Assessing voice health using smartphones: bias and random error of acoustic voice parameters captured by different smartphone types

Comparison of Acoustic Voice Features Derived From Mobile Devices and Studio Microphone Recordings

OBJECTIVES/HYPOTHESIS

Improvements in mobile device technology offer new opportunities for remote monitoring of voice for home and clinical assessment. However, there is a need to establish equivalence between features derived from signals recorded from mobile devices and gold standard microphone-preamplifiers. In this study acoustic voice features from android smartphone, tablet, and microphone-preamplifier recordings were compared.

METHODS

Data were recorded from 37 volunteers (20 female) with no history of speech disorder and six volunteers with Huntington's disease (HD) during sustained vowel (SV) phonation, reading passage (RP), and five syllable repetition (SR) tasks. The following features were estimated: fundamental frequency median and standard deviation (F0 and SD F0), harmonics-to-noise ratio (HNR), local jitter, relative average perturbation of jitter (RAP), five-point period perturbation quotient (PPQ5), difference of differences of amplitude and periods (DDA and DDP), shimmer, and amplitude perturbation quotients (APQ3, APQ5, and APQ11).

RESULTS

Bland-Altman analysis revealed good agreement between microphone and mobile devices for fundamental frequency, jitter, RAP, PPQ5, and DDP during all tasks and a bias for HNR, shimmer and its variants (APQ3, APQ5, APQ11, and DDA). Significant differences were observed between devices for HNR, shimmer, and its variants for all tasks. High correlation was observed between devices for all features, except SD F0 for RP. Similar results were observed in the HD group for SV and SR task. Biological sex had a significant effect on F0 and HNR during all tests, and for jitter, RAP, PPQ5, DDP, and shimmer for RP and SR. No significant effect of age was observed.

CONCLUSIONS

Mobile devices provided good agreement with state of the art, high-quality microphones during structured speech tasks for features derived from frequency components of the audio recordings. Caution should be taken when estimating HNR, shimmer and its variants from recordings made with mobile devices.

Can Smartphones Be Used to Record Children's Voices for Acoustic Analysis?

OBJECTIVES

While technological advancements have enabled the utilization of smartphones for acoustic voice analysis, existing studies have predominantly focused on the adult population. However, dysphonia is prevalent in children, and their anatomy and physiology are different from those of adults. Thus, this paper aims to investigate the feasibility of using smartphones to record children's voices for acoustic voice analysis.

STUDY DESIGN

A methodological study.

METHODS

This study involved 29 children, aged 4-10 years, who had healthy voices. Voice recordings of sustained phonation and reading a sentence were obtained using four devices (1-AKG Micromic C520 headset microphone connected to a computer with the computerized speech lab (CSL), 2-Samsung S9 Plus, 3-iPhone 13 Mini, and 4-Huawei Y9 Prime). Then, all the recorded voice samples were analyzed using CSL, examining a total of 13 acoustic parameters. Pearson correlation analysis, Bland-Altman analysis, and uncertainty of measurement analysis were conducted to assess consistency and agreement across devices.

RESULTS

The highest correlation and accuracy between the smartphone measurements and the reference recording system were found for the fundamental frequency (F0) (r > 0.90, P < 0.01) in both speech samples. For other parameters, limited reliability was observed; while some showed weak correlations, others had low accuracy and consistency. There were, however, moderate-to-excellent correlations for the most measurements and a nonsignificant bias according to the Bland-Altman analysis.

CONCLUSION

This study is the first to investigate the feasibility of using smartphones for acoustic voice analysis focusing specifically on children. The results indicate that smartphone voice recordings can be used to reliably measure F0. More research is needed to improve measurement reliability for other parameters. Nonetheless, the findings demonstrate the potential for smartphones to enable accessible and reliable voice assessment in the pediatric population.

Cross-device and test-retest reliability of speech acoustic measurements derived from consumer-grade mobile recording devices

In recent years, there has been growing interest in remote speech assessment through automated speech acoustic analysis. While the reliability of widely used features has been validated in professional recording settings, it remains unclear how the heterogeneity of consumer-grade recording devices, commonly used in nonclinical settings, impacts the reliability of these measurements. To address this issue, we systematically investigated the cross-device and test-retest reliability of classical speech acoustic measurements in a sample of healthy Chinese adults using consumer-grade equipment across three popular speech tasks: sustained phonation (SP), diadochokinesis (DDK), and picture description (PicD). A total of 51 participants completed two recording sessions spaced at least 24 hours apart. Speech outputs were recorded simultaneously using four devices: a voice recorder, laptop, tablet, and smartphone. Our results demonstrated good reliability for fundamental frequency and cepstral peak prominence in the SP task across testing sessions and devices. Other features from the SP and PicD tasks exhibited acceptable test-retest reliability, except for the period perturbation quotient from the tablet and formant frequency from the smartphone. However, measures from the DDK task showed a significant decrease in reliability on consumer-grade recording devices compared to professional devices. These findings indicate that the lower recording quality of consumer-grade equipment may compromise the reproducibility of syllable rate estimation, which is critical for DDK analysis. This study underscores the need for standardization of remote speech monitoring methodologies to ensure that remote home assessment provides accurate and reliable results for early screening.

Validity of Acoustic Measures Obtained Using Various Recording Methods Including Smartphones With and Without Headset Microphones

PURPOSE

The goal of this study was to assess various recording methods, including combinations of high- versus low-cost microphones, recording interfaces, and smartphones in terms of their ability to produce commonly used time- and spectral-based voice measurements.

METHOD

Twenty-four vowel samples representing a diversity of voice quality deviations and severities from a wide age range of male and female speakers were played via a head-and-thorax model and recorded using a high-cost, research standard GRAS 40AF (GRAS Sound & Vibration) microphone and amplification system. Additional recordings were made using various combinations of headset microphones (AKG C555 L [AKG Acoustics GmbH], Shure SM35-XLR [Shure Incorporated], AVID AE-36 [AVID Products, Inc.]) and audio interfaces (Focusrite Scarlett 2i2 [Focusrite Audio Engineering Ltd.] and PC, Focusrite and smartphone, smartphone via a TRRS adapter), as well as smartphones direct (Apple iPhone 13 Pro, Google Pixel 6) using their built-in microphones. The effect of background noise from four different room conditions was also evaluated. Vowel samples were analyzed for measures of fundamental frequency, perturbation, cepstral peak prominence, and spectral tilt (low vs. high spectral ratio).

RESULTS

Results show that a wide variety of recording methods, including smartphones with and without a low-cost headset microphone, can effectively track the wide range of acoustic characteristics in a diverse set of typical and disordered voice samples. Although significant differences in acoustic measures of voice may be observed, the presence of extremely strong correlations (rs > .90) with the recording standard implies a strong linear relationship between the results of different methods that may be used to predict and adjust any observed differences in measurement results.

CONCLUSION

Because handheld smartphone distance and positioning may be highly variable when used in actual clinical recording situations, smartphone + a low-cost headset microphone is recommended as an affordable recording method that controls mouth-to-microphone distance and positioning and allows both hands to be available for manipulation of the smartphone device.

Multiparametric Analysis of Speaking Fundamental Frequency in Genetically Related Speakers Using Different Speech Materials: Some Forensic Implications

OBJECTIVES

To assess the speaker-discriminatory potential of a set of fundamental frequency estimates in intraidentical twin pair comparisons and cross-pair comparisons (i.e., among all speakers).

PARTICIPANTS

A total of 20 Brazilian Portuguese speakers of the same dialect, namely 10 male identical twin pairs aged between 19 and 35, were recruited.

METHOD

The participants were recorded directly through professional microphones while taking part in a spontaneous dialogue over mobile phones. Acoustic measurements were performed in connected speech samples, and in lengthened vowels, at least 160 ms long produced during spontaneous speech.

RESULTS

f0 baseline, central tendency, and extreme values were found mostly discriminatory in intra-twin pair and cross-pair comparisons. These were also the estimates displaying the largest effect sizes. Overall, only three identical twins were found statistically different regarding their f0 patterns in connected speech, but not for lengthened vowel-based f0 metrics. Estimates of f0 variation and modulation were found the least discriminatory across speakers, which may signal the control of speaking style and dialect on dynamic patterns of f0. Concerning system performance, the base value of f0 (f0 baseline) was found the most reliable metric, displaying the lowest equal error rate (EER).

CONCLUSIONS

The outcomes suggest that, although identical twins were very closely related regarding their f0 patterns, some pairs could still be differentiated acoustically, only in connected speech. Such findings reinforce the relevance of analyzing long-term f0 metrics for speaker comparison purposes, with particular consideration to f0 baseline. Furthermore, f0 differences across subjects were suggested as more expressive in connected speech than in lengthened vowels.

The Efficacy of the Manual Circumlaryngeal Therapy for Muscle Tension Dysphonia: A Systematic Review and Meta-analysis

OBJECTIVE

Muscle tension dysphonia (MTD) is the most common functional voice disorder. Behavioral voice therapy is the front-line treatment for MTD, and laryngeal manual therapy may be a part of this treatment. The objective of this study was to investigate the effect of manual circumlaryngeal therapy (MCT) on acoustic markers of voice quality (jitter, shimmer, and harmonics-to-noise ratio) and vocal function (fundamental frequency) through a systematic review with meta-analysis.

DATA SOURCES

Four databases were searched from inception to December 2022, and a manual search was performed.

REVIEW METHODS

The PRISMA extension statement for reporting systematic reviews incorporating a meta-analysis of health care interventions was applied, and a random effects model was used for the meta-analyses.

RESULTS

We identified 6 eligible studies from 30 studies (without duplicates). The MCT approach was highly effective on acoustics with large effect sizes (Cohen's d > 0.8). Significant improvements were obtained in jitter in percent (mean difference of -.58; 95% CI -1.00 to 0.16), shimmer in percent (mean difference of -5.66; 95% CI -8.16 to 3.17), and harmonics-to-noise ratio in dB (mean difference of 4.65; 95% CI 1.90-7.41), with the latter two measurements continuing to be significantly improved by MCT when measurement variability is considered.

CONCLUSION

The efficacy of MCT for MTD was confirmed in most clinical studies by assessing jitter, shimmer, and harmonics-to-noise ratio related to voice quality. The effects of MCT on the fundamental frequency changes could not be verified. Further contributions of high-quality randomized control trials are needed to support evidence-based practice in laryngology. Laryngoscope, 134:18-26, 2024.

Are smartphones and low-cost external microphones comparable for measuring time-domain acoustic parameters?

PURPOSE

This study examined and compared the diagnostic accuracy and correlation levels of the acoustic parameters of the audio recordings obtained from smartphones on two operating systems and from dynamic and condenser types of external microphones.

METHOD

The study included 87 adults: 57 with voice disorder and 30 with a healthy voice. Each participant was asked to perform a sustained vowel phonation (/a/). The recordings were taken simultaneously using five microphones AKG-P220, Shure-SM58, Samson Go Mic, Apple iPhone 6, and Samsung Galaxy J7 Pro microphones in an acoustically insulated cabinet. Acoustic examinations were performed using Praat version 6.2.09. The data were examined using Pearson correlation and receiver-operating characteristic (ROC) analyses.

RESULTS

The parameters with the highest area under curve (AUC) values among all microphone recordings in the time-domain analyses were the frequency perturbation parameters. Additionally, considering the correlation coefficients obtained by synchronizing the microphones with each other and the AUC values together, the parameter with the highest correlation coefficient and diagnostic accuracy values was the jitter-local parameter.

CONCLUSION

Period-to-period perturbation parameters obtained from audio recordings made with smartphones show similar levels of diagnostic accuracy to external microphones used in clinical conditions.

Disease Delineation for Multiple Sclerosis, Friedreich Ataxia, and Healthy Controls Using Supervised Machine Learning on Speech Acoustics

Neurodegenerative disease often affects speech. Speech acoustics can be used as objective clinical markers of pathology. Previous investigations of pathological speech have primarily compared controls with one specific condition and excluded comorbidities. We broaden the utility of speech markers by examining how multiple acoustic features can delineate diseases. We used supervised machine learning with gradient boosting (CatBoost) to delineate healthy speech from speech of people with multiple sclerosis or Friedreich ataxia. Participants performed a diadochokinetic task where they repeated alternating syllables. We subjected 74 spectral and temporal prosodic features from the speech recordings to machine learning. Results showed that Friedreich ataxia, multiple sclerosis and healthy controls were all identified with high accuracy (over 82%). Twenty-one acoustic features were strong markers of neurodegenerative diseases, falling under the categories of spectral qualia, spectral power, and speech rate. We demonstrated that speech markers can delineate neurodegenerative diseases and distinguish healthy speech from pathological speech with high accuracy. Findings emphasize the importance of examining speech outcomes when assessing indicators of neurodegenerative disease. We propose large-scale initiatives to broaden the scope for differentiating other neurological diseases and affective disorders.

Smartphone Recordings are Comparable to "Gold Standard" Recordings for Acoustic Measurements of Voice

PURPOSE

The purpose of this study was to assess the relationship and comparability of cepstral and spectral measures of voice obtained from a high-cost "flat" microphone and precision sound level meter (SLM) vs. high-end and entry level models of commonly and currently used smartphones (iPhone i12 and iSE; Samsung s21 and s9 smartphones). Device comparisons were also conducted in different settings (sound-treated booth vs. typical "quiet" office room) and at different mouth-to-microphone distances (15 and 30 cm).

METHODS

The SLM and smartphone devices were used to record a series of speech and vowel samples from a prerecorded diverse set of 24 speakers representing a wide range of sex, age, fundamental frequency (F0), and voice quality types. Recordings were analyzed for the following measures: smoothed cepstral peak prominence (CPP in dB); the low vs high spectral ratio (L/H Ratio in dB); and the Cepstral Spectral Index of Dysphonia (CSID).

RESULTS

A strong device effect was observed for L/H Ratio (dB) in both vowel and sentence contexts and for CSID in the sentence context. In contrast, device had a weak effect on CPP (dB), regardless of context. Recording distance was observed to have a small-to-moderate effect on measures of CPP and CSID but had a negligible effect on L/H Ratio. With the exception of L/H Ratio in the vowel context, setting was observed to have a strong effect on all three measures. While these aforementioned effects resulted in significant differences between measures obtained with SLM vs. smartphone devices, the intercorrelations of the measurements were extremely strong (r's > 0.90), indicating that all devices were able to capture the range of voice characteristics represented in the voice sample corpus. Regression modeling showed that acoustic measurements obtained from smartphone recordings could be successfully converted to comparable measurements obtained by a "gold standard" (precision SLM recordings conducted in a sound-treated booth at 15 cm) with small degrees of error.

CONCLUSIONS

These findings indicate that a variety of commonly available modern smartphones can be used to collect high quality voice recordings usable for informative acoustic analysis. While device, setting, and distance can have significant effects on acoustic measurements, these effects are predictable and can be accounted for using regression modeling.

Indexing Cognitive Resource Usage for Acquisition of Initial Voice Therapy Targets

PURPOSE

The purpose of this study was to index cognitive resource usage for acquisition of initial targets of two common voice therapy techniques (resonant voice therapy [RVT] and conversation training therapy [CTT]) based on the theorized depletion effect (i.e., when an initial task requiring high cognitive load leads to poorer performance on a subsequent task).

METHOD

Eleven vocally healthy participants, ages 23-41 years, read aloud the Rainbow Passage and produced consonant-vowel resonant targets (/mi, ma, mu/) followed by a baseline computerized Stroop task and a 15-min washout. Following this baseline period, participants watched and interacted with two videos instructing them in RVT or CTT initial targets. After viewing each video and practicing the associated vocal skills, participants rated the degree of mental effort required to engage in the target vocal technique on a modified Borg scale. Participants recorded their attempts at RVT on /mi, ma, mu/ and CTT on the Rainbow Passage, which were later rated by three voice-specialized speech-language pathologists as to how representative they were of each respective target technique. Changes in fundamental frequency and average auditory-perceptual ratings from baseline were examined to determine if participants adjusted their technique from RVT and CTT baseline to acquisition.

RESULTS

Performance on the Stroop task was, on average, worse post CTT than post RVT, but both post-CTT and post-RVT Stroop scores were poorer than baseline. These results suggest that both treatment techniques taxed cognitive resources but that CTT was more cognitively taxing than RVT. However, despite differences in raw averages, no statistically significant differences were found between the baseline, post-CTT, and post-RVT Stroop scores, likely due to the small sample size. Participant ratings of mental effort for CTT and RVT were statistically similar. Likewise, poorer post-RVT Stroop scores were associated with participants' greater perceived mental effort with RVT acquisition, but there was no significant association between mental effort ratings for CTT acquisition and post-CTT Stroop scores. Significantly higher fundamental frequency and perceived ratings of the accuracy of technique from baseline to acquisition for both CTT and RVT were found, providing evidence of vocal behavior changes as a result of each technique.

CONCLUSIONS

Brief exposure to initial treatment tasks in CTT is more cognitively depleting than initial RVT tasks. Results also indicate that vocally healthy participants are able to make a voice change in response to a brief therapy prompt. Finally, participant-rated measures of mental effort and secondary measures of cognitive depletion do not always correlate.

Microphone and Audio Compression Effects on Acoustic Voice Analysis: A Pilot Study

OBJECTIVE

This study aimed to analyze the effects of microphone and audio compression variables on voice and speech parameters acquisition.

METHOD

Acoustic measures were recorded and compared using a high-quality reference microphone and three testing microphones. The tested microphones displayed differences in specifications and acoustic properties. Furthermore, the impact of the audio compression was assessed by resampling the original uncompressed audio files into the MPEG-1/2 Audio Layer 3 (mp3) format at three different compression rates (128 kbps, 64 kbps, 32 kbps). Eight speakers were recruited in each recording session and asked to produce four sustained vowels: two [a] segments and two [ɛ] segments. The audio was captured simultaneously by the reference and tested microphones. The recordings were synchronized and analyzed using the Praat software.

RESULTS

From a set of eight acoustic parameters assessed (f₀, F1, F2, jitter%, shimmer%, HNR, H1-H2, and CPP), three (f₀, F2, and jitter%) were suggested as resistant regarding the microphone and audio compression variables. In contrast, some parameters seemed to be significantly affected by both factors: HNR, H1-H2, and CPP; while shimmer% was found sensitive only concerning the latter factor. Moreover, higher compression rates appeared to yield more frequent acoustic distortions than lower rates.

CONCLUSION

Overall, the outcomes suggest that acoustic parameters are influenced by both the microphone selection and the audio compression usage, which may reflect the practical implications of these components on the acoustic analysis reliability.

Comparison of In-Person and Online Recordings in the Clinical Teleassessment of Speech Production: A Pilot Study

In certain circumstances, speech and language therapy is proposed in telepractice as a practical alternative to in-person services. However, little is known about the minimum quality requirements of recordings in the teleassessment of motor speech disorders (MSD) utilizing validated tools. The aim here is to examine the comparability of offline analyses based on speech samples acquired from three sources: (1) in-person recordings with high quality material, serving as the baseline/gold standard; (2) in-person recordings with standard equipment; (3) online recordings from videoconferencing. Speech samples were recorded simultaneously from these three sources in fifteen neurotypical speakers performing a screening battery of MSD and analyzed by three speech and language therapists. Intersource and interrater agreements were estimated with intraclass correlation coefficients on seventeen perceptual and acoustic parameters. While the interrater agreement was excellent for most speech parameters, especially on high quality in-person recordings, it decreased in online recordings. The intersource agreement was excellent for speech rate and mean fundamental frequency measures when comparing high quality in-person recordings to the other conditions. The intersource agreement was poor for voice parameters, but also for perceptual measures of intelligibility and articulation. Clinicians who plan to teleassess MSD should adapt their recording setting to the parameters they want to reliably interpret.

Assessment of Two Audio-Recording Methods for Remote Collection of Vocal Biomarkers Indicative of Tobacco Smoking Harm

This study aimed to determine if self-complete at-home recordings could produce audio samples of sufficient quality for use in voice analysis software, and if audio samples of similar or sufficient quality could be extracted from audio-recorded naturalistic phone interviews. Data were obtained from 31 adults aged 18 years and over who smoked. The /a/ sound segment was manually isolated, and analysis functions were used to produce the following values: fundamental frequency, jitter, shimmer, noise ratio, formant 3, and formant 4. The /a/ sound segment was then manually isolated from audio recordings of naturalistic interviews previously conducted by phone. These were analysed in the same way and compared for quality against Evistr-recorded audio samples from the same participants. A third audio sample consisted of an Evistr or phone-recorded sustained phonation of the /a/ sound. Means and standard deviations were calculated for the target vocal parameters. Statistical comparisons for quality of sound segment were conducted for readings, interviews, and vowel phonation and for sound signals extracted via both recording methods. Self-recording by adults who smoked provided audio samples of sufficient quality for analysis of vocal features that have been associated with a clinical outcome. The values obtained for sustained phonation audio samples displayed the least perturbation and noise for the vocal parameters surveyed. Sound signals recorded with smartphones appeared to be affected by electronic interference but have potential for use in diagnostic tools for measuring vocal parameters.

A Tutorial Review on Clinical Acoustic Markers in Speech Science

PURPOSE

The human voice changes with the progression of neurological disease and the onset of diseases that affect articulators, often decreasing the effectiveness of communication. These changes can be objectively measured using signal processing techniques that extract acoustic features. When measuring acoustic features, there are often several steps and assumptions that might be known to experts in acoustics and phonetics, but are less transparent for other disciplines (e.g., clinical medicine, speech pathology, engineering, and data science). This tutorial describes these signal processing techniques, explicitly outlines the underlying steps for accurate measurement, and discusses the implications of clinical acoustic markers.

CONCLUSIONS

We establish a vocabulary using straightforward terms, provide visualizations to achieve common ground, and guide understanding for those outside the domains of acoustics and auditory signal processing. Where possible, we highlight the best practices for measuring clinical acoustic markers and suggest resources for obtaining and further understanding these measures.

Things to Consider When Automatically Detecting Parkinson’s Disease Using the Phonation of Sustained Vowels: Analysis of Methodological Issues

Diagnosing Parkinson’s Disease (PD) necessitates monitoring symptom progression. Unfortunately, diagnostic confirmation often occurs years after disease onset. A more sensitive and objective approach is paramount to the expedient diagnosis and treatment of persons with PD (PwPDs). Recent studies have shown that we can train accurate models to detect signs of PD from audio recordings of confirmed PwPDs. However, disparities exist between studies and may be caused, in part, by differences in employed corpora or methodologies. Our hypothesis is that unaccounted covariates in methodology, experimental design, and data preparation resulted in overly optimistic results in studies of PD automatic detection employing sustained vowels. These issues include record-wise fold creation rather than subject-wise; an imbalance of age between the PwPD and control classes; using too small of a corpus compared to the sizes of feature vectors; performing cross-validation without including development data; and the absence of cross-corpora testing to confirm results. In this paper, we evaluate the influence of these methodological issues in the automatic detection of PD employing sustained vowels. We perform several experiments isolating each issue to measure its influence employing three different corpora. Moreover, we analyze if the perceived dysphonia of the speakers could be causing differences in results between the corpora. Results suggest that each independent methodological issue analyzed has an effect on classification accuracy. Consequently, we recommend a list of methodological steps to be considered in future experiments to avoid overoptimistic or misleading results.

Validation of cepstral peak prominence in assessing early voice changes of Parkinson's disease: Effect of speaking task and ambient noise

Although the cepstral peak prominence (CPP) and its variant, the cepstral peak prominence smooth (CPPS), are considered to be robust acoustic measures for the evaluation of dysphonia, whether they are sensitive to capture early voice changes in Parkinson's disease (PD) has not yet been explored. This study aimed to investigate the voice changes via the CPP measures in the idiopathic rapid eye movement sleep behavior disorder (iRBD), a special case of prodromal neurodegeneration, and recently diagnosed and advanced-stage Parkinson's disease (AS-PD) patients using different speaking tasks across noise-free and noisy environments. The sustained vowel phonation, reading of passages, and monologues of 60 early stage untreated PD, 30 advanced-stage Parkinson's disease, 60 iRBD, and 60 healthy control (HC) participants were evaluated. Significant differences were found between the PD groups and controls in sustained phonation via the CPP (p < 0.05) and CPPS (p < 0.01) and the monologue via the CPP (p < 0.01), although neither the CPP nor CPPS measures were sufficiently sensitive to capture the possible prodromal dysphonia in the iRBD. The quality of the CPP and CPPS measures was influenced substantially by the addition of ambient noise. It was anticipated that the CPP measures might serve as a promising digital biomarker in assessing the dysphonia from the early stages of PD.

Development, Validation, and Reliability of the Teacher-Reported Pediatric Voice Handicap Index

PURPOSE

The purpose of this study was to develop a novel teacher-reported pediatric voice outcome measure and to investigate its psychometric properties.

METHOD

In the first stage, a new instrument, the Teacher-Reported Pediatric Voice Handicap Index (TRPVHI), was developed. After item generation, a panel of experts evaluated the items to assess the content validity. Subsequently, the final version of the preliminary instrument was applied to teachers of 306 children (57 dysphonic and 249 vocally healthy) between the ages of 4 and 11 years. Eventually, the construct validity, criterion-related validity, test-retest reliability, and internal consistency of the developed instrument were examined.

RESULTS

The items with a content validity ratio less than .8 were modified or removed, and accordingly, the preliminary version of the index was finalized. After the application of the preliminary version, item reduction was made based on the factor analysis. The index is composed of 27 questions and three subscales: Functional, Physical, and Emotional. A significant difference was observed between the dysphonic and vocally healthy children for the TRPVHI scores (p < .001). A positive moderate correlation was determined between the Pediatric Voice Handicap Index and TRPVHI scores. Correlation coefficients between the test and retest scores of the TRPVHI were in the range of .92-.98. Cronbach's alpha values computed to assess the internal consistency were in the range of .94-.98.

CONCLUSIONS

The TRPVHI is the only valid and reliable teacher-reported outcome measure of the effects of voice disorders on children. It is anticipated that the deployment of the TRPVHI in conjunction with other subjective tools, both in the initial evaluation and the follow-up of the treatment results, will allow a better understanding of the physical, functional, and emotional effects of voice disorders on children. Furthermore, it can potentially lead further research to enable the use of the TRPVHI for screening purposes.

Terapia de voz en el contexto de la pandemia covid-19; recomendaciones para la práctica clínica

INTRODUCTION

Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment.

OBJECTIVE

To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists.

METHODS

A group of 11 experts in voice and swallowing disorders from 5 different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context.

RESULTS

The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics.

CONCLUSION

This guideline should be taken only as recommendations; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.

Terapia Vocal No Contexto Da Pandemia Do Covid-19; Orientações Para A Prática Clínica

INTRODUCTION

Since the beginning of the new pandemic, Corona Virus Disease 2019 (COVID-19) health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment.

OBJECTIVE

To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists.

METHODS

A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context.

RESULT

The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics.

CONCLUSION

This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.

Voice Therapy in the Context of the COVID-19 Pandemic: Guidelines for Clinical Practice

INTRODUCTION

Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment.

OBJECTIVE

To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists.

METHODS

A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context.

RESULTS

The clinical guide provides 65 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics.

CONCLUSION

This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.

Accuracy of Acoustic Measures of Voice via Telepractice Videoconferencing Platforms

Purpose Telepractice improves patient access to clinical care for voice disorders. Acoustic assessment has the potential to provide critical, objective information during telepractice, yet its validity via telepractice is currently unknown. The current study investigated the accuracy of acoustic measures of voice in a variety of telepractice platforms. Method Twenty-nine voice samples from individuals with dysphonia were transmitted over six video conferencing platforms (Zoom with and without enhancements, Cisco WebEx, Microsoft Teams, Doxy.me, and VSee Messenger). Standard time-, spectral-, and cepstral-based acoustic measures were calculated. The effect of transmission condition on each acoustic measure was assessed using repeated-measures analyses of variance. For those acoustic measures for which transmission condition was a significant factor, linear regression analysis was performed on the difference between the original recording and each telepractice platform, with the overall severity of dysphonia, Internet speed, and ambient noise from the transmitter as predictors. Results Transmission condition was a statistically significant factor for all acoustic measures except for mean fundamental frequency (f o). Ambient noise from the transmitter was a significant predictor of differences between platforms and the original recordings for all acoustic measures except f o measures. All telepractice platforms affected acoustic measures in a statistically significantly manner, although the effects of platforms varied by measure. Conclusions Overall, measures of f o were the least impacted by telepractice transmission. Microsoft Teams had the least and Zoom (with enhancements) had the most pronounced effects on acoustic measures. These results provide valuable insight into the relative validity of acoustic measures of voice when collected via telepractice. Supplemental Material https://doi.org/10.23641/asha.14794812.

Comparing acoustic analyses of speech data collected remotely

Face-to-face speech data collection has been next to impossible globally as a result of the COVID-19 restrictions. To address this problem, simultaneous recordings of three repetitions of the cardinal vowels were made using a Zoom H6 Handy Recorder with an external microphone (henceforth, H6) and compared with two alternatives accessible to potential participants at home: the Zoom meeting application (henceforth, Zoom) and two lossless mobile phone applications (Awesome Voice Recorder, and Recorder; henceforth, Phone). F0 was tracked accurately by all of the devices; however, for formant analysis (F1, F2, F3), Phone performed better than Zoom, i.e., more similarly to H6, although the data extraction method (VoiceSauce, Praat) also resulted in differences. In addition, Zoom recordings exhibited unexpected drops in intensity. The results suggest that lossless format phone recordings present a viable option for at least some phonetic studies.

Accuracy of Acoustic Voice Quality Index Captured With a Smartphone - Measurements With Added Ambient Noise

OBJECTIVE

To evaluate the accuracy of Acoustic Voice Quality Index (AVQI) measures obtained from voice recordings simultaneously using oral and smartphone microphones in a sound-proof room, and to compare them with AVQIs obtained from the same smartphone voice recordings with added ambient noise.

METHODS

A study group of 183 subjects with normal voices (n = 86) and various voice disorders (n = 97) was asked to read aloud a standard text and sustain the vowel /a/. The controlled ambient noise averaged at 29.61 dB SPL was added digitally to the smartphone voice recordings. Repeated measures analysis of variances (ANOVA) with Greenhouse-Geiser correction was used to evaluate AVQI changes within subjects. To evaluate the level of agreement between AVQI measurements obtained from different voice recordings Bland-Altman plots were used.

RESULTS

Repeated measures ANOVA showed that differences among AVQI results obtained from voice recordings done with oral studio microphone, recordings done with a smartphone microphone, and recordings done with a smartphone microphone with added ambient noise were not statistically significant (P = 0.07). No significant systemic differences and acceptable level of random errors in AVQI measurements of voice recordings made with oral and smartphone microphones (including added noise) were revealed.

CONCLUSION

The AVQI measures obtained from smartphone microphones voice recordings with experimentally added ambient noise revealed an acceptable agreement with results of oral microphone recordings, thus suggesting the suitability of smartphone microphone recordings performed even in the presence of acceptable ambient noise for estimation of AVQI.

Using Crowd-Sourced Speech Data to Study Socially Constrained Variation in Nonmodal Phonation

This study examines the status of nonmodal phonation (e.g. breathy and creaky voice) in British English using smartphone recordings from over 2,500 speakers. With this novel data collection method, it uncovers effects that have not been reported in past work, such as a relationship between speakers’ education and their production of nonmodal phonation. The results also confirm that previous findings on nonmodal phonation, including the greater use of creaky voice by male speakers than female speakers, extend to a much larger and more diverse sample than has been considered previously. This confirmation supports the validity of using crowd-sourced data for phonetic analyses. The acoustic correlates that were examined include fundamental frequency, H1*-H2*, cepstral peak prominence, and harmonic-to-noise ratio.

How can technology assist occupational voice users?

SUMMARY

The voice is an important tool for people who use it daily in their occupations. However, what technological options are available to such individuals to allow them to monitor or take care of their voices?

OBJECTIVE

The purpose of this study is to answer two research questions: (1) What technologies exist to monitor or take care of the voice in occupational voice users? (2) What is the technology readiness level (TRL) of the technologies used to monitor or take care of the voice in occupational voice users?

DATA SOURCES

Embase, IEEE, Medline, Proquest, PubMed, Scopus, and Web of Science.

METHODS

A systematic literature review was conducted. Articles that reported results regarding technologies (hardware, software, or mobile apps) that were used to monitor or take care of the voice in occupational voice users were included.

RESULTS

After reviewing 4581 abstracts, 10 full text studies were included in the literature review. The technologies found include 30% hardware, 30% hardware plus software, and 50% mobile apps, with an overall TRL mean of 5.3 (SD = 2.3).

CONCLUSION

Further research is necessary for higher validity in the studies and to increase the readiness in the development of current technologies to offer more options for this population.Implications for RehabilitationThe evidence for the impact of the use of the technologies for occupational voice users is still lowThere is emerging evidence that mobile apps and artificial intelligence algorithms can be used to investigate vocal disorders or potential risks in occupational voice usersMore research is required to increase the readiness developmental stage of current technologies for occupational voice users.

Evaluation of Speech-Based Digital Biomarkers: Review and Recommendations

Speech represents a promising novel biomarker by providing a window into brain health, as shown by its disruption in various neurological and psychiatric diseases. As with many novel digital biomarkers, however, rigorous evaluation is currently lacking and is required for these measures to be used effectively and safely. This paper outlines and provides examples from the literature of evaluation steps for speech-based digital biomarkers, based on the recent V3 framework (Goldsack et al., 2020). The V3 framework describes 3 components of evaluation for digital biomarkers: verification, analytical validation, and clinical validation. Verification includes assessing the quality of speech recordings and comparing the effects of hardware and recording conditions on the integrity of the recordings. Analytical validation includes checking the accuracy and reliability of data processing and computed measures, including understanding test-retest reliability, demographic variability, and comparing measures to reference standards. Clinical validity involves verifying the correspondence of a measure to clinical outcomes which can include diagnosis, disease progression, or response to treatment. For each of these sections, we provide recommendations for the types of evaluation necessary for speech-based biomarkers and review published examples. The examples in this paper focus on speech-based biomarkers, but they can be used as a template for digital biomarker development more generally.

COVID-19 and ENT SLT services, workforce and research in the UK: A discussion paper

BACKGROUND

The COVID-19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high-risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future.

AIMS

To discuss the threats and opportunities from the COVID-19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership.

METHODS & PROCEDURES

The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple-group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors.

MAIN CONTRIBUTION

The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID-19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non-instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face-to-face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge.

CONCLUSIONS & IMPLICATIONS

The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post-COVID era to re-evaluate current practice, embrace opportunities and evaluate new ways of working. What this paper adds What is already known on the subject ENT/laryngology SLTs manage patients with a range of conditions, including voice disorders, airway problems and HNCs. The diverse scope of clinical practice involves highly specialized assessment and treatment practices in patients in high-risk categories. A large majority of active research projects in this field are patient focused and involve instrumental assessment. The COVID-19 pandemic has created both opportunities and threats for ENT SLT clinical services, workforce and research. What this paper adds to existing knowledge This study provides a discussion of the threats and opportunities from the COVID-19 pandemic for ENT/laryngology SLT with specific reference to clinical practice, workforce and research leadership. What are the potential or actual clinical implications of this work? The COVID-19 pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. Changes to clinical practice, professional remits and research priorities are of indeterminant duration at this time, and some components could be permanent. Significant clinical practice, workforce and research opportunities may exist in the post-COVID era.

Passive Sensing of Health Outcomes Through Smartphones: Systematic Review of Current Solutions and Possible Limitations

BACKGROUND

Technological advancements, together with the decrease in both price and size of a large variety of sensors, has expanded the role and capabilities of regular mobile phones, turning them into powerful yet ubiquitous monitoring systems. At present, smartphones have the potential to continuously collect information about the users, monitor their activities and behaviors in real time, and provide them with feedback and recommendations.

OBJECTIVE

This systematic review aimed to identify recent scientific studies that explored the passive use of smartphones for generating health- and well-being-related outcomes. In addition, it explores users' engagement and possible challenges in using such self-monitoring systems.

METHODS

A systematic review was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to identify recent publications that explore the use of smartphones as ubiquitous health monitoring systems. We ran reproducible search queries on PubMed, IEEE Xplore, ACM Digital Library, and Scopus online databases and aimed to find answers to the following questions: (1) What is the study focus of the selected papers? (2) What smartphone sensing technologies and data are used to gather health-related input? (3) How are the developed systems validated? and (4) What are the limitations and challenges when using such sensing systems?

RESULTS

Our bibliographic research returned 7404 unique publications. Of these, 118 met the predefined inclusion criteria, which considered publication dates from 2014 onward, English language, and relevance for the topic of this review. The selected papers highlight that smartphones are already being used in multiple health-related scenarios. Of those, physical activity (29.6%; 35/118) and mental health (27.9; 33/118) are 2 of the most studied applications. Accelerometers (57.7%; 67/118) and global positioning systems (GPS; 40.6%; 48/118) are 2 of the most used sensors in smartphones for collecting data from which the health status or well-being of its users can be inferred.

CONCLUSIONS

One relevant outcome of this systematic review is that although smartphones present many advantages for the passive monitoring of users' health and well-being, there is a lack of correlation between smartphone-generated outcomes and clinical knowledge. Moreover, user engagement and motivation are not always modeled as prerequisites, which directly affects user adherence and full validation of such systems.