Objective assessment of hoarseness by measuring jitter

Preliminary study on phonetic characteristics of patients with pulmonary nodules

OBJECTIVE

Pulmonary nodules (PNs) are one of the imaging manifestations of early lung cancer screening, which should receive more attention. Traditional Chinese medicine believes that voice changes occur in patients with pulmonary diseases. The purpose of this study is to explore the differences in phonetic characteristics between patients with PNs and able-bodied persons.

METHODS

This study explores the phonetic characteristics of patients with PNs in order to provide a simpler and cheaper method for PN screening. It is a case-control study to explore the differences in phonetic characteristics between individuals with and without PNs. This study performed non-parametric statistics on acoustic parameters of vocalizations, collected from January 2017 to March 2018 in Shanghai, China, from these two groups; it explores the differences in third and fourth acoustic parameters between patients with PNs and a normal control group. At the same time, computed tomography (CT) scans, course of disease, combined disease and other risk factors of the patients were collected in the form of questionnaire. According to the grouping of risk factors, the phonetic characteristics of the patients with PNs were analyzed.

RESULTS

This study was comprised of 200 patients with PNs, as confirmed by CT, and 86 healthy people that served as a control group. Among patients with PNs, 43% had ground glass opacity, 32% had nodules with a diameter ≥ 8 mm, 19% had a history of smoking and 31% had hyperlipidemia. Compared with the normal group, there were statistically significant differences in pitch, intensity and shimmer in patients with PNs. Among patients with PNs, patients with diameters ≥ 8 mm had a significantly higher third formant. There was a significant difference in intensity, fourth formant and harmonics-to-noise ratio (HNR) between smoking and non-smoking patients. Compared with non-hyperlipidemia patients, the pitch, jitter and shimmer of patients with PNs and hyperlipidemia were higher and the HNR was lower; these differences were statistically significant.

CONCLUSION

This measurable changes in vocalizations can be in patients with PNs. Patients with PNs had lower and weaker voices. The size of PNs had an effect on the phonetic formant. Smoking may contribute to damage to the voice and formant changes. Voice damage is more pronounced in individuals who have PNs accompanied by hyperlipidemia.

Male Vocal Quality and Its Relation to Females' Preferences

In both correlational and experimental settings, studies on women's vocal preferences have reported negative relationships between perceived attractiveness and men's vocal pitch, emphasizing the idea of an adaptive preference. However, such consensus on vocal attractiveness has been mostly conducted with native English speakers, but a few evidence suggest that it may be culture-dependent. Moreover, other overlooked acoustic components of vocal quality, such as intonation, perceived breathiness and roughness, may influence vocal attractiveness. In this context, the present study aims to contribute to the literature by investigating vocal attractiveness in an underrepresented language (i.e., French) as well as shedding light on its relationship with understudied acoustic components of vocal quality. More specifically, we investigated the relationships between attractiveness ratings as assessed by female raters and male voice pitch, its variation, the formants' dispersion and position, and the harmonics-to-noise and jitter ratios. Results show that women were significantly more attracted to lower vocal pitch and higher intonation patterns. However, they did not show any directional preferences for all the other acoustic features. We discuss our results in light of the adaptive functions of vocal preferences in a mate choice context.

Speech features for telemonitoring of Parkinson's disease symptoms

The aim of this paper is tracking Parkinson's disease (PD) progression based on its symptoms on vocal system using Unified Parkinsons Disease Rating Scale (UPDRS). We utilize a standard speech signal feature set, which contains 6373 static features as functionals of low-level descriptor (LLD) contours, and select the most informative ones using the maximal relevance and minimal redundancy based on correlations (mRMR_C) criteria. Then, we evaluate performance of Gaussian mixture regression (GMR) and support vector regression (SVR) on estimating the third subscale of UPDRS, i.e., UPDRS: motor subscale (UPDRS-III). Among the most informative features, a list of features are selected after redundancy reduction. The selected features depict that LLDs providing information about spectrum flatness, spectral distribution of energy, and hoarseness of voice are the most important ones for estimating UPDRS-III. Moreover, the most informative statistical functions are related to range, maximum, minimum and standard deviation of LLDs, which is an evidence of the muscle weakness due to the PD. Furthermore, GMR outperforms SVR on compact feature sets while the performance of SVR improves by increasing number of features.

Persistent dysphonia after laryngomicrosurgery for benign vocal fold disease

Objectives

Laryngomicrosurgery (LMS) is used to manage most vocal fold lesions. However, the functional voice outcome of the LMS might be diverse due to the influence of various factors. We intend to evaluate the incidence and etiologic factors of persistent dysphonia after LMS for benign vocal fold disease (BVFD).

Methods

We performed a retrospective review of 755 patients who underwent LMS for BVFD. We analyzed the clinical characteristics, preoperative and postoperative two onths voice studies. Postsurgical dysphonia was defined as grade 1 or above in GRBAS (grade, roughness, breathiness, asthenia, and strain) scale. Thirty nine patients (5.2%; 25 males and 14 females; average, 42.9 years; range, 21 to 70 years) were diagnosed with postsurgical dysphonia.

Results

There was no correlation between the diagnosis, coexistence with laryngopharyngeal reflux disease, habit of smoking, or occupational voice abuse and voice outcome. The patients with a worse preoperative acoustic parameter had aworse voice outcome. Stroboscopic findings showed excessive scarring or bowing in 21 cases, presence of lesion remnant in eight cases, prolonged laryngeal edema in five and no abnormal findings in three.

Conclusion

Great care should be taken in patients with worse preoperative jitter. With a few exceptions, postoperative dysphonia can be avoided by the use of an ppropriate surgical technique.

Objective methods of sample selection in acoustic analysis of voice

OBJECTIVES

In acoustic voice analysis, the fact that reproducible methods of sample selection have not been defined impedes research study generalizability and clinical assessment of treatment efficacy. Because perturbation results differ along a single signal, this study sought to establish objective methods of sample selection by use of a moving window to determine the most stable regions of phonation.

METHODS

Voice signals obtained from 21 patients affected by laryngeal conditions associated with Parkinson's disease were analyzed to study jitter, shimmer, signal-to-noise ratio, and correlation dimension parameters when various sample selection procedures were used. Objectively selected voice samples were chosen based upon 5%, 10%, and 20% variance from a signal's minimum perturbation value. The stability of these samples, defined by the standard deviations of the acoustic measurements, was compared to the stability of unselected samples and subjectively selected samples.

RESULTS

A significant decrease in standard deviation values of acoustic parameters was found in comparing the objectively selected samples (particularly those selected with 5% and 10% variance) to the subjectively selected and unselected samples.

CONCLUSIONS

These results suggest that the development of an objective sample selection method may have significant effects on the stability and reliability of acoustic voice measurements.

Acoustic analysis in asthmatics and the influence of inhaled corticosteroid therapy

The impact of sustained inhaled corticosteroid (ICS) therapy on the larynx and pharynx was assessed using a prospective, cross-sectional, and investigator-blinded study conducted at the University Hospital Aintree, Liverpool, UK. Forty-six adults recruited from two local general practices and from general ENT clinics at our University hospital were investigated for the study. Patients were allocated to three groups according to ICS use. Laryngeal effects were measured by correlating the results of a vocal performance questionnaire, a respiratory symptom questionnaire, and measurements obtained by computerized speech analysis. Sustained vowels and connected speech were analyzed in normal and asthmatic subjects. Acoustic analysis was correlated with cellular markers of inflammation after biopsy. Regular ICS users had significantly more pharyngeal inflammation and throat discomfort (P<0.0001). Vocal performance was also worse in this group (P<0.0001). They were more likely to have hoarseness, weakness of voice, aphonia, sore throat, throat irritation, and cough (P<0.0001). All these variables were directly related to one another (P<0.0001). Multiple linear regression analysis showed that jitter was a good objective measure of hoarseness (P<0.05). Regular ICS users were significantly more likely to have abnormal jitter, shimmer, and closed-phase quotient scores (P<0.0001). There was no difference between the groups in the observed parameters of inflammation (P>0.01). A higher pharyngitis score did not correlate with any of the histological markers of inflammation (P>0.01). Local side effects are more common in asthmatics that use ICS regularly. Measures of laryngeal function are significantly worse in regular ICS users. However, histological markers and oropharyngeal redness are not reliable measures of inflammation.

Normatização de medidas acústicas para vozes normais

Pesquisas têm estabelecido que cada serviço deve estabelecer seus padrões normativos para a análise acústica. O objetivo do presente estudo é normatizar as medidas de freqüência fundamental (fo), jitter, shimmer e proporção harmônico-ruído (PHR) para adultos jovens com voz normal. MÉTODO: Participaram deste estudo 20 homens e 20 mulheres, de 20 a 45 anos de idade, sem sinais e sintomas de problemas vocais, produzindo as vogais sustentadas /a/ e /é/, analisadas pelo programa CSL- 4300 Kay-Elemetrics. RESULTADOS: Para as mulheres, respectivamente para a vogal /a/ e /é/ os valores médios foram: fo de 205,82Hz e 206,56Hz; jitter de 0,62% e 0,59%; shimmer de 0,22dB e 0,19dB; PHR de 10,9 dB e 11,04 dB. Para os homens, respectivamente para a vogal /a/ e /é/, os valores médios foram: fo de 119,84Hz e 118,92Hz; jitter de 0,49% e 0,5%; shimmer de 0,22 dB e 0,21 dB; PHR de 9,56 dB e 9,63dB. As medidas de fo e PHR foram significativamente maiores para as mulheres em comparação aos homens. CONCLUSÃO: As diferenças entre os nossos resultados e os dos outros autores confirmam a necessidade de se realizar a normatização para cada programa a ser utilizado.

Standardization of acoustic measures for normal voice patterns

Studies have established that normative data is necessary for acoustic analysis. The aim of the present study is to standardize fundamental frequency measures (fo), jitter, shimmer and harmonic-noise ratio (HNR) for young adults with normal voice.

Method

20 males and 20 females, between 20 and 45 years, without signs and symptoms of vocal problems; CSL-4300 Kay-Elemetrics; vowels /a/ and /é/.

Results

for females, vowels /a/ and /é/ had average measures of: fo 205.82 Hz and 206.56 Hz; jitter of 0.62% and 0.59%; shimmer of 0.22 dB and 0.19 dB; PHR of 10.9 dB and 11.04 dB, respectively. For males, vowel /a/ and /é/ had average measures of: fo 119.84 Hz and 118.92 Hz; jitter of 0.49% and 0.5%; shimmer of 0.22 dB and 0.21 dB; HNR 9.56 dB and 9.63 dB, respectively. Both fo and NHR female measures were significantly higher than their male counterparts.

Conclusion

our results differ from the literature; therefore, it is important to standardize the program in use.

Perception of aperiodicity in pathological voice

Although jitter, shimmer, and noise acoustically characterize all voice signals, their perceptual importance in naturally produced pathological voices has not been established psychoacoustically. To determine the role of these attributes in the perception of vocal quality, listeners were asked to adjust levels of jitter, shimmer, and the noise-to-signal ratio in a speech synthesizer, so that synthetic voices matched naturally produced tokens. Results showed that, although listeners agreed well in their judgments of the noise-to-signal ratio, they did not agree with one another in their chosen settings for jitter and shimmer. Noise-dependent differences in listeners' ability to detect changes in amounts of jitter and shimmer implicate both listener insensitivity and inability to isolate jitter and shimmer as separate dimensions in the overall pattern of aperiodicity in a voice as causes of this poor agreement. These results suggest that jitter and shimmer are not useful as independent indices of perceived vocal quality, apart from their acoustic contributions to the overall pattern of spectrally shaped noise in a voice.

Perceptual and Acoustic Assessment of Voice Pathology and the Efficacy of Endolaryngeal Phonomicrosurgery

Values for acoustic voice measurements were obtained from 88 normal individuals and 98 pathological cases of mass lesions of vocal fold and 50 cases of unilateral vocal fold paralysis. Overall, all items reflecting perturbations of pitch and amplitude as well as glottal noise were significantly higher in the groups of patients compared with the normal group. The measurement of normalized noise energy (NNE) was found to be an optimum parameter for discrimination of normal/abnormal voices. The voices of patients with vocal fold nodules and vocal fold polyps were analyzed before endolaryngeal phonomicrosurgery (EPM) and 2 weeks after. Statistically significant (p < 0.01) improvement was achieved both in perceptual and acoustic analysis. EPM resulted in a significant decrease of mean jitter, shimmer, and NNE. Clinically, these measures provided documentable and measurable evidence of vocal function and were helpful for comparing patients with normal speakers. They also were useful for a thorough documentation of patient's voice pathology and for evaluation of the presurgical and postsurgical voice status.