Research Article| Volume 31, ISSUE 4, P504.e21-504.e33, July 2017

Are Instructions to Manipulate Specific Parameters of Laryngeal Function Associated with Auditory-Perceptual Ratings of Voice Quality in Nondisordered Speakers?

  • Catherine J. Madill
    Address correspondence and reprint requests to Catherine J. Madill, Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia.
    Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
    Search for articles by this author
  • Christine Sheard
    Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
    Search for articles by this author
  • Robert Heard
    Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
    Search for articles by this author
Published:December 16, 2016DOI:



      This preliminary study investigated whether auditory-perceptual judgments of voice quality by experienced speech language pathologists were associated with instructions given to speakers to manipulate specific laryngeal postures.

      Study Design

      Experimental, within-subject design.


      Nine speakers were instructed and trained to manipulate three vocal parameters implicated in functional voice disorders—false vocal fold constriction, vocal fold mass, and larynx height—while reading a standard passage. Experienced judges rated these standard passages in terms of the widely used perceptual voice qualities breathiness, roughness, vocal strain, glottal fry, tone onset, tone color, loudness, and pitch.


      Between-subject factorial analysis of variance, controlling for judge unreliability, revealed some evidence that perceptual judgments are strongly associated with underlying laryngeal muscle activity that can then serve clinical planning of goals for intervention. Eta2 effect sizes were large for all dependent measures, ranging from 0.39 for pitch to 0.77 for strained.


      Although these results are encouraging, they were obtained under ideal conditions. Further research is warranted.

      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


        • Alipour F.
        • Karnell M.
        Aerodynamic and acoustic effects of ventricular gap.
        J Voice. 2014; 28: 154-160
        • Bele I.V.
        Reliability in perceptual analysis of voice quality.
        J Voice. 2005; 19 (Epub 2005/11/23): 555-573
        • Sataloff R.
        • Spiegel R.
        • Hawkshaw M.
        History and physical examination of patients with voice disorders.
        in: Diagnosis and Treatment of Voice Disorders. 2003: 2
        • Hirano H.
        Cover-body theory of vocal fold vibration.
        in: Daniloff R. Speech Science. College Hill, San Diego, CA1985: 1-34
        • 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
        • Kempster G.B.
        • Gerratt B.R.
        • Abbott K.V.
        • et al.
        Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol.
        Am J Speech Lang Pathol. 2009; 18: 124-132
        • Nawka T.
        • Anders L.C.
        • Wendler J.
        Auditory assessment of hoarse voices according to the RBH scale.
        Sprache Stimme Gehor. 1994; 18: 130-133
        • Hirano H.
        Clinical Examination of Voice.
        Springer-Verlag Wien, New York, NY1981
        • Barsties B.
        • De Bodt M.
        Assessment of voice quality: current state-of-the-art.
        Auris Nasus Larynx. 2015; 42: 183-188
        • Oates J.
        Auditory-perceptual evaluation of disordered voice quality pros, cons and future directions.
        Folia Phoniatr Logop. 2009; 61: 49-56
        • Kreiman J.
        • Shue Y.-L.
        • Chen G.
        • et al.
        Variability in the relationships among voice quality, harmonic amplitudes, open quotient, and glottal area waveform shape in sustained phonation.
        J Acoust Soc Am. 2012; 132: 2625-2632
        • Chen S.H.
        • Hsiao T.Y.
        • Hsiao L.C.
        • et al.
        Outcome of resonant voice therapy for female teachers with voice disorders: perceptual, physiological, acoustic, aerodynamic, and functional measurements.
        J Voice. 2007; 21 (Epub 2006/04/04): 415-425
        • Carding P.N.
        • Horsley I.A.
        • Docherty G.J.
        A study of the effectiveness of voice therapy in the treatment of 45 patients with nonorganic dysphonia.
        J Voice. 1999; 13 (Epub 1999/05/01): 72-104
        • Smith C.G.
        • Finnegan E.M.
        • Karnell M.P.
        Resonant voice: spectral and nasendoscopic analysis.
        J Voice. 2005; 19: 607-622
        • Signorello R.
        • Zhang Z.
        • Gerratt B.
        • et al.
        Impact of vocal tract resonance on the perception of voice quality changes caused by varying vocal fold stiffness.
        Acta Acust United Ac. 2016; 102: 209-213
        • Samlan R.A.
        • Kreiman J.
        Perceptual consequences of changes in epilaryngeal area and shape.
        J Acoust Soc Am. 2014; 136: 2798-2806
        • Laukkanen A.M.
        • Björkner E.
        • Sundberg J.
        Throaty voice quality: subglottal pressure, voice source, and formant characteristics.
        J Voice. 2006; 20: 25-37
        • Sundberg J.
        • Thalén M.
        • Alku P.
        • et al.
        Estimating perceived phonatory pressedness in singing from flow glottograms.
        J Voice. 2004; 18: 56-62
        • Estill J.
        An Analysis of the Spectra of Four Voice Qualities: Speech, Sob, Twang, and Opera. Voice Foundation's 10th Annual Symposium.
        The Voice Foundation, New York, NY1981
        • Yanagisawa E.
        • Estill J.
        • Mambrino L.
        • et al.
        Supraglottic contributions to pitch raising. Videoendoscopic study with spectroanalysis.
        Ann Otol Rhinol Laryngol. 1991; 100: 19-30
        • Colton R.H.
        • Estill J.
        Elements of voice quality: perceptual, acoustic, and physiologic aspects.
        Speech Lang. 1981; 5: 311-401
        • Kotby M.N.
        • Kirchner J.A.
        • Kahane J.C.
        • et al.
        Histoanatomical structure of the human laryngeal ventricle.
        Acta Otolaryngol. 1991; 1111: 396-402
        • Reidenbach M.
        The muscular tissue of the vestibular folds of the larynx.
        Eur Arch Otorhinolaryngol. 1998; 255: 365-367
        • Bailly L.
        • Bernardoni N.H.
        • Mueller F.
        • et al.
        Ventricular-fold dynamics in human phonation.
        J Speech Lang Hear Res. 2014; 57: 1219-1242
        • Allen E.L.
        • Hollien H.
        A laminagraphic study of pulse (vocal fry) register phonation.
        Folia Phoniatr (Basel). 1973; 25 (Epub 1973/01/01): 241-250
        • Kasuya H.
        • Ando Y.
        Acoustic analysis, synthesis and perception of breathy voice.
        in: Gauffin J. Hammarberg B. Vocal Fold Physiology: Acoustic, Perceptual and Physiological Aspects of Voice Mechanisms. Singular, San Diego, CA1991: 251-258
        • Bhuta T.
        • Patrick L.
        • Garnett J.D.
        Perceptual evaluation of voice quality and its correlation with acoustic measurements.
        J Voice. 2004; 18 (Epub 2004/08/28): 299-304
        • Titze I.R.
        Principles of Voice Production.
        Prentice Hall, Englewood Cliffs, NJ1994
        • Citardi M.J.
        • Yanagisawa E.
        • Estill J.
        Videoendoscopic analysis of laryngeal function during laughter.
        Ann Otol Rhinol Laryngol. 1996; 105 (Epub 1996/07/01): 545-549
        • Kmucha S.T.
        • Yanagisawa E.
        • Estill J.
        Endolaryngeal changes during high-intensity phonation videolaryngoscopic observations.
        J Voice. 1990; 4: 346-354
        • Harris S.
        Speech therapy for dysphonia.
        in: Harris T. Harris S. Rubin J.S. The Voice Clinic Handbook. Whurr, London, UK1998: 139-206
        • Oates J.M.
        Voice disorders associated with hyperfunction.
        • Boone D.R.
        • McFarlane S.C.
        A critical view of the yawn-sigh as a voice therapy technique.
        J Voice. 1993; 7 (Epub 1993/03/01): 75-80
        • Colton R.H.
        • Casper J.
        • Leonard R.
        Understanding Voice Problems: A Physiological Perspective for Diagnosis and Treatment.
        3rd ed. Lippincott, Williams & Wilkinson, Baltimore, MD2006
        • Boone D.R.
        • McFarlane S.C.
        The Voice and Voice Therapy.
        6th ed. Allyn & Bacon, Boston, MA2000
        • Stemple J.C.
        • Glaze L.E.
        • Gerdeman B.K.
        Clinical Voice Pathology: Theory and Management.
        2nd ed. Singular, San Diego, CA1995
        • Hollien H.
        Vocal fold thickness and fundamental frequency of phonation.
        J Speech Hear Res. 1962; 5 (Epub 1962/09/01): 237-243
        • Hollien H.
        On vocal registers.
        J Phon. 1974; 2: 125-143
        • Henrich N.
        Mirroring the voice from Garcia to the present day: some insights into singing voice registers.
        Logoped Phoniatr Vocol. 2006; 31 (Epub 2006/03/15): 3-14
        • Hollien H.
        • Damste H.
        • Murry T.
        Vocal fold length during vocal fry phonation.
        Folia Phoniatr (Basel). 1969; 21 (Epub 1969/01/01): 257-265
        • Li N.Y.K.
        • Yiu E.M.L.
        Acoustic and perceptual analysis of modal and falsetto registers in females with dysphonia.
        Clin Linguist Phon. 2006; 20: 463-481
        • Bjorkner E.
        • Sundberg J.
        • Cleveland T.
        • et al.
        Voice source differences between registers in female musical theater singers.
        J Voice. 2006; 20 (Epub 2005/07/30): 187-197
        • Sundberg J.
        • Högset J.S.C.
        Voice source differences between falsetto and modal registers in counter tenors, tenors and baritones.
        Logoped Phonatr Vocol. 2001; 26: 26-36
        • Murry T.
        • Xu J.J.
        • Woodson G.E.
        Glottal configuration associated with fundamental frequency and vocal register.
        J Voice. 1998; 12: 44-49
        • Bagnall A.D.
        Voicecraft Workshop Manual.
        Voicecraft International, Adelaide, SA1977
        • Estill J.
        Compulsory Figures for Voice—Level One, Primer of Compulsory Figures.
        Rev. ed. Estill Voice Training Systems, Santa Rosa, CA1997
        • Steinhauer K.M.
        • Grayhack J.P.
        • Smiley-Oyen A.L.
        • et al.
        The relationship among voice onset, voice quality, and fundamental frequency: a dynamic perspective.
        J Voice. 2004; 18: 432-442
        • Hertegard S.
        • Gauffin J.
        • Sundberg J.
        Open and covered singing as studied by fibre optics, inverse filtering and spectral analysis.
        J Voice. 1990; 4: 220-230
        • Honda K.
        • Hirai H.
        • Estill J.
        • et al.
        Contributions of vocal tract shape to voice quality: MRI data and articulatory modelling.
        in: Fujimura O. Hirano M. Vocal Fold Physiology: Voice Quality Control. Singular, San Diego, CA1995: 23-38
        • Honda K.
        • Hirai H.
        • Masaki S.
        • et al.
        Role of vertical larynx movement and cervical lordosis in Fo control.
        Lang Speech. 1999; 42: 401
        • Sundberg J.
        • Askenfelt A.G.
        Larynx height and voice source: a relationship?.
        in: Bless D.M. Abbs J.M. Vocal Fold Physiology: Contemporary Research and Clinical Issues. College Hill, San Diego, CA1983: 307-316
        • Sheard C.
        • Adams R.D.
        • Davis P.J.
        Reliability and agreement of ratings of ataxic dysarthric speech samples with varying intelligibility.
        J Speech Lang Hear Res. 1991; 34: 285
        • Bergan C.C.
        • Titze I.R.
        Perception of pitch and roughness in vocal signals with subharmonics.
        J Voice. 2001; 15 (Epub 2001/06/20): 165-175
        • Gerratt B.R.
        • Kreiman J.
        Measuring vocal quality with speech synthesis.
        J Acoust Soc Am. 2001; 110 (Epub 2002/01/05): 2560-2566
        • Klatt D.H.
        • Klatt L.C.
        Analysis, synthesis, and perception of voice quality variations among female and male talkers.
        J Acoust Soc Am. 1990; 87: 820-857
        • Kreiman J.
        • Garellek M.
        • Chen G.
        • et al.
        Perceptual evaluation of voice source models.
        J Acoust Soc Am. 2015; 138: 1-10
        • Madill C.
        • Sheard C.
        • Heard R.
        Differentiated vocal tract control and the reliability of interpretations of nasendoscopic assessment.
        J Voice. 2010; 24: 337-345
        • Titze I.R.
        Workshop on Acoustic Voice Analysis: Summary Statement.
        National Centre for Voice and Speech, Denver, CO1995
        • Syntrillium Software Corporation
        Cool Edit Pro LE Version 1.2.
        Syntrillium Software Corporation, Phoenix, AZ1999
        • Fairbanks G.
        Voice and Articulation Handbook.
        Harper and Row, New York, NY1960
        • Horii Y.
        Some statistical characteristics of voice fundamental frequency.
        J Speech Hear Res. 1975; 18 (Epub 1975/03/01): 192-201
        • Oates J.
        • Russell A.
        Learning voice analysis using an interactive multi-media package: development and preliminary evaluation.
        J Voice. 1998; 12: 500-512
        • Hammarberg B.
        Voice research and clinical needs.
        Folia Phoniatr Logop. 2000; 52 (Epub 1999/09/04): 93-102
        • Bunch M.A.
        A cephalometric study of structures of the head and neck during sustained phonation of covered and open qualities.
        Folia Phoniatr (Basel). 1976; 28 (Epub 1976/01/01): 321-328
        • Microsoft
        Excel 5.0.
        Microsoft Corporation, Bellview, WA2002
        • Portney L.G.
        • Watkins M.P.
        Foundations of Clinical Research: Applications to Practice.
        Appleton & Lange, Norwalk, CT1993
        • Murphy K.R.
        • Myors B.
        Statistical Power Analysis: A Simple and General Model for Traditional and Modern Hypothesis Tests.
        L. Erlbaum Associates, Mahwah, NJ1998
        • Kahane J.
        Musculature and mechanisms of the laryngeal vestibule.
        in: The Voice Foundation's 31st Annual Symposium: Care of the Professional Voice. The Voice Foundation, Philadelphia, PA2002
        • Hammarberg B.
        • Fritzell B.
        • Gauffin J.
        • et al.
        Acoustic and perceptual analysis of vocal dysfunction.
        J Phon. 1986; 14: 533-547
        • Fritzell B.
        • Hammarberg B.
        • Gauffin J.
        • et al.
        Breathiness and insufficient vocal fold closure.
        J Phon. 1986; 14: 549-553
        • Baken R.J.
        • Orlikoff R.F.
        Clinical Measurement of Speech and Voice.
        Singular Publishing Group, San Diego, CA2000
        • Kreiman J.
        • Gerratt B.R.
        Sources of listener disagreement in voice quality assessment.
        J Acoust Soc Am. 2000; 108: 1867-1876
        • Kreiman J.
        • Gerratt B.
        Measuring vocal quality.
        in: Kent R.D. Ball M.J. Voice Quality Measurement. Singular, San Diego, CA2000: 73-101
        • Gerratt B.R.
        • Kreiman J.
        • Antonanzas-Barroso N.
        • et al.
        Comparing internal and external standards in voice quality judgments.
        J Speech Hear Res. 1993; 36: 14-20
        • Kreiman J.
        • Gerratt B.R.
        • Kempster G.B.
        • et al.
        Perceptual evaluation of voice quality: review, tutorial, and a framework for future research.
        J Speech Hear Res. 1993; 36: 21-40
        • Chan K.M.K.
        • Yiu E.M.L.
        The effect of anchors and training on the reliability of perceptual voice evaluation.
        J Speech Lang Hear Res. 2002; 45: 111
        • Eadie T.L.
        • Baylor C.R.
        The effect of perceptual training on inexperienced listeners' judgments of dysphonic voice.
        J Voice. 2005; 20 (Epub 2005/12/06): 527-544
        • Chan K.M.
        • Yiu E.M.
        A comparison of two perceptual voice evaluation training programs for naive listeners.
        J Voice. 2006; 20 (Epub 2005/09/06): 229-241
        • De Bodt M.S.
        • Wuyts F.L.
        • Van de Heyning P.H.
        • et al.
        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
        • Dejonckere P.H.
        • Obbens C.
        • de Moor G.M.
        • et al.
        Perceptual evaluation of dysphonia: reliability and relevance.
        Folia Phoniatr (Basel). 1993; 45 (Epub 1993/01/01): 76-83
        • Mathieson L.
        • Greene M.C.L.
        Greene and Mathieson's the voice and its disorders.
        Whurr, London2001