilepsy and to assess the vocal outcome in the known laryngeal dysmotility patterns induced by VNS. We enrolled 16 adult patients without cognitive impairment who had undergone VNS implant for drug-resistant epilepsy at least 1 year prior. They were evaluated by flexible fibreoptic laryngeal examination and Voice Handicap Index questionnaire administration; acoustic and perceptual voice analysis was performed both at rest and during VNS activation. All recruited patients were admitted to the study. The VNS implant systematically determined laryngeal motility alterations, which were in turn mirrored by perceptual, subjective, and/or acoustic analysis voice alterations in all patients. Patients with intact vocal fold function at rest performed worse during acoustic voice analysis in terms of jitter during VNS activation and shimmer at rest when compared to other laryngeal patterns (P= 0.027 and P = 0.034, respectively, Kruskal-Wallis test). Furthermore, VNS activation determined an overall worsening of the perceptual and acoustically analysed voice quality: the grade of hoarseness, instability and breathiness parameters of the GRBASI (grade, roughness, breathiness, asthenia, strain, instability) scale and the jitter, shimmer and noise-to-harmonic ratio of the acoustic analysis worsened significantly during VNS activation (P = 0.001, P = 0.021, P = 0.012, P.001, P = 00.002, P = 0.039, respectively, Wilcoxon test). According to our results, the VNS implant determines a significantly impaired vocal outcome that has a surprisingly mild impact on Voice Handicap Index scores. Such impairment is significantly greater in patients with intact vocal fold function at rest.

Summary Objectives/Hypothesis To determine predictors of voice therapy initiation. Study Design Cross-sectional cohort study. Methods All patients were evaluated in an interdisciplinary model at the University of Wisconsin Voice and Swallow Clinics between June 2016 and October 2017. Patients were eligible if they were diagnosed with a voice disorder and recommended for voice therapy as the only treatment. The dependent variable was attendance in at least once voice therapy session. Independent variables included therapeutic alliance, measured using the Session Rating Scale, and patient- and disease-related factors. These factors included gender, age, distance to the clinic, education level, household composition, occupational voice demand, Voice Handicap Index score, auditory-perceptual dysphonia severity (Grade, Roughness, Breathiness, Asthenia, Strain), and medical voice diagnosis. Results Ninety-five patients were enrolled in the study. Voice therapy initiation rate was 70%. Having fewer school-aged children (5-18 years) in the household was significantly different between the group that initiated voice therapy and the group that did not (P = 0.048). There was no difference between groups for all other factors. Conclusions This investigation suggests that household composition, specifically having fewer school-aged children in the household, may predict initiation of voice therapy. This study confirms in a prospective fashion the absence of relationship between voice therapy initiation and most patient- and disease-related factors. Therapeutic alliance should be further investigated for its ability to predict voice therapy initiation using a measure that is validated for the population of patients with dysphonia.

OBJECTIVES This study aims to report on the effectiveness of voice rehabilitation following radiotherapy for laryngeal cancer in a long-term perspective, i.e., up to three years after completion of radiotherapy. METHODS The study included a total of 74 patients that were randomised into an intervention group (n = 37) or a control group (n = 37). Voice recordings with blinded assessment of voice quality with the GRBAS protocol (Grade, Roughness, Breathiness, Asthenia, Strain) and acoustic analysis was performed at baseline, 12 and 36 months following radiotherapy. Voice rehabilitation was performed in 10 sessions immediately following completion of radiotherapy. Patients also filled out the Swedish Self-Evaluation of Communication Experiences after Laryngeal cancer. RESULTS The S-SECEL demonstrated statistically significant improvements in the intervention group when comparing baseline and 36 months, and no changes in the control group. Acoustic measures did not reveal any significant changes. The perceptual analysis demonstrated that when comparing the changes within the groups between baseline and 36 months there were statistically significant differences between the intervention and control group regarding the voice qualities Roughness, Breathiness and Strain. In the control group, 50% demonstrated deterioration in roughness, while in the intervention group only 7% deteriorated during this time. In Breathiness and Strain, 57 and 50%, respectively, improved in the intervention group, while only 32% and 23% improved, respectively, in the control group. CONCLUSION Voice rehabilitation following radiotherapy for laryngeal cancer demonstrate positive effects in patient reported outcomes and perceptual measures of voice quality, and the effects remain up to three years following radiotherapy.

Objectives/hypothesis To compare the 12-month evolution of voice quality outcomes in patients who benefited from types 1-2 transoral CO2 laser cordectomy (TLC) for an early-stage vocal fold squamous cell carcinoma (VFSCC). Study design Prospective uncontrolled study. Methods Sixty patients with cT1 VFSCC were consecutively recruited from a single medical center. Thirty patients benefited from type 1 TLC, while type 2 TCL was performed in 30 patients. The following voice quality outcomes were evaluated at baseline, 3-, 6-, and 12-month post-TLC: voice handicap index (VHI), GRBAS, speech rate, maximum phonation time (MPT), and acoustic parameters. Voice quality evolution was compared between type 1 and type 2 TLC. Results Fifty-seven patients completed the evaluations. Type 1 TLC patients reported significant improvements of VHI, grade of dysphonia, and breathiness at 3-, 6-, and 12-month post-TLC. Speech rate and jitter values improved 6- and 12-month post-TLC. A few voice quality outcomes reported 3- or 6-month post-TLC improvements in type 2 TLC group, while VHI, grade of dysphonia improved at 6- and 12-month post-TLC. MPT significantly decreased at 6- and 12-month post-TLC, while there were no acoustic measurement changes in type 2 TLC. Conclusions The effect of TLC on voice quality may depend on the type of TLC. Type 1 TLC was associated with faster voice quality improvements compared with type 2 TLC. VHI and dysphonia grade were identified as the most relevant tool of voice changes irrespective to the TLC type. Level of evidence 3 Laryngoscope, 2021.

This paper examines the history of aspiration in Eastern Balochi and aims to posit the course of its development and the extent to which it can be said to be contrastive. It uses primary data obtained by the author directly from various locales and compares sets of these data with the secondary data available on Balochi from 19th and early 20th century material. I maintain that, historically, voiceless aspiration arose word-initially in Eastern Balochi, in the sounds /p t č k/, and spread from there to other positions. In the discussion of aspiration, literature on Balochi has seen the question of influence from the neighbouring Indo-Aryan languages as an important problem. In this paper it is argued that equally relevant to the issue are two other important historical phenomena: post-vocalic lenition of stops and affricates, and gemination, a widely found but less well explored feature of Balochi. Also observed in Eastern Balochi, but less frequently remarked upon, is the breathiness found in voiced stops and affricate, a feature hitherto understood to be restricted to a small lexicon borrowed from Indo-Aryan. Focusing on a large number of Eastern Balochi varieties rather than seeing it as a unified whole, I attempt to show that contrastive status of aspiration appears to be gradually developing in these varieties. Many processes are leading in this direction, such as degemination and fortition of fricatives; among these one important diagnostic for the ultimate status of aspiration, I propose, is the transposition of glottal fricative.

Professional voice users form an increasing part of our population. Physical fitness instructors listed as professional voice users are at risk for voice problem as they perform vigorous exercises, instruct at the same time and compete vocally with loud background music. Hence, there is a dire need to study the voice problems in this population. The current study was aimed at investigating the phonatory and respiratory functions in physical fitness instructors in comparison to a control group.Cross-sectional study design MATERIALS AND METHODS: Fifty physical fitness instructors (48 males and two females) and 50 controls (45 males and five females) with the age range of 18-40 years were initially enrolled in the study. The phonatory function measures (perceptual, physiological, and acoustic) and respiratory function measures (aerodynamics) were obtained.Following the data analysis only for male participants, the majority of the perceptual parameters such as grade, roughness, breathiness, and strain showed significant increase in the clinical group compared to controls (P0.05). Similarly, few acoustic parameters such as fundamental frequency (FFew perceptual and acoustic parameters are sensitive in differentiating the voice problems in physical fitness instructors from the controls. The significant perceptual and acoustic parameters implied that they are at risk for developing voice problems. Hence, early identification and prevention of voice problems in this population is warranted.

Summary Objectives The objective of this study was to present a novel surgical technique involving the use of a “bipedicled vocal fold mucosal flap” to repair a mucosal defect and to evaluate the outcomes of patients in whom it was used. Material and methods This was a retrospective study of 6 clinical cases. All patients underwent surgery between November 2000 and July 2018, and all procedures were performed by the same surgeon. For the auditory-perceptual assessment, the Grade-Roughness-Breathiness-Asthenia-Strain hoarseness scale was used. We based the stroboscopic evaluation on the European Laryngological Society protocol, analyzing the parameters glottal closure, mucosal wave, and phase symmetry. Results Ages at the time of surgery ranged from 10 to 52 years, and all of the patients were male. Preexisting vocal fold lesions included polyps, cysts, a sulcus, and mucosal bridges. Among the stroboscopic parameters, only the mucosal wave differed significantly between the preoperative and postoperative periods (P = 0.046). There were also significant postoperative improvements in the overall grade of dysphonia (P = 0.025) and in the degree of breathiness (P = 0.025). Conclusions The use of a bipedicled vocal fold mucosal flap appears to promote significant improvements in the mucosal wave and in voice quality. In the patients evaluated here, the technique was used without preoperative planning. However, it proved to be a safe and appropriate means of repairing mucosal defects in the vocal folds, with the potential to preserve rheological properties and promote healing with less chance of fibrosis.

Summary Objective This study compared the voice outcomes of selected patients with unilateral vocal fold palsy (UVFP) who underwent either nonselective laryngeal reinnervation (LR) or Type 1 thyroplasty (thyroplasty) in a Malaysian tertiary centre using multidimensional voice assessments. Participants The study included 16 patients with UVFP who underwent either LR (9 patients) or thyroplasty (7 patients) between 2015 and 2018 who fulfilled the inclusion criteria. Main Outcome Measures The outcomes were measured subjectively and objectively with: (1) voice handicap index-10 (VHI-10- Malay version); (2) auditory perceptual evaluation using the breathiness component of Grade, Roughness, Breathiness, Asthenia, Strain scale; (3) maximum phonation time (MPT); and (4) acoustic analysis (jitter%, shimmer%, and NHR) using OperaVOXTM. The outcomes were measured at baseline, 6 and 12-months postoperative. The comparison of outcomes between pre and postoperative of each group was evaluated using one-way ANOVA test. Mann-Whitney test was used to compare the outcomes between the two groups. Results Comparison of each group at different time points showed significant improvement of VHI-10 and MPT of LR group between baseline and 12 months (P ≤ 0.05) whereas, the improvement in thyroplasty group was observed at all time points (P ≤ 0.05). When comparing between the two groups at 12 months, the VHI-10 and MPT was significantly better in the LR group than thyroplasty group with P = 0.004 and P = 0.001 respectively. Other outcome measures did not reveal significant difference between the two groups. Conclusion This observational study showed that LR may be better than thyroplasty in improving VHI-10 and MPT in selected patients with UVFP.

Sarcasm, a form of nonliteral language and a subtype of verbal irony, refers to the use of words that mean the opposite of what is intended and express negative attitudes toward persons or events. Sarcasm is prevalent in everyday conversation and the appropriate understanding of the speaker's intent is crucial for successful communication. This study investigated voice qualities associated with sarcastic and literal utterances using listeners’ ratings and acoustic analyses. Listeners’ ratings and acoustic analyses showed that acoustic profiles associated with sarcasm in different languages (English and Korean) are different. Listeners’ ratings revealed that nasal, breathy, and pharyngealized voice quality are associated with sarcastic utterances. Acoustic analyses showed that jitter and harmonics-to-noise ratio were significantly different between sarcastic and literal utterances. Correlation between listeners’ ratings and acoustic analyses were seen in Korean. The results support that specific voice qualities were associated with sarcastic utterances. The results also suggested the interplay of multiple vocal qualities to denote sarcasm. Acoustic analyses and perceptual ratings were found to be complementary in investigating voice quality associated with sarcasm.

Purpose The purpose of this study was to determine concurrent validity of the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) auditory-perceptual scales in children with voice disorders. A secondary purpose was to determine correlation between the GRBAS, CAPE-V, and objective voice measures. Method GRBAS and CAPE-V ratings and acoustic and aerodynamic measures were collected from the University of Wisconsin–Madison Voice and Swallow Outcomes Database. Correlations between CAPE-V and GRBAS ratings were calculated for overall severity of dysphonia, roughness, breathiness, and strain. Correlations between auditory-perceptual voice ratings and objective voice measures were also examined. Results One hundred thirty GRBAS and CAPE-V auditory-perceptual ratings were significantly correlated for overall severity, roughness, breathiness, and strain. r 2 values were highest for overall severity of dysphonia ( r 2 = .75) and lowest for strain ( r 2 = .54). CAPE-V and GRBAS ratings were largely associated with similar acoustic and aerodynamic measures. The highest correlations were observed for auditory-perceptual ratings of breathiness and jitter% (CAPE-V r 2 = .44, GRBAS r 2 = .44), shimmer% (CAPE-V r 2 = .45, GRBAS r 2 = .45), noise-to-harmonic ratio (CAPE-V r 2 = .42, GRBAS r 2 = .40), fundamental frequency (CAPE-V r 2 = .47, GRBAS r 2 = .44), and maximum phonation time (CAPE-V r 2 = .56, GRBAS r 2 = .51). Akaike information criterion values indicated that CAPE-V ratings were more strongly correlated with objective voice measures than GRBAS ratings. Conclusions CAPE-V and GRBAS scales have concurrent validity in children with voice disorders. CAPE-V ratings are more strongly correlated with acoustic and aerodynamic voice measures.

To assess the concurrent validity and the diagnostic accuracy of the Acoustic Breathiness Index (ABI) in Brazilian Portuguese.The counting numbers 1-20 and the vowel /a/ of 150 subjects were recorded (37 vocally healthy and 113 with dysphonia). The analyzed samples were the counting number 1-11 and 3 s of the sustained vowel. Nine voice specialists performed the perceptual judgment of the degree of breathiness. The Spearman Correlation and the receiver operating characteristic (ROC) curve were used to assess ABI's concurrent validity and diagnosis accuracy.Results from five listeners were chosen for the study analyses due to moderate and substantial intra-rater reliability (Cohen's Kappa values = 0.520-0.772) and moderate inter-rater reliability (Fleiss Kappa = 0.353). The ABI presented a high concurrent validity (The ABI is a valid tool for screening and patient's follow-up regarding breathy vocal qualities in the Brazilian Portuguese language.

This paper presents a study of the approaches in the state-of-the-art in the field of pathological speech signal analysis with a special focus on parametrization techniques. It provides a description of 92 speech features where some of them are already widely used in this field of science and some of them have not been tried yet (they come from different areas of speech signal processing like speech recognition or coding). As an original contribution, this work introduces 36 completely new pathological voice measures based on modulation spectra, inferior colliculus coefficients, bicepstrum, sample and approximate entropy and empirical mode decomposition. The significance of these features was tested on 3 (English, Spanish and Czech) pathological voice databases with respect to classification accuracy, sensitivity and specificity., Comment: 41 pages, published in Neurocomputing, Volume 167, 2015, Pages 94-111, ISSN 0925-2312

Background The evaluation of voice quality with acoustic measurements is useful to objectify the diagnostic process. Particularly, breathiness was highly evaluated and the Acoustic Breathiness Index (ABI) might have promising features. Objective of review The goal of the present meta-analysis is to quantify, from existing cross-validation studies, the evidence for the diagnostic accuracy of ABI, including its sensitivity and specificity. Type of review Meta-analysis. Search strategy We searched in MEDLINE, Google Scholar and Science Citation Index, and as manual search for the term Acoustic Breathiness Index from inception to February 2020. Studies were included that used equal proportion of continuous speech and sustained vowel segments, a recording hardware with a sufficient standard for voice signal analyses, the software Praat for signal processing and the customised Praat script, and two groups of subjects (vocally healthy and voice-disordered). Furthermore, the diagnostic accuracy of ABI was measured. Evaluation method The primary outcome variable was ABI. The score ranged from 0 to 10 with varying thresholds according to different languages to determine the absence or presence of breathiness. A meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses of diagnostic test accuracy study guidelines. Data were extracted, and the risk of bias was assessed using the QUADAS-2 tool. The pooled sensitivity and specificity of ABI were determined using a summary receiver operating characteristic (SROC) approach to calculate also a weighted threshold value of ABI with its sensitivity and specificity. Results A total of 34 unique citations were screened, and 10 full-text articles were reviewed, including six studies. In total, 3603 voice samples were considered for further analysis separating into 467 vocally healthy and 3136 voice-disordered voice samples. The pooled sensitivity was 0.84 (95% CI, 0.83-0.85), and the pooled specificity was 0.92 (95% CI, 0.89-0.94). The area under the curve of the SROC curve of this analysis showed an excellent value of 0.94. The weighted ABI threshold was determined at 3.40 (sensitivity: 0.86, 95% CI, 0.84-0.87.; specificity: 0.90, 95% CI 0.88-0.92). Conclusions The results confirm the ABI as robust and valid objective measure for evaluating breathiness.

Purpose Semi-occluded vocal tract (SOVT) exercises with tubes or straws have been widely used for a variety of voice disorders. Yet, the effects of longer periods of SOVT exercises (lasting for weeks) on the aging voice are not well understood. This study investigated the effects of a 6-week straw phonation in water (SPW) exercise program. Method Thirty-seven elderly subjects with self-perceived voice problems were assigned into two groups: (a) SPW exercises with six weekly sessions and home practice (experimental group) and (b) vocal hygiene education (control group). Before and after intervention (2 weeks after the completion of the exercise program), acoustic analysis, auditory–perceptual evaluation, and self-assessment of vocal impairment were conducted. Results Analysis of covariance revealed significant differences between the two groups in smoothed cepstral peak prominence measures, harmonics-to-noise ratio, the auditory–perceptual parameter of breathiness, and Voice Handicap Index-10 scores postintervention. No significant differences between the two groups were found for other measures. Conclusions Our results supported the positive effects of SOVT exercises for the aging voice, with a 6-week SPW exercise program being a clinical option. Future studies should involve long-term follow-up and additional outcome measures to better understand the efficacy of SOVT exercises, particularly SPW exercises, for the aging voice.

Both in speech and singing, humans are capable of generating sounds of different phonation types (e.g., breathy, modal and pressed). Previous studies in the analysis and classification of phonation types have mainly used voice source features derived using glottal inverse filtering (GIF). Even though glottal source features are useful in discriminating phonation types in speech, their performance deteriorates in singing voice due to the high fundamental frequency of these sounds that reduces the accuracy of source-filter separation in GIF. In the present study, features describing the glottal source were computed using three signal processing methods that do not compute source-filter separation. These three methods are zero frequency filtering (ZFF), zero time windowing (ZTW) and single frequency filtering (SFF). From each method, a group of scalar features were extracted. In addition, cepstral coefficients were derived from the spectra computed using ZTW and SFF. Experiments were conducted with the proposed features to analyse and classify phonation types using three phonation types (breathy, modal and pressed) for speech and singing voice. Statistical pair-wise comparisons between the phonation types showed that most of the features were capable of separating the phonation types significantly for speech and singing voices. Classification with support vector machine classifiers indicated that the proposed features and their combinations showed improved accuracy compared to usually employed glottal source features and mel-frequency cepstral coefficients (MFCCs).

Chichimec (Otomanguean) has two tones, high and low, and a phonological three-way phonation contrast: modal /V/, breathy /V¨/, and creaky /Ṽ/. Tone and phonation type contrasts are used independently. This paper investigates the acoustic realization of modal, breathy, and creaky vowels; the timing of phonation in non-modal vowels; and the production of tone in combination with different phonation types. The results of cepstral peak prominence and three spectral tilt measures showed that phonation type contrasts are not distinguished by the same acoustic measures for women and men. In line with expectations for laryngeally complex languages, phonetic modal and non-modal phonation are sequenced in phonological breathy and creaky vowels. With respect to the timing pattern, however, the results show that non-modal phonation is not, as previously reported, mainly located in the middle of the vowel. Non-modal phonation is, instead, predominantly realized in the second half of phonological breathy and creaky vowels. Tone is distinguished in all three phonation types, and non-modal vowels do not exhibit distinct F0 ranges except for creaky vowels produced by women in which F0 declines in the creaky portion. The results of the acoustic analysis provide additional insights to phonological accounts of laryngeal complexity in Chichimec.

Potential differences between homosexual and heterosexual men have been studied on a diverse set of social and biological traits. Regarding acoustic features of speech, researchers have hypothesized a feminization of such characteristics in homosexual men, but previous investigations have so far produced mixed results. Moreover, most studies have been conducted with English-speaking populations, which calls for further cross-linguistic examinations. Lastly, no studies investigated so far the potential role of testosterone in the association between sexual orientation and speech acoustic features. To fill these gaps, we explored potential differences in acoustic features of speech between homosexual and heterosexual native French men and investigated whether the former showed a trend toward feminization by comparing theirs to that of heterosexual native French women. Lastly, we examined whether testosterone levels mediated the association between speech acoustic features and sexual orientation. We studied four sexually dimorphic acoustic features relevant for the qualification of feminine versus masculine voices: the fundamental frequency, its modulation, and two understudied acoustic features of speech, the harmonics-to-noise ratio (a proxy of vocal breathiness) and the jitter (a proxy of vocal roughness). Results showed that homosexual men displayed significantly higher pitch modulation patterns and less breathy voices compared to heterosexual men, with values shifted toward those of heterosexual women. Lastly, testosterone levels did not influence any of the investigated acoustic features. Combined with the literature conducted in other languages, our findings bring new support for the feminization hypothesis and suggest that the feminization of some acoustic features could be shared across languages.

OBJECTIVES In case of insufficient voice improvement after injection laryngoplasty (IL), additional IL will be one of the next option of treatments. However, little is known about the voice outcomes regarding an additional IL. STUDY DESIGN Retrospective comparative study in single institution. METHODS We enrolled the patients of unilateral vocal fold paralysis (UVFP), who received IL (N = 76) twice because of insufficient voice improvement. The etiologies of UVFP were related with thoracic and esophageal surgery (51.3%), neck surgery (30.3%), skull base surgery (7.9%), or unknown (10.5%). The subjective and objective voice parameters were collected before and after (mean: 5.3 months) each IL. RESULTS Aspiration, maximum phonation time (MPT), jitter percentage, shimmer percentage, and noise to harmonic ratio (NHR) were significantly improved after both the first and second rounds of IL (P

Summary Objectives. The objective of this study was to investigate the ability of a two-stage method of cepstral peak identification to effectively discriminate rough vs breathy vs typical voice in sustained vowel productions. It was hypothesized that a dual-stage search for cepstral peak prominences (CPP's) above and below specified quefrency/F0 cutoffs would result in a CPP difference that would be characteristic of the rough, diplophonic voice type. Methodology. Central one-second portions of sustained vowel /a/ productions were obtained from 90 subjects (rough, breathy, and normophonic voices). All voice samples were analyzed using a a two-stage cepstral analysis process in which a CPP H i g h − L o w difference value was obtained by identifying cepstral peaks above and below a lower limit for expected F0 (150 Hz for females and 90 Hz for males), called CPPHigh and CPPLow respectively. Results. The CPP H i g h − L o w difference value was observed to be a highly significant predictor, with negative values for this parameter characteristic of a dominant subharmonic in the voice signal and the perception of diplophonic, rough voice. Correct classification of rough vs nonrough voice samples was 82.2% (sensitivity 0.80 and specificity 0.833). In the consideration of three group classification (breathy vs. normophonic vs. rough), models incorporating two predictors (the CPP obtained from a single search through a 60 to 300 Hz frequency range (CPPDefault) and the CPP H i g h − L o w difference value) correctly classified 78.88% of the voice samples. Conclusions. Rough, diplophonic voices were consistently observed to have a subharmonic peak that was greater in amplitude than the cepstral peak obtained within the region of the expected F0, resulting in a negative value for the CPP H i g h − L o w difference. The two-stage cepstral analysis process described herein is visually intuitive from the graphical display of a cepstrum and is a simple extended calculation derived from cepstral analysis procedures that have been recommended as essential in the acoustic description of vocal quality.

To analyze the immediate effects of voiced high-frequency oscillation (VHFO) and Lax Vox technique on vocal quality and self-reported intensity of vocal and laryngeal symptoms in individuals with behavioral dysphonia.This experimental, prospective, randomized cross-over study, investigated thirty adults (15 women and 15 men) with behavioral dysphonia (vocal complaints, altered voice on auditory-perceptual evaluation, vocal nodules or mucosal thickening, and incomplete glottic closure). The outcome variables analyzed were auditory-perceptual analysis, acoustic analysis (voice quality characteristics), and self-reported intensities of vocal and laryngeal symptoms. Each participant performed two exercises-VHFO and Lax Vox technique-in a random sequence for 3 minutes. A 7-day washout period was provided between the exercises. The data were analyzed using the paired t-test and Wilcoxon test (P0.05).After VHFO, no significant difference was observed on auditory-perceptual evaluation in all participants, whereas the Lax Vox technique worsened breathiness among women (P = 0.027). VHFO significantly increased the fundamental frequency (P = 0.014) and decreased the noise harmonic ratios for women (P = 0.026). Among men, there was a decrease in shimmer parameter (P = 0.035). Moreover, symptoms such as "lump in the throat" (P = 0.005), "voice loss" (P = 0.017), and "high-pitched voice" (P = 0.023) decreased in women after VHFO, whereas in men, "itchiness" and "hoarseness" (P0.001) decreased after VHFO. The Lax Vox technique decreased "hoarseness" (P = 0.003) in women, without any effect in men.The VHFO exercise provided more positive immediate effects results than the Lax Vox technique regarding vocal quality and self-reported symptom intensity in participants with behavioral dysphonia.

BackgroundDisorders of voice can limit an individual's participation and impair social interaction, thus affecting overall quality of life. Perceptual and objective evaluations can provide the clinician with detailed information regarding voice disorders.MethodsThis study comprised 40 subjects aged 34–46 years, 20 of whom (10 male, 10 female) had unilateral vocal fold palsy. Data were obtained for all participants from: the Voice Handicap Index, the grade, roughness, breathiness, asthenia and strain (‘GRBAS’) scale, acoustic voice analysis, electroglottography, and voice range profiles.ResultsThe voice evaluations revealed statistically significant (p< 0.05) differences between the controls and study group, both in males and females, pre- and post-therapy.ConclusionDespite the normalisation of vocal parameters, acoustic, perceptual and self-rated assessments revealed statistically significant differences after therapy. Hence, acoustic measures, namely electroglottographic perturbation, and voice frequency and intensity range, are recommended prior to termination of therapy.

Voice change is one of the major symptoms in patients with vocal fold polyp. As a result, phonomicrosurgery is commonly required in these patients. Since voice outcomes after polyp treatment can be variable according to polyp characteristics, we aimed to investigate the predicting factors of postoperative voice improvements in terms of polyp characteristics in patients with vocal fold polyp who underwent cold knife surgery.A total of 77 patients who were diagnosed with vocal fold polyp and underwent phonomicrosurgery with cold knife instruments. The polyp characteristics of color, size, shape, and location were evaluated at baseline. Acoustic and aerodynamic analyses, voice handicap index questionnaire and grade, roughness, breathiness, asthenia, strain scale were evaluated at baseline and 6 weeks after surgery.All values of postoperative voice parameters improved after cold knife surgery. (P0.05) In patient with an organized vocal fold polyp, less improvement in postoperative values of maximum phonation time were observed. (P0.05) Likewise, less improvement of voice handicap index questionnaire score and grade, roughness, breathiness, asthenia, strain scale after surgery was shown in organized vocal fold polyp. (P0.05) CONCLUSIONS: Among the various polyp characteristics, the organized polyp was significantly related to relatively less improvement of objective and subjective voice parameters after surgery. These polyp characteristics would help to predict postoperative voice improvement and plan for personalized treatment in patients with vocal fold polyp.

Voice plays an important role in online communications by increasing intimacy among people. Despite the advantages of using voice in computer-mediated communications (CMC), it is difficult for people with speech or hearing impairments to participate in such communication methods. In this study, we investigate different attributes of voices and how it affects users’ preference. We also deployed a website called ‘Voice Creator’ for people who want to create an online voice by specifying the levels of different voice attributes: gender, age group, breathiness, smoothness, hoarseness, and variation. We plan to conduct a user study on the target users and study the behavior of voice customization in future work.

Introduction Dysphonia and laryngeal problems are some of the manifestations of the COVID-19 pandemic due to respiratory disease as a primary effect of COVID-19. The aim of the present study was to investigate voice quality and vocal tract discomfort symptoms in patients with COVID-19. Materials and Methods Forty-four COVID-19 patients with a mean age of 49.61 ± 16.48 years and 44 healthy subjects with a mean age of 48.52 ± 13.8 years participated in the study. The voice quality of the participants was evaluated using auditory-perceptual evaluation with the GRBAS scale. The vocal tract discomfort symptoms of the participants were assessed using the Persian version of the VTD scale. Results Patients with COVID-19 had higher scores in all items of the GRBAS, including grade, roughness, breathiness, asthenia, and strain, than healthy subjects, and these differences were statistically significant (p < 0.05). Among the GRBAS parameters, grade had the highest effect size and asthenia had the lowest effect size in both speech tasks. The COVID-19 patients had a greater frequency of vocal tract discomfort symptoms than healthy subjects in all items of the VTDp scale and these differences were statistically significant (p < 0.05) in the following items: burning, tight, dry, pain, sore, irritable, and lump in the throat. The most and the least effect size in frequency of the vocal tract discomfort symptoms were related to dry (d = 1.502) and tickling (d = 0.157), respectively. Also, COVID-19 patients had more significant severity in all items of the VTDp scale except tight and tickling. The most and the least effect size in severity of the vocal tract discomfort symptoms was related to dry (d = 1.416) and tickling (d = 0.152), respectively. Conclusion The present study suggests that COVID-19 patients have more deviations in voice quality than healthy subjects. Moreover, mild vocal tract discomfort is prevalent in patients with COVID-19, and patients have more frequent and severe physical discomforts of the vocal tract than healthy subjects.

Purpose This study assessed the reliability and accuracy of auditory-perceptual voice evaluations by experienced clinicians via telepractice platforms. Method Voice samples from 20 individuals were recorded after transmission via telepractice platforms. Twenty experienced clinicians (10 speech-language pathologists, 10 laryngologists) evaluated the samples for dysphonia percepts (overall severity, roughness, breathiness, and strain) using a modified Consensus Auditory-Perceptual Evaluation of Voice. Reliability was calculated as the mean of squared differences between repeated ratings (intrarater agreement), and between individual and group mean ratings (interrater agreement). Repeated measures analyses of variance were constructed to measure effects of transmission condition (e.g., original recording, WebEx, Zoom), dysphonia percept, and their interaction on intrarater agreement, interrater agreement, and average ratings. Significant effects were evaluated with post hoc Tukey's tests. Results There were significant effects of transmission condition, percept, and their interaction on average ratings, and a significant effect of percept on interrater agreement. Post hoc testing revealed statistically, but not clinically, significant differences in average roughness ratings across transmission conditions, and significant differences in interrater agreement for several percepts. Overall severity had the highest agreement and strain had the lowest. Conclusion Telepractice transmission does not substantially reduce reliability or accuracy of auditory-perceptual voice evaluations by experienced clinicians.

International audience; Voice quality is known to be an important factor for the characterization of a speaker's voice, both in terms of physiological features (mainly laryngeal and supralaryngeal) and of the speaker's habits (sociolinguistic factors). This paper is devoted to one of the main components of voice quality: phonation type. It proposes neural representations of speech followed by a cascade of two binary neural network-based classifiers, one dedicated to the detection of modal and nonmodal vowels, and one for the classification of nonmodal vowels into creaky and breathy types. This approach is evaluated on the spontaneous part of the PTSVOX database, following an expert manual labelling of the data by phonation type. The results of the proposed classifiers reaches on average 85 % accuracy at the framelevel and up to 95 % accuracy at the segment-level. Further research is planned to generalize the classifiers on more contexts and speakers, and thus pave the way for a new workflow aimed at characterizing phonation types.

International audience; Objectivesthis study concerns the subjective perception of the quality of the voice, more particularly in the case of dysphonia. Our general objective is to study the perceptual mechanisms, which constitute Hirano's GRBAS multidimensional perceptual rating scale.Material and methodsWe tested the reliability of the GRB perceptual scale both in terms of test-retest reliability (intra-listener stability) and in terms of inter-listener agreement. We also studied how listeners process the three different parameters of the scale by varying the perceptual rating conditions of G, R, and B. The three attributes were rated simultaneously in one condition and in isolation in a second condition. The experiment was based on texts read by fifty dysphonic speakers. We selected five listeners specialized in voice assessment to provide perceptual judgments of the voices.Results and conclusionsOur results show that G is strongly correlated with R and/or B. When the GRB rating process is simultaneous, G is almost equal to the maximum score assigned to the R and/or B parameter (R² = 0.97). Conversely, R and B are poorly correlated. While intra-listener variability was limited, inter-judge variability was important even in a homogeneous panel of judges.Perceptual evaluation of dysphonia—Voice quality—GRBAS—Perception—Perceptual agreement

Summary Objective The aim of the present study was to investigate the performance of the Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) in synthesized voice samples. Method The validity of the AVQI and ABI performances was analyzed in synthesized voice samples controlling the degree of predefined deviations for overall voice quality (G-scale) and breathiness (B-scale). A range of 26 synthesized voice samples with various severity degrees in G-scale with and without prominence of breathiness for male and female voices were created. Results ABI received higher validity in the evaluation of breathiness than AVQI. Furthermore, ABI evaluated accurately breathiness degrees without considering roughness effects in voice samples and confirmed the findings of other studies with natural voices. Furthermore, ABI was more robust than AVQI in the evaluation of severe voice-disordered voice samples. Finally, AVQI represented moreover overall voice quality with an emphasis of breathiness evaluation and less roughness although roughness had a necessary component in overall voice quality evaluation. Conclusion AVQI and ABI are two robust measurements in the evaluation of voice quality. However, ABI received fewer errors than AVQI in the analyses of higher abnormalities in the voice signal. Disturbances of other subtypes of abnormal overall voice quality such as roughness were not demonstrated in the results of ABI.

Summary Objective To discuss the utility and outcomes of bilateral myoneurectomy for treatment of abductor spasmodic dysphonia. Methods Bilateral myoneurectomy is a known treatment option for patients with adductor spasmodic dysphonia. Its use for treatment of abductor spasmodic dysphonia, however, has not been documented previously. In this case report, treatment and long-term outcomes of abductor spasmodic dysphonia with bilateral myoneurectomy are discussed. Results A 50-year-old male presented with abductor spasmodic dysphonia. His initial Voice Handicap Index-10 (VHI-10) score was 29, and he had breathy breaks during 60 series. He had no improvement in vocal quality after 6 botulinum toxin injections over 21 months. He underwent staged bilateral posterior cricoarytenoid partial myoneurectomy, with the left posterior cricoarytenoid myoneurectomy performed 33 months after presentation and right posterior cricoarytenoid myectomy 11 months later. Eight years postoperatively, his VHI-10 score was 12. During postoperative 60 series, the patient demonstrated few breathy breaks. Overall, the patient reports improved quality of life and satisfaction with his voice. Conclusion This is the first report of a long-term follow-up data for bilateral, endoscopic, partial posterior cricoarytenoid muscle myoneurectomy to treat refractory abductor spasmodic dysphonia. Long-term VHI-10 results suggest improvement of symptoms, despite mild difficulty with 60 series. While botulinum toxin therapy is the mainstay of management for abductor spasmodic dysphonia, surgical treatment is a potential alternative at least for refractory cases.

Pediatric dysphonia is common; however, not all vocal fold pathology in children is due to nodules. Laryngeal stroboscopy (transoral or transnasal) often is essential for the diagnosis of other not-nodule lesions. As in adults, multidisciplinary care with a speech language pathologist helps with patient buy-in for therapy. Breathy dysphonia due to glottic incompetence may be related to vocal fold movement impairment (VFMI) or posterior glottic insufficiency. There are several medialization procedures available for children with VFMI due to recurrent laryngeal nerve injury.