Summary
Introduction
The diagnoses of voice disorders, as well as treatment outcomes, are often tracked
using visual (eg, stroboscopic images), auditory (eg, perceptual ratings), objective
(eg, from acoustic or aerodynamic signals), and patient report (eg, Voice Handicap
Index and Voice-Related Quality of Life) measures. However, many of these measures
are known to have low to moderate sensitivity and specificity for detecting changes
in vocal characteristics, including vocal quality.
Objective
The objective of this study was to compare changes in estimated pitch strength (PS)
with other conventionally used acoustic measures based on the cepstral peak prominence
(smoothed cepstral peak prominence, cepstral spectral index of dysphonia, and acoustic
voice quality index), and clinical judgments of voice quality (GRBAS [grade, roughness,
breathiness, asthenia, strain] scale) following laryngeal framework surgery.
Methods
This study involved post hoc analysis of recordings from 22 patients pretreatment
and post treatment (thyroplasty and behavioral therapy). Sustained vowels and connected
speech were analyzed using objective measures (PS, smoothed cepstral peak prominence,
cepstral spectral index of dysphonia, and acoustic voice quality index), and these
results were compared with mean auditory-perceptual ratings by expert clinicians using
the GRBAS scale.
Results
All four acoustic measures changed significantly in the direction that usually indicates
improved voice quality following treatment (P < 0.005). Grade and breathiness correlated the strongest with the acoustic measures
(|r| ~ 0.7) with strain being the least correlated.
Conclusions
Acoustic analysis on running speech highly correlates with judged ratings. PS is a
robust, easily obtained acoustic measure of voice quality that could be useful in
the clinical environment to follow treatment of voice disorders.
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 accessOne-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:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Evidence-based practice in communication disorders: An introduction [Technical Report].2004
- Evidence-based medicine.Semin Perinatol. 1997; 21: 3-5
- Factors influencing referral of patients with voice disorders from primary care to otolaryngology.Laryngoscope. 2014; 124: 214-220https://doi.org/10.1002/lary.24280
- What to expect during a visit with a voice doctor. Part II: the examination.J Singing. 2009; 65: 321
- Evidence-based clinical voice assessment: a systematic review.Am J Speech Lang Pathol. 2013; 22: 212-226
- Voice assessment: updates on perceptual, acoustic, aerodynamic, and endoscopic imaging methods.Curr Opin Otolaryngol Head Neck Surg. 2008; 16: 211-215
- Diagnostic accuracy of history, laryngoscopy, and stroboscopy.Laryngoscope. 2013; 123: 215-219
- Mucosal wave measurement and visualization techniques.J Voice. 2011; 25: 395-405
- Examiner bias: influence of patient history on perceptual ratings of videostroboscopy.J Voice. 1995; 9: 95-105
- Recognizing and understanding the limitations of laryngeal videostroboscopy.Perspect Voice Voice Disord. 2007; 17: 3-7
- The use of an auditory model in predicting perceptual ratings of breathy voice quality.J Voice. 2003; 17: 502-512
- Perceptual evaluation of voice quality: review, tutorial, and a framework for future research.J Speech Hear Res. 1993; 36: 21-40
- Improving Agreement Between Graduate Students And Experts For CAPE-V Measures [M.S.].MGH Institute of Health Professions, Ann Arbor, MI2015
- Effects of consensus training on the reliability of auditory perceptual ratings of voice quality.J Voice. 2012; 26: 304-312
- Auditory-perceptual evaluation of dysphonia: a comparison between narrow and broad terminology systems.J Voice. 2017; (pii: S0892-1997(17)30196-0)https://doi.org/10.1016/j.jvoice.2017.07.006
- Acoustic measurement of overall voice quality: a meta-analysis.J Acoust Soc Am. 2009; 126: 2619-2634
- Comparison of voice analysis systems for perturbation measurement.J Speech Hear Res. 1996; 39: 126-134
- Acoustic analyses of sustained and running voices from patients with laryngeal pathologies.J Voice. 2008; 22: 1-9
- Cepstral peak prominence: a more reliable measure of dysphonia.Ann Otol Rhinol Laryngol. 2003; 112: 324-333
- Workshop on Acoustic Voice Analysis: Summary Statement.(Denver, CO) National Center for Voice and Speech, 1995
- Suitability of dysphonia measurements for telemonitoring of Parkinson's disease.IEEE Trans Biomed Eng. 2009; 56: 1015
- The impact of vocal hyperfunction on relative fundamental frequency during voicing offset and onset.J Speech Lang Hear Res. 2010; 53: 1220-1226
- The relationship between cepstral peak prominence and selected parameters of dysphonia.J Voice. 2002; 16: 20-27
- The acoustic voice quality index: toward improved treatment outcomes assessment in voice disorders.J Commun Disord. 2010; 43: 161-174
- Validation of the cepstral spectral index of dysphonia (CSID) as a screening tool for voice disorders: development of clinical cutoff scores.J Voice. 2016; 30: 130-144
- Pitch strength of normal and dysphonic voices.J Acoust Soc Am. 2012; 131: 2261-2269
- Toward improved ecological validity in the acoustic measurement of overall voice quality: combining continuous speech and sustained vowels.J Voice. 2010; 24: 540-555
- Toward validation of the cepstral spectral index of dysphonia (CSID) as an objective treatment outcomes measure.J Voice. 2013; 27: 401-410
- Psychoacoustics: Facts and Models.Springer, New York; Berlin2007
- Modeling of breathy voice quality using pitch-strength estimates.J Voice. 2016; 30 (e1-774.e7): 774
- Pitch strength as an outcome measure for treatment of dysphonia.J Voice. 2017; 31: 691-696
- Use of spectral/cepstral analyses for differentiating normal from hypofunctional voices in sustained vowel and continuous speech contexts.J Speech Lang Hear Res. 2011; 54: 1525-1537
- Acoustic analyses of trained singers perceptually identified from speaking samples.J Voice. 2001; 15: 25-35
- PRAAT: A system for doing phonetics by computer. Report of the Institute of Phonetic Sciences of the University of Amsterdam 132.1996
- A sawtooth waveform inspired pitch estimator for speech and music.J Acoust Soc Am. 2008; 124: 1638-1652
- On the use of auditory models' elements to enhance a sawtooth waveform inspired pitch estimator on telephone-quality signals.(2012 11th International Conference on Information Science, Signal Processing and their Applications (ISSPA); 2012 2–5 July)2012
- Intraclass correlations: uses in assessing rater reliability.Psychol Bull. 1979; 86: 420
- Kurtosis as peakedness, 1905 – 2014. R.I.P.Am Stat. 2014; 68: 191-195
- Application of psychometric theory to the measurement of voice quality using rating scales.J Speech Lang Hear Res. 2005; 48: 323-335
- Perceptual evaluation of voice quality and its correlation with acoustic measurements.J Voice. 2004; 18: 299-304
- Cepstral peak sensitivity: a theoretic analysis and comparison of several implementations.J Voice. 2015; 29: 670-681
Article info
Publication history
Published online: May 14, 2018
Accepted:
March 27,
2018
Footnotes
This work was partially supported by the National Institutes of Health (Grant Nos. R01DC004224 and R01DC012315) from the National Institute on Deafness and Other Communication Disorders.
Research presentation: This research was presented at the 2016 Voice Foundation Symposium in Philadelphia, PA.
Identification
Copyright
© 2018 Published by Elsevier Inc. on behalf of The Voice Foundation.
