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Purpose The purpose of this study was to obtain a more comprehensive understanding of the pathophysiology and impact on daily voice use of nonphonotraumatic vocal hyperfunction (NPVH). Method An ambulatory voice monitor collected 1 week of data from 36 patients with NPVH and 36 vocally healthy matched controls. A subset of 11 patients with NPVH were monitored after voice therapy. Daily voice use measures included neck-skin acceleration magnitude, fundamental frequency ( f o ), cepstral peak prominence (CPP), and the difference between the first and second harmonic magnitudes (H1–H2). Additional comparisons included 118 patients with phonotraumatic vocal hyperfunction (PVH) and 89 additional vocally healthy controls. Results The NPVH group, compared to the matched control group, exhibited increased f o (Cohen's d = 0.6), reduced CPP ( d = −0.9), and less positive H1–H2 skewness ( d = −1.1). Classifiers used CPP mean and H1–H2 mode to maximally differentiate the NPVH and matched control groups (area under the receiver operating characteristic curve of 0.78). Classifiers performed well on unseen data: the logit decreased in patients with NPVH after therapy; ≥ 85% of the control and PVH groups were identified as “normal” or “not NPVH,” respectively. Conclusions The NPVH group's daily voice use is less periodic (CPP), is higher pitched ( f o ), and has less abrupt vocal fold closure (H1–H2 skew) compared to the matched control group. The combination of CPP mean and H1–H2 mode appears to reflect a pathophysiological continuum in NPVH patients of inefficient phonation with minimal potential for phonotrauma. Further validation of the classification model is needed to better understand potential clinical uses. Supplemental Material https://doi.org/10.23641/asha.14390771

Summary Background In addition to language differences in fundamental frequency between bilinguals and monolinguals, studies have also included other acoustic parameters to analyze differences in voice production associated with the language spoken. Aim To identify differences in voice acoustic parameters during English productions between monolingual and bilingual English speakers. Method Exploratory cross-sectional study with two groups of subjects: monolingual English speakers (n = 40), and bilingual English-Spanish speakers (n = 13). Participants filled out a questionnaire and recorded one reading in English (second sentence of Rainbow passage “The rainbow is a division of white light into many beautiful colors”) under a “virtual-simulated” acoustic condition of No Noise and Medium Reverberation Time (0.8 seconds). Result Analysis by gender shows that monolingual speakers had higher fundamental frequency mode, and lower standard deviation of fundamental frequency compared to bilingual English-Spanish speakers. Bilingual male speakers had higher jitter and harmonics-to-noise ratio than monolingual speakers. On the contrary, female bilingual speakers had lower jitter and shimmer than monolingual speakers. Conclusions Speaking a second language may influence voice acoustic parameters, and therefore, should be considered when comparing acoustic speech metrics.

Summary Introduction Computer analysis of voice recordings is an integral part of the evaluation and management of voice disorders. In many practices, voice samples are taken in rooms that are not sound attenuated and/or sound-proofed; further, the technology used is rarely consistent. This will likely affect the recordings, and therefore, their analyses. Objectives The objective of this study is to compare various acoustic outcome measures taken from samples recorded in a sound-proofed booth to those recorded in more common clinic environments. Further, the effects from six different commonly used microphones will be compared. Methods Thirty-six speakers were recorded while reading a text and producing sustained vowels in a controlled acoustic environment. The collected samples were reproduced by a Head and Torso Simulator and recorded in three clinical rooms and in a sound booth using six different microphones. Newer measures (eg, Pitch Strength, cepstral peak prominence, Acoustic Voice Quality Index), as well as more traditional measures (eg Jitter, Shimmer, harmonics-to-noise ratio and Spectrum Tilt), were calculated from the samples collected with each microphone and within each room. Results The measures which are more robust to room acoustic differences, background noise, and microphone quality include Jitter and smooth cepstral peak prominence, followed by Shimmer, Acoustic Voice Quality Index, harmonics-to-noise ratio, Pitch Strength, and Spectrum Tilt. Conclusions The effect of room acoustics and background noise on voice parameters appears to be stronger than the type of microphone used for the recording. Consequently, an appropriate acoustical clinical space may be more important than the quality of the microphone.

Purpose The aim of this study was to use the Daily Phonotrauma Index (DPI) to quantify group-based changes in the daily voice use of patients with phonotraumatic vocal hyperfunction (PVH) after receiving voice therapy as the sole treatment. This is part of an ongoing effort to validate an updated theoretical framework for PVH. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and posttreatment data from 52 female patients with PVH. Normative weeklong data were also obtained from 52 matched controls. Each week was represented by the DPI, which is a combination of neck-surface acceleration magnitude skewness and the standard deviation of the difference between the first and second harmonic magnitudes. Results Compared to pretreatment, the DPI statistically decreased towards normal in the patient group after treatment (Cohen's d = −0.25). The posttreatment patient group's DPI was still significantly higher than the control group ( d = 0.68). Conclusions The DPI showed the pattern of improved ambulatory voice use in a group of patients with PVH following voice therapy that was predicted by the updated theoretical framework. Per the prediction, voice therapy was associated with a decreased potential for phonotrauma in daily voice use, but the posttreatment patient group data were still significantly different from the normative control group data. This posttreatment difference is interpreted as reflecting the impact on voice use of the persistence of phonotrauma-induced structural changes to the vocal folds. Further validation of the DPI is needed to better understand its potential clinical use.

Summary Introduction Vocal loading tasks (VLTs) help researchers gather acoustic measurements and understand how a healthy speaker adjusts their voice in response to challenges. There is a dearth of evidence measuring the impact of speaking rate in VLTs on acoustic voice parameters and vocal fatigue. Objectives In the present study, the relationships between acoustic voice parameters and self-reported vocal fatigue were examined through an experimental VLT. Methods 38 students completed a 45-minute VLT which involved the recording of three randomized reading tasks. The tasks varied by the speed in which the words were presented (slow, medium, fast) on a computer monitor. Vocal fatigue ratings were measured subjectively using a Borg scale and negative adaptations to vocal loading were measured objectively using Sound Pressure Level (SPL, in dBA), fundamental frequency (fo, in semitones), and phonation time (Dt %). Results Analysis indicated that vocal fatigue increases with time, and the slope of this relationship is affected by the speaking rate. SPL and fo increased with speaking rate and the standard deviation of SPL and fo decreased with speaking rate. On average, the male participants’ phonation time values were 7.8% lower than the female participants. The rate of increase of vocal fatigue with time during the experiment was higher in the fast speaking style compared to the slow and medium ones. Conclusion The results provide support that the novel VLT altered multiple vocal parameters to induce measurable changes in vocal fatigue.

SUMMARY Aims (1) Determine the difference in vocal fry phonation in English and Spanish productions among bilingual young adults, (2) Characterize the effect of spoken language and native language on vocal fry production among English-Spanish bilingual speakers, (3) Identify the effect of first and second language knowledge of the listener in the voice perceptual assessment, and (4) Define the effect of the environment of the assessment (in situ vs. online), in the voice perceptual assessment. Method Exploratory cross-sectional study of 34 bilingual (Spanish-English) speakers and six inexperienced listeners. Participating speakers produced two speech samples (one in English and one in Spanish). Six inexperienced monolingual and bilingual listeners performed the voice perceptual assessment of vocal fry, General grade of hoarseness, and Roughness using a 4-point rating scale. Results Bilingual speakers used vocal fry more often when they were speaking in English (around 3%) compared with their production in Spanish (around 2%). Bilingual native English speakers used vocal fry more often during their productions in both languages compared with bilingual native Spanish speakers. Bilingual listeners had the highest agreement when identifying vocal fry in both languages. Conclusions Differences in production of vocal fry between native speakers of American English and native speakers of Spanish may be evidence of transferring of vocal behavior (such as vocal fry) from one language to the second one. In addition, being a bilingual listener may have an important effect on the perceptual identification of voice quality in English and Spanish, as well as vocal fry in English.

Summary Purpose This study aimed to (1) examine the effect of dysphonia and background noise on the identifiability of vowels, and (2) evaluate the relationship between the degree of vowel intelligibility and vowel-related acoustic measurements. Method A speech perception experiment was conducted with speech samples collected from 10 adult females with healthy voices and 10 adult females with dysphonia. The speech material was 11 vowels of American English in /h/-vowel-/d/ format. Cafeteria noise was added to these samples at a signal-to-noise ratio of −6 dB. A total of 10 adults with normal hearing participated in a speech perception experiment, in which the vowels were presented with and without the noise. F1 and F2 frequencies of the vowels were measured, and their relationships with the vowel intelligibility were statistically evaluated. Results The group-level analysis showed that vowel intelligibility was lower in dysphonic speech than normal speech, both in quiet and at signal-to-noise ratio of −6 dB. The intelligibility was higher for the high vowels than the low vowels. In general, the vowel confusion pattern was similar between normal and dysphonic speech. However, data from a speaker with severe diplophonia showed a distinct confusion pattern. Voice quality ratings did not significantly correlate with the vowel intelligibility. There was a significant correlation between F2 and the vowel intelligibility in quiet. A post-hoc acoustic analysis revealed that vowels of the speakers with lower vowel intelligibility had lower acoustic energy above 1 kHz. Conclusion Dysphonia negatively affects vowel intelligibility. Low vowels were more vulnerable to the effect of dysphonia than high vowels. Among different types of dysphonic voice qualities, diplophonia appears to be particularly detrimental to vowel intelligibility. F2 significantly correlated with vowel intelligibility; however, this result requires a careful interpretation. Given that the acoustic energy above 1 kHz resulted in better intelligibility in noise, a treatment strategy that targets this frequency region may help improve intelligibility in noise. Future studies should examine the generalizability of this finding to different age and gender groups, and intelligibility as a whole.

Summary Introduction In classical singing techniques, it is common to manipulate the vocal tract to channel airflow to increase voice quality and volume. Technique varies according to the style of the music, the voice type, and range of a given singer. Although these practices are intentional, fixed physiological aspects of a singer's vocal instrument also play an extremely impactful role in determining voice quality. Objectives In the present study, the relationship between the dimensions of the maxillary dental arch and voice quality were examined in professional singers. Methods The dimensions of the palate were measured from the maxillary dental casts of 14 female singers. Audio recordings were made for the same participants while singing a sustained /a/ singing vowel, a glissando, the song "Are You Sleeping", and a selected song from their personal repertoire. The dimensions of the palate were measured from maxillary dental casts. From the recordings, two parameters were calculated: (1) the Singing Power Ratio (SPR) and (2) A2 A1 ratio. Higher SPR values indicate a stronger ring in the voice, typical of operatic singing style, while higher A2 A1 ratio values are associated with the belting singing style. Results Singers with larger frontal palate depth, smaller posterior palate depth, larger frontal palate width, and smaller posterior palate width seem to be more suitable for an operatic singing style. Singers who had larger overall depth and width of the palate measurements produced an increased second harmonic, typical of the belting style. Conclusions When considering a singer's ability to produce vocalizations successfully, physiological structure is an increasingly important factor. The present study discovered that palate depth and width are associated with statistically significant differences in SPR and A2/A1 parameters. These parameters correlate with two styles of singing, operatic, and belting respectively.

The purpose of this study was to quantify the relationships between voice parameters and room acoustics. A comprehensive literature search was conducted using PubMed/MEDLINE, Science Direct, and Scopus. Several terms regarding self-reported vocal parameters (vocal fatigue, vocal effort, vocal load, and vocal comfort), as well as possible variants, were included in the search. Also, we included different terms related to room acoustic parameters, such as reverberation time, noise conditions, decay times, room sizes, among others. Finally, a focus group of four experts in the field (current authors) worked together to make conceptual connections and quantify the proposed relationship. In total, 26 publications met the criteria for inclusion. The occurrence and frequency of the most common parameters in the literature are presented, and a quantitative summary of their relationships are reported. The most common journals and proceedings that may be involved in this subject are also pointed out. Through a comprehensive literature search, the most relevant parameters reported are Sound Pressure Level and self-reported vocal assessments for voice parameters, and reverberation time and/or noise conditions for room acoustics. These relationships are quantified and reported while maintaining the concepts as stated in the original articles and outlining their similarities.