Research Article| Volume 37, ISSUE 2, P297.e1-297.e6, March 2023

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Acoustic and Auditory-Perceptual Analysis of Voice in the Female Smokers Who Do Not Have Self-Reported Voice Complaint

Published:January 13, 2021DOI:



      Smoking affects the voice quality and the previous studies presented higher Voice Handicap Index (VHI) scores, and abnormal acoustic data in smokers. However, there is no study revealing any voice parameter indicating incipient damage in voice functionality. The studies documented that the adverse effects of smoking on phonatory function were higher in females than males and further the prevalence of smoking among females tends to increase. The purpose of this study was to investigate the effect of smoking on the acoustic and auditory-perceptual analysis of the speaking voice in female smokers who scored the VHI-10 scale as grade 0 (absent), and thus to look for a criterion for incipient vocal damage of smoking.


      The study group composed of 22 female smokers and 22 female nonsmokers between the ages of 18 and 55 years. The acoustic parameters (mean F0, jitter local [%], jitter local abs, jitter rap, jitter ppq, shimmer local [%], shimmer local [dB], shimmer apq3, shimmer apq5, shimmer apq11, and mean HNR) and the GRBAS scale were analyzed in all subjects.


      No significant difference observed between the smoker and nonsmokers groups in acoustic voice analysis. It was seen that the smokers presented a small but significant increase in the Strain parameter of the GRBAS scale while there was no significant difference in the Grade, Roughness, Breathiness, and Asthenia parameters between the study groups.


      The results of this study indicate that increase in Strain could be considered as an early data in the smokers without voice complaints. However, our data declared that conventional acoustic perturbation analysis did not reveal incipient Strain in voice.

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        • Auerbach O
        • Hammond EC
        • Garfinkel L.
        Histologic changes in the larynx in relation to smoking habits.
        Cancer. 1970; 25: 92-104<92::AID-CNCR2820250114>3.0.CO;2-E
        • Hirabayashi H
        • Koshii K
        • Uno K
        • et al.
        Laryngeal epithelial changes on effects of smoking and drinking.
        Auris Nasus Larynx. 1990; 17: 105-114
        • Banjara H
        • Mungutwar V
        • Singh D
        • et al.
        ve and subjective evaluation of larynx in smokers and nonsmokers: a comparative study.
        Indian J Otolaryngol Head Neck Surg. 2014; 66: 99-109
        • Samet JM.
        Adverse effects of smoke exposure on the upper airway.
        Tob Control. 2004; 13: 57-60
        • Marcotullio D
        • Magliulo G
        • Pezone T.
        Reinke's edema and risk factors: clinical and histopathologic aspects.
        Am J Otolaryngol - Head Neck Med Surg. 2002; 23: 81-84
        • Liard R
        • Perdrizet S
        • Correman J
        • et al.
        and chronic respiratory symptoms: prevalence in male and female smokers.
        Am J Public Health. 1980; 70: 271-273
        • Prescott E
        • Bjerg AM
        • Andersen PK
        • et al.
        difference in smoking effects on lung function and risk of hospitalization for COPD: results front a Danish longitudinal population study.
        Eur Respir J. 1997; 10: 822-827
        • Simberg S
        • Udd H
        • Santtila P.
        Gender differences in the prevalence of vocal symptoms in smokers.
        J Voice. 2015; 29: 588-591
        • Samet JM
        • Yoon S-Y.
        Women and the Tobacco Epidemic. Challenges for the 21st Century.
        World Health Organization, Geneva2001
        • The Ministry of Health of Turkey
        Global Adult Tobacco Survey Turkey Report..
        • CDC, WHO, SB
        GATS (Global Adult Tobacco Survey) Fact Sheet, Turkey 2016.
        • Sorensen D
        • Horii Y.
        Cigarette smoking and voice fundamental frequency.
        J Commun Disord. 1982; 15: 135-144
        • Murphy CH
        • Doyle PC.
        The effects of cigarette smoking on voice-fundamental frequency.
        Otolaryngol Neck Surg. 1987; 97: 376-380
        • Damborenea Tajada J
        • Fernandez Liesa R
        • Llorente Arenas E
        • et al.
        The effect of tobacco consumption on acoustic voice analysis (in Spanish).
        Acta Otorrinolaringol Esp. 1999; 50: 448-452
        • Gonzalez J
        • Carpi A.
        Early effects of smoking on the voice: a multidimensional study.
        Med Sci Monit. 2004; 10: 649-656
        • Ayoub MR
        • Larrouy-Maestri P
        • Morsomme D.
        The effect of smoking on the fundamental frequency of the speaking voice.
        J Voice. 2019; 33 (802.e11-802.e16)
        • Byeon H
        • Cha S.
        Evaluating the effects of smoking on the voice and subjective voice problems using a meta-analysis approach.
        Sci Rep. 2020; 10: 1-8
        • Hamdan AL
        • Sibai A
        • Mahfoud L
        • et al.
        Short term effect of hubble-bubble smoking on voice.
        J Laryngol Otol. 2011; 125: 486-491
        • Tuhanioğlu B
        • Erkan SO
        • Özdaş T
        • et al.
        The effect of electronic cigarettes on voice quality.
        J Voice. 2019; 33 (811.e13-811.e17)
        • Jacobson BH
        • Johnson A
        • Grywalski C
        • et al.
        The Voice Handicap Index (VHI): development and validation.
        Am J Speech-Lang Pathol. 1997; 6: 66-69
        • Hogikyan ND
        • Sethuraman G.
        Validation of an instrument to measure voice-related quality of life (V-RQOL).
        J Voice. 1999; 13: 557-569
        • Pinar D
        • Cincik H
        • Erkul E
        • et al.
        Investigating the effects of smoking on young adult male voice by using multidimensional methods.
        J Voice. 2016; 30: 721-725
        • Tafiadis D
        • Toki EI
        • Miller KJ
        • et al.
        Effects of early smoking habits on young adult female voices in Greece.
        J Voice. 2017; 31: 728-732
        • Heman-Ackah YD
        • Dean CM
        • Sataloff RT.
        Strobovideolaryngoscopic findings in singing teachers.
        J Voice. 2002; 16: 81-86
        • Daggumati S
        • Panossian H
        • Sataloff RT.
        Vocal fold paresis: incidence, and the relationship between Voice Handicap Index and laryngeal EMG findings.
        J Voice. 2019; 33: 940-944
        • Laver J
        • Wirz S
        • Mackenzie J
        • et al.
        A perceptual protocol for the analysis of vocal profiles.
        Work in Progress. Vol 14. University of Edinburgh, Department of Linguistics;, 1981: 139-155
        • Hirano M.
        Clinical Examination of Voice.
        Springer, New York1981
        • Wilson DK.
        Voice Problems of Children.
        Williams & Wilkins, Baltimore, MA1987
        • Hammarberg B.
        Voice research and clinical needs.
        Folia Phoniatr Logop. 2000; 52: 93-102
        • Kempster GB
        • Gerratt BR
        • Abbott KV
        • et al.
        Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol.
        Am J Speech-Lang Pathol. 2009; 18: 124-132
        • De Bodt MS
        • Van De Heyning PH
        • Wuyts FL
        • et al.
        ceptual evaluation of voice disorders.
        Acta Otorhinolaryngol Belg. 1996; 50: 283-291
        • Yamaguchi H
        • Shrivastav R
        • Andrews ML
        • et al.
        A comparison of voice quality ratings made by Japanese and American listeners using the GRBAS scale.
        Folia Phoniatr Logop. 2003; 55: 147-157
        • Kılıç MA
        • Okur E
        • Yıldırım I
        • et al.
        Ses Handikap Endeksi (Voice Handicap Index) Türkçe versiyonunun güvenilirliği ve geçerliliği.
        Kulak Burun Boğaz Ihtis Derg. 2008; 18: 139-147
        • Boersma P
        • Weenink D.
        Praat: Doing Phonetics by Computer [Computer software version 6.0.36].
        2017 (PublishedAccessed December 20, 2017)
        • Kılıç MA.
        Klinik fonetik ve ağız araştırmaları için özelleştirilmiş Praat programı ile uygulama.
        Understanding Speech and Language Disorders: Clinical Phonetic and Linguistics Course. 2014 (Istanbul)
        • Remijsen B.
        msr&check_spectr_indiv_interv.psc. Script for Praat.
        2004 (PublishedAccessed August 20, 2018)
        • Bhuta T
        • Patrick L
        • Garnett JD.
        Perceptual evaluation of voice quality and its correlation with acoustic measurements.
        J Voice. 2004; 18: 299-304
        • Viera AJ
        • Garrett JM.
        Understanding interobserver agreement: the kappa statistic.
        Fam Med. 2005; 37: 360-363
        • Tafiadis D
        • Kosma EI
        • Chronopoulos SK
        • et al.
        Voice Handicap Index and interpretation of the cutoff points using receiver operating characteristic curve as screening for young adult female smokers.
        J Voice. 2018; 32: 64-69
        • Brockmann M
        • Storck C
        • Carding PN
        • et al.
        Voice loudness and gender effects on jitter and shimmer in healthy adults.
        J Speech Lang Hear Res. 2008; 51: 1152-1160
        • Brockmann M
        • Drinnan MJ
        • Storck C
        • et al.
        Reliable jitter and shimmer measurements in voice clinics: the relevance of vowel, gender, vocal intensity, and fundamental frequency effects in a typical clinical task.
        J Voice. 2011; 25: 44-53
        • Oguz H
        • Tunc T
        • Safak MA
        • et al.
        Objective voice changes in nondysphonic Parkinson's disease patients.
        J Otolaryngol. 2006; 35: 349-354
        • Oguz H
        • Demirci M
        • Safak MA
        • et al.
        Effects of unilateral vocal cord paralysis on objective voice measures obtained by Praat.
        Eur Arch Oto-Rhino-Laryngology. 2007; 264: 257-261
        • Saltürk Z
        • Kumral TL
        • Bekiten G
        • et al.
        Objective and subjective aspects of voice in pregnancy.
        J Voice. 2016; 30: 70-73
        • Niebudek-Bogusz E
        • Woznicka E
        • Zamyslowska-Szmytke E
        • et al.
        Correlation between acoustic parameters and voice handicap index in dysphonic teachers.
        Folia Phoniatr Logop. 2010; 62: 55-60
        • Dehqan A
        • Yadegari F
        • Scherer RC
        • et al.
        Correlation of VHI-30 to acoustic measurements across three common voice disorders.
        J Voice. 2017; 31: 34-40
        • Dejonckere PH
        • Remacle M
        • Fresnel-Elbaz E
        • et al.
        Differentiated perceptual evaluation of pathological voice quality: reliability and correlations with acoustic measurements.
        Rev Laryngol Otol Rhinol (Bord). 1996; 117: 219-224
        • De Bodt MS
        • Wuyts FL
        • Van De Heyning PH
        • 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