Toward Improved Ecological Validity in the Acoustic Measurement of Overall Voice Quality: Combining Continuous Speech and Sustained Vowels

  • Youri Maryn
    Address correspondence and reprint requests to Youri Maryn, Department of Speech-Language Pathology and Audiology, Sint-Jan General Hospital, Ruddershove 10, 8000 Bruges, Belgium.
    Department of Otorhinolaryngology, Head and Neck Surgery, Speech-Language Pathology and Audiology, Sint-Jan General Hospital, Bruges, Belgium

    Faculty of Health Care Vesalius, University College Ghent, Ghent, Belgium

    Department of Otorhinolaryngology & Head and Neck Surgery and Speech-Language Pathology, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
    Search for articles by this author
  • Paul Corthals
    Faculty of Health Care Vesalius, University College Ghent, Ghent, Belgium

    Department of Otorhinolaryngology & Head and Neck Surgery and Speech-Language Pathology, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
    Search for articles by this author
  • Paul Van Cauwenberge
    Department of Otorhinolaryngology & Head and Neck Surgery and Speech-Language Pathology, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
    Search for articles by this author
  • Nelson Roy
    Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah
    Search for articles by this author
  • Marc De Bodt
    Department of Otorhinolaryngology & Head and Neck Surgery and Speech-Language Pathology, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium

    Department of Otorhinolaryngology & Head and Neck Surgery and Communication Disorders, University Hospital, Antwerp, Belgium
    Search for articles by this author
Published:November 02, 2009DOI:


      To improve ecological validity, perceptual and instrumental assessment of disordered voice, including overall voice quality, should ideally sample both sustained vowels and continuous speech. This investigation assessed the utility of combining both voice contexts for the purpose of auditory-perceptual ratings as well as acoustic measurement of overall voice quality. Sustained vowel and continuous speech samples from 251 subjects with (n=229) or without (n=22) various voice disorders were concatenated and perceptually rated on overall voice quality by five experienced voice clinicians. After removing the nonvoiced segments within the continuous speech samples, the concatenated samples were analyzed using 13 acoustic measures based on fundamental frequency perturbation, amplitude perturbation, spectral and cepstral analyses. Stepwise multiple regression analysis yielded a six-variable acoustic model for the multiparametric measurement of overall voice quality of the concatenated samples (with a cepstral measure as the main contributor to the prediction of overall voice quality). The correlation of this model with mean ratings of overall voice quality resulted in rs=0.78. A cross-validation approach involving the iterated internal cross-correlations with 30 subgroups of 100, 50, and 10 samples confirmed a comparable degree of association. Furthermore, the ability of the model to distinguish voice-disordered from vocally normal participants was assessed using estimates of diagnostic precision including receiver operating characteristic (ROC) curve analysis, sensitivity, and specificity, as well as likelihood ratios (LRs), which adjust for base-rate differences between the groups. Depending on the cutoff criteria employed, the analyses revealed an impressive area under ROC=0.895 as well as respectable sensitivity, specificity, and LR. The results support the diagnostic utility of combining voice samples from both continuous speech and sustained vowels in acoustic and perceptual analysis of disordered voice. The findings are discussed in relation to the extant literature and the need for further refinement of the acoustic algorithm.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hirano M.
        Psycho-acoustic evaluation of voice.
        in: Arnold G.E. Winckel F. Wyke B.D. Disorders of Human Communication 5. Clinical Examination of Voice. Springer-Verlag, Vienna, Austria1981: 81-84
      1. Hillman R. Overview of the consensus auditory-perceptual evaluation of voice (CAPE-V), instrument developed by ASHA Special Interest Division 3. Presented at: 32nd Symposium of the Voice Foundation: Care of the Professional Voice; June 4–8, 2003; Philadelphia.

        • Kempster G.B.
        • Gerratt B.R.
        • Verdolini Abbott K.
        • Barkmeier-Kraemer J.
        • Hillman R.E.
        Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol.
        Am J Speech Lang Pathol. 2008; (epub ahead of print)
        • De Bodt M.
        • Van de Heyning P.H.
        • Wuyts F.L.
        • Lambrechts L.
        The perceptual evaluation of voice disorders.
        Acta Otorhinolaryngol Belg. 1996; 50: 283-291
      2. De Bodt M. A framework for voice assessment, the relation between subjective and objective parameters in the judgment of normal and pathological voice [unpublished doctoral dissertation]. Antwerp, Belgium: University of Antwerp; 1997.

        • Bele I.V.
        Reliability in perceptual analysis of voice quality.
        J Voice. 2005; 19: 555-573
        • Kreiman J.
        • Gerratt B.R.
        • Kempster G.B.
        • Erman A.
        • Berke G.S.
        Perceptual evaluation of voice quality: review, tutorial, and a framework for research.
        J Speech Hear Res. 1993; 36: 21-40
        • Kreiman J.
        • Gerratt B.R.
        • Precoda K.
        Listener experience and perception of voice quality.
        J Speech Hear Res. 1990; 33: 103-115
        • Kreiman J.
        • Gerratt B.R.
        • Precoda K.
        • Berke G.
        Individual differences in voice quality perception.
        J Speech Hear Res. 1992; 35: 512-520
        • De Bodt M.S.
        • Wuyts F.L.
        • Van de Heyning P.H.
        • Croux C.
        Test-retest study of the GRBAS scale: influence of experience and professional background on perceptual rating of voice quality.
        J Voice. 1997; 11: 74-80
        • Wolfe V.I.
        • Martin D.P.
        • Palmer C.I.
        Perception of dysphonic voice quality by naïve listeners.
        J Speech Lang Hear Res. 2000; 43: 697-705
        • Eadie T.L.
        • Baylor C.R.
        The effect of perceptual training on inexperienced listeners' judgments of dysphonic voice.
        J Voice. 2006; 20: 527-544
        • Rabinov C.R.
        • Kreiman J.
        • Gerratt B.R.
        • Bielamowicz S.
        Comparing reliability of perceptual ratings of roughness and acoustic measure of jitter.
        J Speech Hear Res. 1995; 38: 26-32
        • Dejonckere P.H.
        • Obbens C.
        • de Moor G.M.
        • Wieneke G.H.
        Perceptual evaluation of dysphonia: reliability and relevance.
        Folia Phoniatr. 1993; 45: 76-83
        • Wuyts F.L.
        • De Bodt M.S.
        • Van de Heyning P.H.
        Is the reliability of a visual analog scale higher than an ordinal scale? An experiment with the GRBAS scale for the perceptual evaluation of dysphonia.
        J Voice. 1999; 13: 508-517
        • Eadie T.L.
        • Doyle P.C.
        Direct magnitude estimation and interval scaling of pleasantness and severity in dysphonic and normal speakers.
        J Acoust Soc Am. 2002; 112: 3014-3021
        • Yu P.
        • Revis J.
        • Wuyts F.L.
        • Zanaret M.
        • Giovanni A.
        Correlation of instrumental voice evaluation with perceptual voice analysis using a modified visual analog scale.
        Folia Phoniatr Logop. 2002; 54: 271-281
        • Karnell M.P.
        • Melton S.D.
        • Childes J.M.
        • Coleman T.C.
        • Dailey S.A.
        • Hoffman H.T.
        Reliability of clinician-based (GRBAS and CAPE-V) and patient-based (V-RQOL and IPVI) documentation of voice disorders.
        J Voice. 2007; 21: 576-590
        • Zraick R.I.
        • Wendel K.
        • Smith-Olinde L.
        The effect of speaking task on perceptual judgment of the severity of dysphonic voice.
        J Voice. 2005; 19: 574-581
        • Orlikoff R.F.
        • Dejonckere P.H.
        • Dembowski J.
        • et al.
        The perceived role of voice perception in clinical practice.
        Phonoscope. 1999; 2: 89-104
        • Hammarberg B.
        • Fritzell B.
        • Gauffin J.
        • Sundberg J.
        • Wedin L.
        Perceptual and acoustic correlates of abnormal voice qualities.
        Acta Otolaryngol. 1980; 90: 441-451
        • Awan S.N.
        • Roy N.
        Toward the development of an objective index of dysphonia severity: a four-factor acoustic model.
        Clin Linguist Phon. 2006; 20: 35-49
        • Parsa V.
        • Jamieson D.G.
        Acoustic discrimination of pathological voice: sustained vowels versus continuous speech.
        J Speech Lang Hear Res. 2001; 44: 327-339
        • Portney L.G.
        • Watkins M.P.
        Foundations of Clinical Research: Applications to Practice.
        2nd Ed. Prentice-Hall, Upper Saddle River, NJ2000
        • Buder E.H.
        Acoustic analysis of voice quality: a tabulation of algorithms 1902–1990.
        in: Kent R.D. Ball M.J. Voice Quality Measurement. Singular Publishing Group, San Diego, CA2000: 119-244
      3. Maryn Y, De Bodt M, Van Cauwenberge P, Roy N, Corthals P. Acoustic measurement of overall voice quality: a meta-analysis. J Acoust Soc Am. 2008. Submitted for publication.

        • Murry T.
        • Doherty E.T.
        Selected acoustic characteristics of pathological and normal speakers.
        J Speech Hear Res. 1980; 23: 361-369
        • Askenfelt A.G.
        • Hammarberg B.
        Speech waveform perturbation analysis: a perceptual-acoustical comparison of seven measures.
        J Speech Hear Res. 1986; 29: 50-64
        • Yiu E.
        • Worrall L.
        • Longland J.
        • Mitchell C.
        Analysing vocal quality of connected speech using Kay's computerized speech lab: a preliminary finding.
        Clin Linguist Phon. 2000; 14: 295-305
        • Roy N.
        • Gouse M.
        • Mauszycki S.C.
        • Merrill R.M.
        • Smith M.E.
        Task specificity in adductor spasmodic dysphonia versus muscle tension dysphonia.
        Laryngoscope. 1995; 115: 311-316
        • de Krom G.
        Consistency and reliability of voice quality ratings for different types of speech fragments.
        J Speech Hear Res. 1994; 37: 985-1000
        • Revis J.
        • Giovanni A.
        • Wuyts F.
        • Triglia J.M.
        Comparison of different voice samples for perceptual analysis.
        Folia Phoniatr Logop. 1999; 51: 108-116
        • Wolfe V.
        • Cornell R.
        • Fitch J.
        Sentence/vowel correlation in the evaluation of dysphonia.
        J Voice. 1995; 9: 297-303
        • Hillenbrand J.
        • Houde R.A.
        Acoustic correlates of breathy vocal quality: dysphonic voices and continuous speech.
        J Speech Hear Res. 1996; 39: 311-321
        • Prosek R.A.
        • Montgomery A.A.
        • Walden E.
        • Hawkins D.B.
        An evaluation of residue features as correlates of voice disorders.
        J Commun Dis. 1987; 20: 105-117
        • Eskenazi L.
        • Childers D.G.
        • Hicks D.M.
        Acoustic correlates of vocal quality.
        J Speech Hear Res. 1990; 33: 298-306
        • Wolfe V.
        • Fitch J.
        • Cornell R.
        Acoustic prediction of severity in commonly occurring voice problems.
        J Speech Hear Res. 1995; 38: 273-279
        • Giovanni A.
        • Robert D.
        • Estublier N.
        • Teston B.
        • Zanaret M.
        • Cannoni M.
        Objective evaluation of dysphonia: preliminary results of a device allowing simultaneous acoustic and aerodynamic measurements.
        Folia Phoniatr Logop. 1996; 48: 175-185
        • Wolfe V.
        • Fitch J.
        • Martin D.
        Acoustic measures of dysphonic severity across and within voice types.
        Folia Phoniatr Logop. 1997; 49: 292-299
        • Piccirillo J.F.
        • Painter C.
        • Fuller D.
        • Haiduk A.
        • Fredrickson J.M.
        Assessment of two objective voice function indices.
        Ann Otol Rhinol Laryngol. 1998; 107: 396-400
        • Wuyts F.L.
        • De Bodt M.S.
        • Molenberghs G.
        • et al.
        The dysphonia severity index: an objective measure of vocal quality based on a multiparameter approach.
        J Speech Lang Hear Res. 2000; 43: 796-809
        • Yu P.
        • Ouaknine M.
        • Revis J.
        • Giovanni A.
        Objective voice analysis for dysphonic patients: a multiparametric protocol including acoustic and aerodynamic measurements.
        J Voice. 2001; 15: 529-542
        • Bhuta T.
        • Patrick L.
        • Garnett J.D.
        Perceptual evaluation of voice quality and its correlation with acoustic measurement.
        J Voice. 2004; 18: 299-304
        • Ma E.
        • Yiu E.
        Multiparametric evaluation of dysphonic severity.
        J Voice. 2006; 20: 380-390
        • Jacobson B.H.
        • Johnson A.
        • Grywalski C.
        • Silbergleit A.
        • Jacobson G.
        • Benninger M.S.
        The voice handicap index (VHI): development and validation.
        Am J Speech Lang Pathol. 1997; 6: 66-70
        • Van de Weijer J.C.
        • Slis I.H.
        Nasaliteitsmeting met de nasometer.
        Tijdschrift voor Logopedie en Foniatrie. 1991; 63: 97-101
      4. Van Lierde K. Nasalance and nasality in clinical practice [unpublished doctoral dissertation]. Ghent, Belgium: University of Ghent; 2001.

        • AKG Acoustics
        C420: User Instruction. MicroMic Series II.
        AKG Acoustics Harman Pro, München, Germany2000
        • Roark R.M.
        Frequency and voice: perspectives in the time domain.
        J Voice. 2006; 20: 325-354
        • KayPentax
        Multi-Speech and CSL Software: Software Instruction Manual.
        KayPentax, Lincoln Park, NJ2004
        • Boersma P.
        Praat, a system for doing phonetics by computer.
        Glot Int. 2001; 5: 341-345
      5. Boersma P, Weenink D [computer program]. Praat: Doing Phonetics by Computer (Version 4.6.15). Amsterdam, The Netherlands: Institute of Phonetic Sciences; 2006. Available at: Accessed February 20, 2007.

        • Chan K.M.
        • Yiu E.M.
        The effect of anchors and training on the reliability of perceptual voice evaluation.
        J Speech Lang Hear Res. 2002; 45: 111-126
        • Kreiman J.
        • Gerratt B.
        Measuring vocal quality.
        in: Kent R.D. Ball M.J. Voice Quality Measurement. Singular Publishing Group, San Diego, CA2000: 73-101
      6. Hillenbrand J. SpeechTool, Version 1.56 [computer program], 2006. Available at: Accessed February 20, 2007.

        • Hillenbrand J.
        • Cleveland R.A.
        • Erickson R.L.
        Acoustic correlates of breathy vocal quality.
        J Speech Hear Res. 1994; 37: 769-778
        • Cohen J.A.
        A coefficient of agreement for nominal scales.
        Educ Psychol Meas. 1960; 20: 37-46
        • Sheskin D.J.
        Handbook of Parametric and Nonparametric Statistical Procedures.
        CRC Press LLC, Boca Raton, FL1997
        • Frey L.R.
        • Botan C.H.
        • Friedman P.G.
        • Kreps G.L.
        Investigating Communication: An Introduction to Research Methods.
        Prentice-Hall, Englewood Cliffs, NJ1991
        • Parsa V.
        • Jamieson D.G.
        Identification of pathological voices using glottal noise measures.
        J Speech Lang Hear Res. 2000; 43: 469-485
        • Heman-Ackah Y.D.
        • Heuer R.J.
        • Michael D.D.
        • et al.
        Cepstral peak prominence: a more reliable measure of dysphonia.
        Ann Otol Rhinol Laryngol. 2003; 112: 324-333
        • Umapathy K.
        • Krishnan S.
        • Parsa V.
        • Jamieson D.G.
        Discrimination of pathological voices using a time-frequency approach.
        IEEE T Bio-Med Eng. 2005; 52: 421-430
        • Dollaghan C.A.
        The Handbook for Evidence-Based Practice in Communication Disorders.
        MD Brookes, Baltimore, MD2007
        • Heman-Ackah Y.D.
        • Michael D.D.
        • Goding G.S.
        The relationship between cepstral peak prominence and selected parameters of dysphonia.
        J Voice. 2002; 16: 20-27
        • Dejonckere P.H.
        • Wieneke G.H.
        Cepstra of normal and pathological voices: correlation with acoustic, aerodynamic and perceptual data.
        in: Ball M.J. Duckworth M. Advances in Clinical Phonetics. John Benjamins Publishing Co, Amsterdam, The Netherlands1996: 217-226
        • Kreiman J.
        • Gerratt B.
        Perception of aperiodicity in pathological voice.
        J Acoust Soc Am. 2005; 117: 2201-2211
        • Kreiman J.
        • Gerratt B.R.
        • Ito M.
        When and why listeners disagree in voice quality assessment tasks.
        J Acoust Soc Am. 2007; 122: 2354-2364
        • Qi Y.
        • Hillman R.E.
        • Milstein C.
        The estimation of signal-to-noise ratio in continuous speech for disordered voices.
        J Acoustic Soc Am. 1999; 105: 2532-2535