The Validity of Cepstral Analysis to Distinguish Between Different Levels of Perceptual Dysphonia in the Persian Vocal Tasks



      The validity of cepstral analysis (Cepstral Peak Prominence [CPP] and Cepstral Peak Prominence-Smoothed [CPPS]) as an indicator of perceptual dysphonia was investigated in the Persian language

      Study design

      Cross-sectional study.


      A total of 223 participants (159 with and 64 without dysphonia) uttered vowels /a/ and /i/, six standard sentences, and non-standard connected speech. All vocal samples were perceptually evaluated by three raters on a visual analog scale and put into four groups (normal voice, mild, moderate, and severe perpetual dysphonia). CPP and CPPS of sustained vowel /a/, reading the second standard sentence, and a sentence extracted from non-standard connected speech were established using “Praat” software. Statistical analysis involved a one-way factorial analysis of variance (ANOVA), Kruskal-Wallis H, Kendall's Tau-b correlation, t test, and receiver operating characteristics (ROC) curve.


      The results showed that CPP of sustained vowels and reading the standard sentence and CPPS of sustained vowel differed significantly (P < 0.05), except between the normal voice and mild perpetual dysphonia groups (P > 0.05). The CPP of non-standard connected speech, CPPS of reading the standard sentence, and non-standard connected speech differed significantly between all groups (P < 0.05). The mean of cepstral analysis of all tasks, “averaged CPP,” and “averaged CPPS” were significantly different between two groups of the normal voice and perceptual dysphonia (P < 0.05). Correlation between the cepstral analysis and the perceptual ratings demonstrated that the correlation coefficients for CPP and CPPS were between 0.4 and 0.6 (P < 0.05). ROC curve analysis revealed that the area under the ROC curve for “averaged CPP” and “averaged CPPS” was greater than 0.8 (P < 0.05). The values of 22.11 and 12.29 were determined as cut-off scores of “averaged CPP” and “averaged CPPS,” respectively.


      Cepstral analysis was known as useful clinical tool for diagnosis of perpetual dysphonia and determining its severity level in the Persian language.

      Key Words

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      1. Boone DR, McFarlane SC, Berg SLV. The Voice and Voice Therapy. Pearson Education; 2014. The Voice and Voice Therapy, 9th ed. (Pearson, Boston, MA.

        • Núñez-Batalla F
        • Cartón-Corona N
        • Vasile G
        • et al.
        Validation of the measures of cepstral peak prominence as a measure of dysphonia severity in Spanish-Speaking Subjects.
        Acta Otorrinolaringologica (English Edition). 2019; 70: 222-228
        • Delgado-Hernández J
        • León-Gómez NM
        • Izquierdo-Arteaga LM
        • et al.
        Cepstral analysis of normal and pathological voice in Spanish adults. Smoothed cepstral peak prominence in sustained vowels versus connected speech.
        Acta Otorrinolaringologica (English Edition). 2018; 69: 134-140
        • Hasanvand A
        • Salehi A
        • Ebrahimipour M.
        A cepstral analysis of normal and pathologic voice qualities in Iranian adults: a comparative study.
        J Voice. 2017; 31: 508.e17-508.e23
        • Dejonckere PH
        • Bradley P
        • Clemente P
        • et al.
        A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques.
        Eur Arch Otorhinolaryngol. 2001; 258: 77-82
        • Parsa V
        • Jamieson DG.
        Acoustic discrimination of pathological voice.
        J Speech Lang Hear Res. 2001; 44: 327-339
        • Gaskill CS
        • Awan JA
        • Watts CR
        • et al.
        Acoustic and perceptual classification of within-sample normal, intermittently dysphonic, and consistently dysphonic voice types.
        J Voice. 2017; 31: 218-228
        • Kumar BR
        • Bhat JS
        • Prasad N.
        Cepstral analysis of voice in persons with vocal nodules.
        J Voice. 2010; 24: 651-653
      2. Stemple JC, Roy N, Klaben BK. Clinical Voice Pathology Theory and Management. Plural Publishing; 2014. Plural Publishing; 2018 Dec 20.

        • Hillenbrand J
        • Houde RA.
        Acoustic correlates of breathy vocal quality: dysphonic voices and continuous speech.
        J Speech Lang Hear Res. 1996; 39: 311-321
        • Hillenbrand J
        • Cleveland RA
        • Erickson RL.
        Acoustic correlates of breathy vocal quality.
        J Speech Lang Hear Res. 1994; 37: 769-778
        • Brockmann-Bauser M
        • Van Stan JH
        • Sampaio MC
        • et al.
        Effects of vocal intensity and fundamental frequency on cepstral peak prominence in patients with voice disorders and vocally healthy controls.
        J Voice. 2019; 35: 411-417
        • Fraile R
        • Godino-Llorente JI.
        Cepstral peak prominence: a comprehensive analysis.
        Biomed Signal Process Control. 2014; 14: 42-54
        • Aghajanzadeh M
        • Saeedi S.
        Efficacy of cepstral measures in voice disorder diagnosis: a literature review.
        J Modern Rehabilitation. 2022; (In press)
        • Patel RR
        • Awan SN
        • Barkmeier-Kraemer J
        • et al.
        Recommended protocols for instrumental assessment of voice: American Speech-Language-Hearing Association expert panel to develop a protocol for instrumental assessment of vocal function.
        Am J Speech Lang Pathol. 2018; 27: 887-905
        • Heman-Ackah YD
        • Sataloff RT
        • Laureyns G
        • et al.
        Quantifying the cepstral peak prominence, a measure of dysphonia.
        J Voice. 2014; 28: 783-788
        • Heman-Ackah YD
        • Michael DD
        • Baroody MM
        • et al.
        Cepstral peak prominence: a more reliable measure of dysphonia.
        Ann Otol, Rhinol Laryngol. 2003; 112: 324-333
        • Maryn Y
        • Roy N
        • De Bodt M
        • et al.
        Acoustic measurement of overall voice quality: a meta-analysis.
        J Acoust Soc Am. 2009; 126: 2619-2634
        • Lopes LW
        • Sousa ESdS
        • Silva ACFd
        • et al.
        Cepstral measures in the assessment of severity of voice disorders.
        SciELO Brasil;. 2019; 31e20180175
        • Mizuta M
        • Abe C
        • Taguchi E
        • et al.
        Validation of cepstral acoustic analysis for normal and pathological voice in the Japanese Language.
        J Voice. 2020; 17 (S0892-1997(20)30325-8)
        • Hassan EM
        • Abdel Hady AF
        • Shohdi SS
        • et al.
        Assessment of dysphonia: cepstral analysis versus conventional acoustic analysis.
        Logoped Phoniatr Vocol. 2021; 46: 99-109
        • Maryn Y
        • Corthals P
        • Van Cauwenberge P
        • et al.
        Toward improved ecological validity in the acoustic measurement of overall voice quality: combining continuous speech and sustained vowels.
        J Voice. 2010; 24: 540-555
        • Zraick RI
        • 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
        • Askenfelt AG
        • Hammarberg B.
        Speech waveform perturbation analysis: a perceptual-acoustical comparison of seven measures.
        J Speech Lang Hear Res. 1986; 29: 50-64
        • Watts CR
        • Awan SN.
        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
        • Gerratt BR
        • Kreiman J
        • Garellek M.
        Comparing measures of voice quality from sustained phonation and continuous speech.
        J Speech Lang Hear Res. 2016; 59: 994-1001
        • Lowell SY
        • Hylkema JA.
        The effect of speaking context on spectral-and cepstral-based acoustic features of normal voice.
        Clin Linguist Phon. 2016; 30: 1-11
        • Moers C
        • Möbius B
        • Rosanowski F
        • et al.
        Vowel-and text-based cepstral analysis of chronic hoarseness.
        J Voice. 2012; 26: 416-424
        • Halberstam B.
        Acoustic and perceptual parameters relating to connected speech are more reliable measures of hoarseness than parameters relating to sustained vowels.
        ORL. 2004; 66: 70-73
        • Heman-Ackah YD
        • Michael DD
        • Goding Jr, GS
        The relationship between cepstral peak prominence and selected parameters of dysphonia.
        J Voice. 2002; 16: 20-27
        • Selamtzis A
        • Castellana A
        • Salvi G
        • et al.
        Effect of vowel context in cepstral and entropy analysis of pathological voices.
        Biomed Signal Proc Contr. 2019; 47: 350-357
        • Larijani B
        • Zahedi F.
        Contemporary medical ethics: an overview from Iran.
        Devel World Bioeth. 2008; 8: 192-196
        • Munier C
        • Brockmann-Bauser M
        • Laukkanen A-M
        • et al.
        Relationship between laryngeal signs and symptoms, acoustic measures, and quality of life in Finnish primary and kindergarten school teachers.
        J Voice. 2018; 34: 259-271
        • Khoramshahi H
        • Khatoonabadi AR
        • Khoddami SM
        • et al.
        Responsiveness of Persian version of Consensus Auditory Perceptual Evaluation Of Voice (CAPE-V), Persian version of Voice Handicap Index (VHI), and praat in vocal mass lesions with muscle tension dysphonia.
        J Voice. 2018; 32: 770.e21-770.e30
        • Phadke KV
        • Laukkanen A-M
        • Ilomäki I
        • et al.
        Cepstral and perceptual investigations in female teachers with functionally healthy voice.
        J Voice. 2018; 34: 485.e33-485.e43
        • Maryn Y
        • Weenink D.
        Objective dysphonia measures in the program Praat: smoothed cepstral peak prominence and acoustic voice quality index.
        J Voice. 2015; 29: 35-43
        • Deliyski DD
        • Shaw HS
        • Evans MK.
        Adverse effects of environmental noise on acoustic voice quality measurements.
        J Voice. 2005; 19: 15-28
      3. Watts CR, Awan SN. Laryngeal Function and Voice Disorders: Basic Science to Clinical Practice. Thieme; 2019; 2019 Jan 7.

        • Balasubramanium RK
        • Bhat JS
        • Fahim III S
        • et al.
        Cepstral analysis of voice in unilateral adductor vocal fold palsy.
        J Voice. 2011; 25: 326-329
        • Brinca LF
        • Batista APF
        • Tavares AI
        • et al.
        Use of cepstral analyses for differentiating normal from dysphonic voices: a comparative study of connected speech versus sustained vowel in European Portuguese female speakers.
        J Voice. 2014; 28: 282-286
        • Kim G-H
        • Bae I-H
        • Park H-J
        • et al.
        Comparison of cepstral analysis based on voiced-segment extraction and voice tasks for discriminating dysphonic and normophonic Korean speakers.
        J Voice. 2019; 35: 328.e11-328.e22
        • Lowell SY
        • Colton RH
        • Kelley RT
        • et al.
        Predictive value and discriminant capacity of cepstral-and spectral-based measures during continuous speech.
        J Voice. 2013; 27: 393-400