Research Article|Articles in Press

Relationship Between Aerodynamic Measurement of Maximum Phonation Time With Acoustic Analysis and the Effects of Sex and Dysphonia Type



      This study set out to uncover the correlation between maximum phonation time (MPT) with acoustic and cepstral analysis in the dysphonic and control groups, considering the effects of sex and dysphonia type.


      For this cross-sectional study, a sample of 179 attendees (141 dysphonic and 38 control) were randomly selected and requested to sustain the vowel /a/ as long as they could with their habitual pitch and loudness. Reading standard sentences and conversational connected speech tasks were obtained too. Using Praat, the MPT, jitter, shimmer, noise-to-harmonic ratio, cepstral peak prominence (CPP), and smoothed cepstral peak prominence (CPPS) were calculated in the target vocal tasks.


      There was a very low to low significant correlation (r = 0.00–0.50) between MPT amounts and acoustic analysis in the dysphonic group (P < 0.05), except for between MPT with shimmer (P > 0.05). In contrast, findings showed no significant correlation between MPT and acoustic analysis in the control group, not even separated by sex (P > 0.05). There was a very low to low correlation between MPT amounts and acoustic analysis in the male dysphonic group (P < 0.05), except for the MPT with shimmer (P > 0.05). There was no significant correlation between MPT and acoustic analysis in the female dysphonic group (P > 0.05), except for MPT with CPP (sustained vowel) (P < 0.05). Finally, very low to high correlations between MPT and some of the acoustic analysis in all the different dysphonia types were observed (P < 0.05).


      MPT contains some information about the acoustic features of the dysphonic voice, specifically the CPP and smoothed cepstral peak prominence. The data suggested that the observed relationship between MPT and the acoustic analysis has the capacity to be considered for the development of new multiparametric tests of voice assessment in dysphonia, regarding the sex and dysphonia type.

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        • Ferrand CT
        Voice Disorders: Scope of Theory and Practice.
        Pearson Education, New York City, New York, United States2019
        • 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
        • Johnson A
        • Goldfine A
        Intrasubject reliability of maximum phonation time.
        J Voice. 2016; 30: 775.e771-775.e774
        • Kent RD
        • Kent JF
        • Rosenbek JC
        Maximum performance tests of speech production.
        J Speech Hear Dis. 1987; 52: 367-387
        • Mueller P
        • Larson G
        • Summers P
        Letter to the editor: Additional data on s/z ratios in kindergarten children.
        Lang Speech Hear Serv Sch. 1993; 24: 177-178
        • Solomon NP
        • Garlitz SJ
        • Milbrath RL
        Respiratory and laryngeal contributions to maximum phonation duration.
        J Voice. 2000; 14: 331-340
        • Boone DR
        • McFarlane SC
        • Berg SLV
        • et al.
        The Voice and Voice Therapy.
        Pearson Education, Hoboken, New Jersey, United StatesReference2014
        • Shanks SJ
        • Mast D
        Maximum duration of phonation: objective tool for assessment of voice.
        Percept Mot Skills. 1977; 45: 1315-1322
        • Maslan J
        • Leng X
        • Rees C
        • et al.
        Maximum phonation time in healthy older adults.
        J Voice. 2011; 25: 709-713
        • Al-Yahya SN
        • Akram MHHM
        • Kumar KV
        • et al.
        Maximum phonation time normative values among malaysians and its relation to body mass index.
        J Voice. 2020; 36: 457-463
        • Wuyts FL
        • Bodt MSD
        • 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: 796-809
        • Yu P
        • Ouaknine M
        • Revis J
        • et al.
        Objective voice analysis for dysphonic patients: a multiparametric protocol including acoustic and aerodynamic measurements.
        J Voice. 2001; 15: 529-542
        • Aghajanzadeh M
        • Darouie A
        • Dabirmoghaddam P
        • et al.
        The relationship between the aerodynamic parameters of voice and perceptual evaluation in the iranian population with or without voice disorders.
        J Voice. 2017; 31: 250.e9-250.e15
        • Kreiman J
        • Gerratt BR
        • Precoda K
        Listener experience and perception of voice quality.
        J Speech Lang Hear Res. 1990; 33: 103-115
        • Kreiman J
        • Gerratt BR
        • Precoda K
        • et al.
        Individual differences in voice quality perception.
        J Speech Lang Hear Res. 1992; 35: 512-520
        • Kent RD
        Hearing and believing: some limits to the auditory-perceptual assessment of speech and voice disorders.
        Am J Speech Lang Pathol. 1996; 5: 7-23
        • Kreiman J
        • Gerratt BR
        Sources of listener disagreement in voice quality assessment.
        J Acoust Soc Am. 2000; 108: 1867-1876
        • Neiman G
        • GS N
        Procedural aspects of elicting maximum phonation time.
        Folia Phoniatr (Basel). 1981; 33: 285-293
        • Parsa V
        • Jamieson DG
        Acoustic discrimination of pathological voice: Sustained vowels versus continuous speech.
        J Speech Lang Hear Res. 2001; 44: 327-339
        • Gunjawate DR
        • Ravi R
        • Bellur R
        Acoustic analysis of voice in singers: a systematic review.
        J Speech Lang Hear Res. 2018; 61: 40-51
        • Kent RD
        • Vorperian HK
        • Kent JF
        • et al.
        Voice dysfunction in dysarthria: application of the multi-dimensional voice program™.
        J Commun Disord. 2003; 36: 281-306
        • Kraemer HC
        Correlation coefficients in medical research: from product moment correlation to the odds ratio.
        Stat Methods Med Res. 2006; 15: 525-545
        • Hung M
        • Bounsanga J
        • Voss MW
        Interpretation of correlations in clinical research.
        Postgrad Med. 2017; 129: 902-906
        • Saeedi S
        • Aghajanzadeh M
        • Khatoonabadi AR
        A literature review of voice indices available for voice assessment.
        J Rehabilitat Sci Res. 2022; 9: 151-155
        • Puri K
        • Suresh K
        • Gogtay N
        • et al.
        Declaration of Helsinki, 2008: implications for stakeholders in research.
        J Postgrad Med. 2009; 55: 131
        • 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
        • Salary Majd N
        • Maryam Khoddami S
        • Drinnan M
        • et al.
        Validity and rater reliability of Persian version of the Consensus Auditory Perceptual Evaluation of Voice.
        Audiology. 2014; 23: 65-74
        • 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
        • 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; 36 (17): 770-776
        • Boersma P
        • Weenink D
        Praat: Doing Phonetics by Computer (Version 6.1.50)[Computer Software].
        Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands2021
        • 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
        • Hetzler RK
        • Stickley CD
        • Lundquist KM
        • et al.
        Reliability and accuracy of handheld stopwatches compared with electronic timing in measuring sprint performance.
        J Strength Cond Res. 2008; 22: 1969-1976
      1. IBM SPSS Statistics (Version 25) [Computer Software].
        IBM SPSS Inc, Chicago, IL2017
        • Landis JR
        • Koch GG
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Lee E
        • Whitehead A
        • Jacques R
        • et al.
        The statistical interpretation of pilot trials: should significance thresholds be reconsidered?.
        BMC Med Res Method. 2014; 14: 41
        • McCough JJ
        • Faraone SV
        Estimating the size of treatment effects: moving beyond p values.
        Psychiatry (Edgmont). 2009; 6: 21-29
        • Tomczak M
        • Tomczak E
        The need to report effect size estimates revisited. An overview of some recommended measures of effect size.
        Trends Sport Sci. 2014; 1: 19-25
        • Hinkle DE
        • Wiersma W
        • Jurs SG
        Applied Statistics for the Behavioral Sciences. 663. Rand McNally College Publishing, Skokie, Illinois, United States1979
        • Cantarella G
        • Baracca G
        • Pignataro L
        • et al.
        Assessment of dysphonia due to benign vocal fold lesions by acoustic and aerodynamic indices: a multivariate analysis.
        Logoped Phoniatr Vocol. 2011; 36: 21-27
        • Darouie A
        • Aghajanzadeh M
        • Dabirmoghaddam P
        • et al.
        The design and assessment of a multiparametric model for the dysphonia severity index for Persian-speaking populations.
        J Voice. 2017; 33: 226-231
        • Awan SN
        • Novaleski CK
        • Yingling JR
        Test-retest reliability for aerodynamic measures of voice.
        J Voice. 2013; 27: 674-684
        • Karlsen T
        • Sandvik L
        • Heimdal J-H
        • et al.
        Acoustic voice analysis and maximum phonation time in relation to voice handicap index score and larynx disease.
        J Voice. 2020; 34: 161.e27-161.e35
        • Aghajanzadeh M
        • Saeedi S
        Efficacy of cepstral measures in voice disorder diagnosis: a literature review.
        J Modern Rehabilitat. 2022; 16: 120-129
        • Saeedi S
        • Aghajanzadeh M
        • Khoddami SM
        • et al.
        The validity of cepstral analysis to distinguish between different levels of perceptual dysphonia in the Persian vocal tasks.
        J Voice. 2022; S0892-1997: 00112-00116
        • Onwordi LN
        • Al Yaghchi C
        Airway Glottic Insufficiency.
        StatPearls Publishing, St. Petersburg, Florida, United States2019
        • Latoszek BBv
        • Maryn Y
        • Gerrits E
        • et al.
        A meta-analysis: acoustic measurement of roughness and breathiness.
        J Speech Lang Hear Res. 2018; 61: 298-323
        • Nguyen DD
        • Kenny DT
        • Tran ND
        • et al.
        Muscle tension dysphonia in Vietnamese female teachers.
        J Voice. 2009; 23: 195-208
        • Khoddami SM
        • Mehri A
        • Jahani Y
        The role of sex in glottic closure pattern in people with normal voice.
        Audiology. 2011; 20: 64-72
        • 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
        • 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
        • 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 Esp (Engl Ed). 2019; 70: 222-228
        • Stemple JC
        • Roy N
        • Klaben BK
        Clinical Voice Pathology Theory and Management.
        Plural Publishing, San Diego, California, United States2014
        • Peterson EA
        • Roy N
        • Awan SN
        • et al.
        Toward validation of the cepstral spectral index of dysphonia (CSID) as an objective treatment outcomes measure.
        J Voice. 2013; 27: 401-410
        • 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
        • Latoszek BBv
        • 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
        • Lee SJ
        • Choi H-S
        • Kim H
        Acoustic psychometric severity index of dysphonia (APSID): development and clinical application.
        J Voice. 2019; 35: 660.e19-660.e25