Accuracy Analysis of the Multiparametric Acoustic Indices AVQI, ABI, and DSI for Speech-Language Pathologist Decision-Making

  • Fabiana Andrade Penido
    Address correspondence and reprint requests to Fabiana Andrade Penido, Superintendência Central de Perícia Médica e Saúde Ocupacional do Estado de Minas Gerais, Rua da Bahia, 1148, Belo Horizonte/MG - Brazil, CEP 30160-011.
    Superintendência Central de Perícia Médica e Saúde Ocupacional do Estado de Minas Gerais, Belo Horizonte (MG), Brazil
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  • Ana Cristina Côrtes Gama
    Departamento de Fonoaudiologia, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brazil
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Published:January 02, 2023DOI:



      To investigate the accuracy of the Acoustic Voice Quality Index (AVQI), the Acoustic Breathiness Index (ABI), and the Dysphonia Severity Index (DSI) for speech-language pathologist (SLP) decision-making in the evaluation of teachers' voice conditions.


      Cross-sectional observational study with a convenience sample composed of 21 teachers “fit” in carrying out their work activities as a teacher, and 21 considered “unfit” for the same. All teachers underwent a voice evaluation, carried out by a voice-specialized speech-language pathologist. Voice evaluation included the SLP's opinion on whether the teachers presented “fit” or “unfit” for work. The voice and speech samples used for the AVQI and ABI scores were the mid-three seconds of a sustained vowel /a/, and a spontaneous count from 1 to 10. The following parameters were used to extract the DSI score: mid-three seconds of a sustained vowel /a/, maximum phonation time of a sustained vowel /a/, ascending vocal glide on the vowel /a/ until reaching the highest pitch, and sustained vowel /a/ at the softest possible vocal intensity. The t-test was used to compare the difference between the AVQI and ABI indices. The Mann-Whitney test was used for the DSI index, with a confidence level of 95%. The receiver operating characteristic curve (ROC) was used for accuracy analysis.


      There was a difference in AVQI values (P=0.008), ABI (P=0.014), and DSI (P=0.000) between groups. The cutoff points that revealed the highest specificity for the AVQI, ABI, and DSI respectively were 3.33 (sensitivity 57.1% and specificity 90.5%), 4 (sensitivity 57.1% and specificity 85.7%), and 1.62 (sensitivity 71.4% and specificity 90.5%).


      The AVQI, ABI, and DSI are instruments that provide robust voice information and can help speech-language pathologists in their decision-making about whether teachers must or must not be restricted in their vocal activities at work.

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        • Behlau M
        • Zambon F
        • Guerrieri AC
        • et al.
        Epidemiology of voice disorders in teachers and nonteachers in Brazil: prevalence and adverse effects.
        J Voice. 2012; 26: 665
        • Van Houtte E
        • Van Lierde K
        • D'Haeseleer E
        • et al.
        The prevalence of laryngeal pathology in a treatment-seeking population with dysphonia.
        Laryngoscope. 2010; 120: 306-312
        • Hunter EJ
        • Titze IR.
        Variations in intensity, fundamental frequency, and voicing for teachers in occupational versus non-occupational settings.
        J Speech Lang Hear Res. 2010; 53: 862-875
        • Medeiros AM
        • Barreto SM
        • Assunção AA.
        Voice disorders (dysphonia) in public school female teachers working in belo horizonte: prevalence and associated factors.
        J Voice. 2008; 22: 676-687
        • Secretaria do Estado de Planejamento e Gestão (MG)
        Cartilha institucional da Superintendência Central de Perícia Médica e Saúde Ocupacional (SCPMSO).
        Belo Horizonte, 2016 (Available at:)
        • Ferreira LP
        • Algodoal MJ
        • Andrada e Silva MA
        Avaliação da voz na visão (e no ouvido) do Fonoaudiólogo: saber o que se procura para entender o que se acha.
        Tópicos em Fonoaudiologia. Lovise, São Paulo1998: 393-413
        • 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
        • Teixeira JP
        • Oliveira C
        • Lopes C.
        Vocal acoustic analysis – Jitter, shimmer and HNR parameters.
        Proc Technol. 2013; 9: 1112-1122
        • Roy N
        • Barkmeier-Kraemer J
        • Eadie T
        • et al.
        Evidence-based clinical voice assessment: a systematic review.
        Am J Speech Lang Pathol. 2013; 22: 212-226
        • Oates J.
        Auditory-perceptual evaluation of disordered voice quality.
        Folia Phoniatrica Logopedica. 2009; 61: 49-56
        • Yamasaki R
        • Gama ACC.
        Desafios e referências na avaliação perceptivo-auditiva da voz.
        Fundamentos e atualidades em voz Clínica. Thieme Revinter, Rio de Janeiro2019: 9-30
        • 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
        • Buder EH.
        Acoustic analysis of voice quality: a tabulation of algorithms 1902-1990.
        in: Kent RD Ball MJ Voice quality measurement. Singular Publishing Group, San Diego, CA2000: 119-244
        • Awan SN
        • Roy N
        • Dromey C.
        Estimating dysphonia severity in continuous speech: application of a multi-parameter spectral/cepstral model.
        Clin Ling Phonetics. 2009; 23: 825-841
        • Heman-Ackah YD
        • Michael DD
        • Goding GS.
        The relationship between cepstral peak prominence and selected parameters of dysphonia.
        J Voice. 2002; 16: 20-27
        • Lopes LW
        • Sousa ESS
        • da Silva ACF
        • et al.
        Cepstral measures in the assessment of severity of voice disorders.
        Codas. 2019; 31: 1-8
        • Madill C
        • Nguyen DD
        • Eastwood C
        • et al.
        Comparison of cepstral peak prominence measures using the ADSV, SpeechTool, and VoiceSauce acoustic analysis programs in vocally healthy female speakers.
        Acoustics Australia. 2018; 46: 215-226
        • Maryn Y
        • De Bodt M
        • Roy N.
        The Acoustic Voice Quality Index: toward improved treatment outcomes assessment in voice disorders.
        J Commun Disord. 2010; 43: 161-174
        • Awan SN
        • Roy N.
        Toward the development of an objective index of dysphonia severity: a four-factor model.
        Clin Ling Phonetics. 2006; 20: 35-49
        • 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. 2009; 24: 540-555
        • Barsties B
        • Maryn Y
        • Gerrits E
        • et al.
        The Acoustic Breathiness Index (ABI): a multivariate acoustic model for breathiness.
        J Voice. 2017; 31: 511
        • Wuyts FL
        • De Bodt M
        • Molenberghs G
        • et al.
        The Dysphonia Severity Index: an objective measure of vocal quality based on a multiparameter approach.
        J Speech Lang Hear Res. 2000; 43: 769-809
        • Barsties B
        • Englert M
        • Lucero JC
        • et al.
        The performance of the acoustic quality index and acoustic breathiness index in synthesized voices.
        J Voice. 2021; 1: 1
        • Barsties B
        • Maryn Y.
        External validation of the Acoustic Voice Quality Index version 03.01 with extended representativity.
        Ann Otol Rhinol Laryngol. 2016; 125: 571-583
      1. Boersma P, Weenink D. Praat: doing phonetics by computer. Version 5.2.25. 2011. Available at:

        • Englert M
        • Barsties B
        • Maryn Y
        • et al.
        Validation of the acoustic voice quality index, version 03.01, to the Brazilian Portuguese Language.
        J Voice. 2019; 35: 160
        • Englert M
        • Lima L
        • Behlau M.
        Acoustic voice quality index and acoustic breathiness index: analysis with different speech material in the Brazilian Portuguese.
        J Voice. 2020; 34: 810
        • Englert M
        • Barsties B
        • Maryn Y
        • et al.
        Validation of the acoustic breathiness index to the Brazilian Portuguese language.
        Logop Phoniatr Vocol. 2021; 1: 1
        • Maryn Y
        • Morsomme D
        • De Bodt M.
        Measuring the Dysphonia Severity Index (DSI) in the Program Praat.
        J Voice. 2017; 31: 644
        • Uloza V
        • Barsties B
        • Ulozaitè-Stanienè N
        • et al.
        A comparison of dysphonia severity index and acoustic voice quality index measures in differentiating normal and dysphonic voices.
        Laryngology. 2018; 275: 949-958
        • Pontes P
        • Behlau M
        • Kyrillos L.
        Glottic configurations and glottic proportion: an attempt to understand the posterior triangular glottic chink.
        Revue Otologie Rhinologie Laryngologie (Bord). 1994; 115: 261-266
        • Barsties B
        • Maryn Y
        • Gerrits E
        • et al.
        The Acoustic Breathiness Index (ABI): a multivariate acoustic model for breathiness.
        J Voice. 2017; 31: 511.e11-511.e27
        • Maryn Y
        • Zarowski A.
        Calibration of clinical audio recording and analysis systems for sound intensity measurement.
        Am J Speech Lang Pathol. 2015; 24: 608-618
        • Wongpakaran N
        • Wongpakaran T
        • Wedding D
        • et al.
        A comparison of Cohen's Kappa and Gwet's AC1 when calculating inter-rater reliability coefficients: a study conducted with personality disorder samples.
        BMC Medical Research Methodology. 2013; 13: 1-7
        • Gwet KL.
        Computing inter-rater reliability and its variance in the presence of high agreement.
        Br J Math Stat Psychol. 2008; 61: 29-48
        • Portney L
        • Watkins M.
        Foundations of clinical research: applications to practice. 2. Prentice Hall Health, Upper Saddle River2000
        • Hakkesteegt M
        • Brocaar M
        • Wieringa M.
        The Applicability of the dysphonia severity index and the voice handicap index in evaluating effects of voice therapy and phonosurgery.
        J Voice. 2010; 24: 199-205
        • Hosokawa K
        • Barsties B
        • Iwahashi T
        • et al.
        Validation of the acoustic voice quality index in the Japanese language.
        J Voice. 2017; 31: 260.e1-260.e9
        • Pommee T
        • Maryn Y
        • Finck C
        • et al.
        Validation of the acoustic voice quality index, version 03.01, in French.
        J Voice. 2018; 34: 646
        • Englert M
        • Lopes L
        • Vieira V
        • et al.
        Accuracy of acoustic voice quality index and its isolated acoustic measures to discriminate the severity of voice disorders.
        J Voice. 2020; 36: 582
        • Barsties B
        • Lehnert B
        • Janotte B.
        Validation of the acoustic voice quality index version 03.01 and acoustic breathiness index in German.
        J Voice. 2018; 34: 157
        • Nemr K
        • Simões-Zenari M
        • De Souza G
        • et al.
        Correlation of the Dysphonia Severity Index (DSI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and gender in Brazilians with and without voice disorders.
        J Voice. 2015; 30: 765
        • Sobol M
        • Sielska-Badurek E.
        The dysphonia severity index (dsi)—normative values. systematic review and meta-analysis.
        J Voice. 2022; 36: 143