Effect of Age and Gender on Acoustic Voice Quality Index Across Lifespan: A Cross-sectional Study in Indian Population

Cepstral Peak Prominence Smoothed - CPPS and Acoustic Voice Quality Index - AVQI in healthy and altered children's voices: comparation, relationship with auditory-perceptual judgment and cut-off points

PURPOSE

To compare the acoustic measurements of Cepstral Peak Prominence Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) of children with normal and altered voices, to relationship with auditory-perceptual judgment (APJ) and to establish cut-off points.

METHODS

Vocal recordings of the sustained vowel and number counting tasks of 185 children were selected from a database and submitted to acoustic analysis with extraction of CPPS and AVQI measurements, and to APJ. The APJ was performed individually for each task, classified as normal or altered, and for the tasks together defining whether the child would pass or fail in a situation of vocal screening.

RESULTS

Children with altered APJ and who failed the screening had lower CPPS values and higher AVQI values, than those with normal APJ and who passed the screening. The APJ of the sustained vowel task was related to CPPS and AVQI, and APJ of the number counting task was related only to AVQI and CPPS numbers. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the vowel CPPS, 7.62 for the CPPS numbers and 2.01 for the AVQI.

CONCLUSION

Children with altered voices, have higher AVQI values and lower CPPS values, when detected in children with voices within the normal range. The acoustic measurements were related to the auditory perceptual judgment of vocal quality in the sustained vowel task, however, the number counting task was related only to the AVQI and CPPS. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the CPPS vowel, 7.62 for the CPPS numbers and 2.01 for the AVQI. The three measures were similar in identifying voices without deviation and dysphonic voices.

Accuracy Analysis of the Multiparametric Acoustic Voice Indices, the VWI, AVQI, ABI, and DSI Measures, in Differentiating between Normal and Dysphonic Voices

The study aimed to investigate and compare the accuracy and robustness of the multiparametric acoustic voice indices (MAVIs), namely the Dysphonia Severity Index (DSI), Acoustic Voice Quality Index (AVQI), Acoustic Breathiness Index (ABI), and Voice Wellness Index (VWI) measures in differentiating normal and dysphonic voices. The study group consisted of 129 adult individuals including 49 with normal voices and 80 patients with pathological voices. The diagnostic accuracy of the investigated MAVI in differentiating between normal and pathological voices was assessed using receiver operating characteristics (ROC). Moderate to strong positive linear correlations were observed between different MAVIs. The ROC statistical analysis revealed that all used measurements manifested in a high level of accuracy (area under the curve (AUC) of 0.80 and greater) and an acceptable level of sensitivity and specificity in discriminating between normal and pathological voices. However, with AUC 0.99, the VWI demonstrated the highest diagnostic accuracy. The highest Youden index equaled 0.93, revealing that a VWI cut-off of 4.45 corresponds with highly acceptable sensitivity (97.50%) and specificity (95.92%). In conclusion, the VWI was found to be beneficial in describing differences in voice quality status and discriminating between normal and dysphonic voices based on clinical diagnosis, i.e., dysphonia type, implying the VWI's reliable voice screening potential.

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

OBJECTIVE

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

STUDY DESIGN

Cross-sectional study.

METHODS

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

RESULTS

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

CONCLUSION

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

A Cross-sectional Study of Perceptual and Acoustic Voice Characteristics in Healthy Aging

PURPOSE

The human voice qualitatively changes across the lifespan. Although some of these vocal changes may be pathologic, other changes likely reflect natural physiological aging. Normative data for voice characteristics in healthy aging is limited and disparate studies have used a range of different acoustic features, some of which are implicated in pathologic voice changes. We examined the perceptual and acoustic features that predict healthy aging.

METHOD

Participants (N = 150) aged between 50 and 92 years performed a sustained vowel task. Acoustic features were measured using the Multi-Dimensional Voice Program and the Analysis of Dysphonia in Speech and Voice. We used forward and backward variable elimination techniques based on the Bayesian information criterion and linear regression to assess which of these acoustic features predict age and perceptual features. Hearing thresholds were determined using pure-tone audiometry tests at frequencies 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. We further explored potential relationships between these acoustic features and clinical assessments of voice quality using the Consensus Auditory-Perceptual Evaluation of Voice.

RESULTS

Chronological age was significantly predicted by greater voice turbulence, variability of cepstral fundamental frequency, low relative to high spectral energy, and cepstral intensity. When controlling for hearing loss, age was significantly predicted by amplitude perturbations and cepstral intensity. Clinical assessments of voice indicated perceptual characteristics of speech were predicted by different acoustic features. For example, breathiness was predicted by the soft phonation index, mean cepstral peak prominence, mean low-high spectral ratio, and mean cepstral intensity.

CONCLUSIONS

Findings suggest that acoustic features that predict healthy aging are different than those previously reported for the pathologic voice. We propose a model of healthy and pathologic voice development in which voice characteristics are mediated by the inability to monitor vocal productions associated with age-related hearing loss. This normative data of healthy vocal aging may assist in separating voice pathologies from healthy aging.

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

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

Horses cross-modally recognize women and men

Several studies have shown that horses have the ability to cross-modally recognize humans by associating their voice with their physical appearance. However, it remains unclear whether horses are able to differentiate humans according to different criteria, such as the fact that they are women or men. Horses might recognize some human characteristics, such as sex, and use these characteristics to classify them into different categories. The aim of this study was to explore whether domesticated horses are able to cross-modally recognize women and men according to visual and auditory cues, using a preferential looking paradigm. We simultaneously presented two videos of women and men's faces, while playing a recording of a human voice belonging to one of these two categories through a loudspeaker. The results showed that the horses looked significantly more towards the congruent video than towards the incongruent video, suggesting that they are able to associate women's voices with women's faces and men's voices with men's faces. Further investigation is necessary to determine the mechanism underlying this recognition, as it might be interesting to determine which characteristics horses use to categorize humans. These results suggest a novel perspective that could allow us to better understand how horses perceive humans.

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

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

Voice Quality in Telephone Interviews: A preliminary Acoustic Investigation

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Individual Voice Dimensions' Prediction of Overall Dysphonia Severity on Two Auditory-Perceptual Scales

BACKGROUND

Auditory-perceptual evaluation of dysphonic voice is an essential clinical activity that characterizes the nature of dysphonia and aids in planning its clinical management. Although there are multidimensional acoustic measures that correlate well with overall severity ratings, they tend to include measures that have only small or moderate correlations with individual voice characteristics frequently perceptually measured (e.g., breathiness or roughness). Given this difference between perceptual and acoustic measures, it is unclear how much individual voice characteristics contribute to a listener's perception of overall severity of dysphonia.

PURPOSE

The purpose of this study was to explore individual voice characteristics' relative contribution to the rating of overall dysphonia severity and to explore sex-related differences.

METHOD

Two hundred ninety-six voice samples were accessed from the Perceptual Voice Qualities Database. Roughness, breathiness, asthenia, strain, pitch, and loudness ratings from the Grade, Roughness, Breathiness, Asthenia, Strain and Consensus Auditory-Perceptual Evaluation of Voice scales were used to predict overall voice quality severity in linear regression with bootstrapped coefficients.

RESULTS

Roughness, breathiness, and strain were the strongest predictors of overall severity. Asthenia and, to a lesser extent, pitch were also significant predictors of overall severity. Loudness was not a significant predictor. There were several sex-related differences noted, as well as differences related to the scale used.

CONCLUSIONS

Breathiness, roughness, and strain were all important predictors of overall severity for all regressions. Clinicians should be aware of scale-related differences if they are using auditory-perceptual measures to choose voice therapy targets. Analyses accounting for perceptual strategy differences were recommended for future studies.

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

BACKGROUND

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

OBJECTIVE OF REVIEW

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

TYPE OF REVIEW

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

EVALUATION METHOD

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

RESULTS

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

CONCLUSIONS

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

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Comparison and Validation of Acoustic Voice Quality Index Version 2 and Version 3 among South Indian Population

BACKGROUND

Acoustic Voice Quality Index (AVQI) has emerged in the recent past as a robust multiparametric voice quality evaluation tool. Two versions of AVQI derived using the program PRAAT have found extensive clinical and research applications. These versions have been validated in several languages around the world. However, no research reports are available on validation of AVQI in the South Indian population. Further, studies comparing the performance of the two versions of AVQI are limited in the literature.

OBJECTIVES

This study was designed to validate and compare the two versions of AVQI (AVQIv02.02 and AVQIv03.01) in South Indian languages (Malayalam and Kannada).

METHODS

A retrospective analysis of previously recorded voice samples was carried out on a total of 160 (91 normophonic and 69 dysphonic) voice samples. These samples were perceptually rated on a GRBAS scale by five experienced speech-language pathologists. Standardized Syllable Number (SSN) necessary to derive AVQIv03.01 was computed. Following this, these samples were analyzed to obtain the AVQIv02.02 and AVQIv03.01. The concurrent validity and diagnostic accuracy of these measures were then examined and compared.

RESULTS

A moderate agreement was obtained across the judges on perceptual evaluation of voice quality. SSN in Malayalam and Kannada languages were identified to be 29 and 25 syllables respectively. Language differences were not observed on both versions of AVQI. The concurrent validity of AVQIv03.01 (r = 0.788) was superior to that of AVQIv02.02 (r = 0.655). Further, the threshold of differentiating normophonic and dysphonic samples were determined to be >3.45 for AVQIv02.02 and >2.45 for AVQIv03.01.

CONCLUSIONS

AVQIv03.01 is superior to AVQIv02.02 in terms of its diagnostic accuracy and concurrent validity. Current findings also extend the application of AVQI as a robust tool for the evaluation of voice characteristics to the South Indian population.

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

SUMMARY

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