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Meta-Analysis on the Validity of the Acoustic Voice Quality Index

  • Christina Batthyany
    Affiliations
    GZA Sint-Augustinus, Department of Otorhinolaryngology and Head & Neck Surgery, European Institute of ORL-HNS, Antwerp, Belgium
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  • Ben Barsties V. Latoszek
    Affiliations
    SRH University of Applied Health Sciences, Speech-Language Pathology, Düsseldorf, Germany

    University of Münster, University Hospital Münster, Department of Phoniatrics and Pediatric Audiology, Münster, Germany
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  • Youri Maryn
    Correspondence
    Address correspondence and reprint requests to Youri Maryn, GZA Sint-Augustinus, Department of Otorhinolaryngology & Head and Neck Surgery, European Institute for ORL-HNS, Oosterveldlaan 24, 2610 Wilrijk (Antwerp), Belgium.
    Affiliations
    GZA Sint-Augustinus, Department of Otorhinolaryngology and Head & Neck Surgery, European Institute of ORL-HNS, Antwerp, Belgium

    Ghent University, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent, Belgium

    University College Ghent, Department of Speech-Language Therapy and Audiology, Ghent, Belgium

    Université Catholique de Louvain, Faculty of Psychology and Pedagogical Sciences, School of Logopedics, Ottignies-Louvain-La-Neuve, Belgium

    Phonanium, Lokeren, Belgium
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      Summary

      Background

      Acoustic measurements are useful tools to objectively measure overall voice quality. The Acoustic Voice Quality Index (AVQI) has shown to be a valid multiparametric tool to objectify dysphonia severity. The increasing number of validity studies investigating AVQI's validity demands a comprehensive synthesis of the available outcomes.

      Objective of review

      The aim of the present meta-analysis is to quantify the evidence for the diagnostic accuracy of the AVQI, including its sensitivity, specificity and likelihood ratio statistics, and its concurrent validity and sensitivity to changes in auditory-perceptual voice quality ratings.

      Type of review

      Meta-analysis

      Search strategy

      MEDLINE, EMBASE, the Cochrane library and Web of Science were searched from 2010 till April 2021 with an additional manual search, using keywords related to AVQI and common terminologies of validity outcomes. Studies considering the clinical validity of AVQI (ie, diagnostic accuracy, concurrent validity and sensitivity to change), using auditory-perceptual voice quality evaluation as reference, were included.

      Evaluation method

      The Preferred Reporting Items for Systematic reviews and Meta-Analyses of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines were used. Quality assessment of included studies was conducted using the QUADAS-2 tool. For the diagnostic accuracy of AVQI, the pooled sensitivity, specificity and likelihood ratio statistics were determined using a summary receiver operating characteristic approach. Weighted correlation coefficient measures ( r W ¯ ) were used to assess the concurrent validity and sensitivity to change.

      Results

      A total of 198 studies were screened and 33 articles were included. In total, voice samples of 11447, 10272, and 367 different subjects were considered for analysis of diagnostic accuracy, concurrent validity and change responsiveness, respectively. Satisfying diagnostic accuracy results were found with a pooled sensitivity of 0.83 (95% CI: 0.82-0.83), a pooled specificity of 0.89 (95% CI: 0.88-0.90), a pooled positive LR of 7.75 (95% CI: 6.04-9.95), a pooled negative LR of 0.20 (95% CI: 0.16-0.23), and a pooled diagnostic odds ratio of 47.13 (95% CI: 34.82-63.79). Summary receiver operating characteristic curve analysis showed an excellent AUC value of 0.937 and Q* index of 0.874. Strong correlations of r W ¯  = 0.838 for concurrent validity and r W ¯  = 0.796 for sensitivity to change were found.

      Conclusions

      Our results confirm the general clinical utility of the AVQI as a robust and valid objective measure for evaluating overall dysphonia severity across languages and study methods.

      Key Words

      Abbreviations:

      AUC (area under the curve), AVQI (acoustic voice quality index), CAPE-V (consensus auditory-perceptual evaluation of voice), CPPS (smoothed cepstral peak prominence), dOR (diagnostic odds ratio), EAI (equal-appearing interval scale), FN (false negatives), FP (false positives), G (grade), GRBAS scale (grade, roughness, breathiness, asthenia and strain scale), H (parameter hoarseness of the GRBAS scale), HNR (harmonics-to-noise-ratio), ICC (intraclass correlation coefficient), LR (likelihood ratio), LR+ (positive likelihood ratio), LR– (negative likelihood ratio), PRISMA (preferred reporting items for systematic reviews and meta-analyses standards), QUADAS-2 (quality assessment of diagnostic accuracy studies, revised version), RBH scale (roughness, breathiness and hoarseness scale), ROC curve (receiver operating characteristics curve), SL (shimmer local), SLdB (shimmer local dB), Slope (general slope of the long-term average spectrum), SROC curve (summary receiver operating characteristics curve), Tilt (tilt of the regression line through the long-term average spectrum), TN (true negatives), TP (true positives), VAS (visual analog scale)
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