Does the Acoustic Voice Quality Index (AVQI) Correlate with Perceived Creak and Strain in Normophonic Young Adult Finnish Females?

<b><i>Background:</i></b> The Acoustic Voice Quality Index (AVQI) is a correlate of dysphonia. It has been found to differentiate between dysphonic and normophonic speakers and to indicate the effects of voice therapy. This study investigates how the AVQI reacts towards creak and strain, which are common in normophonic speakers. <b><i>Methods:</i></b> The material was obtained from an earlier study on 104 Finnish female university students (mean age 24.3 years, SD 6.3 years) with no known pathology of voice or hearing and a perceptually normal voice (G = 0 in GRBAS), who were recorded while reading aloud a standard text and sustaining the vowel [a:]. Perceptual analysis for the amount of creak and strain was carried out by 2 expert listeners. In this study, the AVQI v03.01 was analyzed and correlated with perceptual evaluations. Samples with low and high amounts of creak and strain were compared with <i>t</i> tests. <b><i>Results:</i></b> On average, the AVQI was below the threshold value of dysphonia in the Finnish population. The AVQI (ρ = 0.35, <i>p</i> = 0.000) and its subparameters, smoothed cepstral peak prominence (CPPS; ρ = –0.35, <i>p</i> = 0.000) and harmonics-to-noise ratio (HNR; ρ = –0.30, <i>p</i> = 0.002) showed low but significant correlations with creak. Strain had low but significant correlations with spectral Slope (ρ = 0.38, <i>p</i> = 0.000) and Tilt (ρ = –0.40, <i>p</i> = 0.009). The AVQI was lower (better) in samples that were evaluated as having a high amount of strain, but the difference was not significant. Only CPPS differentiated significantly between low and high amounts of creak. <b><i>Conclusion:</i></b> The AVQI does not seem to differentiate between high and low amounts of creak and strain in normophonic speakers.

Cultural and Linguistic Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) Into Hindi

Aim The purpose of this study was to develop and assess the reliability of a Hindi version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Reliability was assessed by comparing Hindi CAPE-V ratings with English CAPE-V ratings and by the Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Method Hindi sentences were created to match the phonemic load of the corresponding English CAPE-V sentences. The Hindi sentences were adapted for linguistic content. The original English and adapted Hindi CAPE-V and GRBAS were completed for 33 bilingual individuals with normal voice quality. Additionally, the Hindi CAPE-V and GRBAS were completed for 13 Hindi speakers with disordered voice quality. The agreement of CAPE-V ratings was assessed between language versions, GRBAS ratings, and two rater pairs (three raters in total). Pearson product–moment correlation was completed for all comparisons. Results A strong correlation ( r > .8, p < .01) was found between the Hindi CAPE-V scores and the English CAPE-V scores for most variables in normal voice participants. A weak correlation was found for the variable of strain ( r < .2, p = .400) in the normative group. A strong correlation ( r > .6, p < .01) was found between the overall severity/grade, roughness, and breathiness scores in the GRBAS scale and the CAPE-V scale in normal and disordered voice samples. Significant interrater reliability ( r > .75) was present in overall severity and breathiness. Conclusions The Hindi version of the CAPE-V demonstrates good interrater reliability and concurrent validity with the English CAPE-V and the GRBAS. The Hindi CAPE-V can be used for the auditory-perceptual voice assessment of Hindi speakers.

Artificial Intelligence Application for Vocal Fold Disease Prediction Through Voice Recognition: Development and Usability Study (Preprint)

BACKGROUND Dysphonia influences the quality of life by interfering with communication. However, laryngoscopic examination is expensive and not readily accessible in primary care units. Experienced laryngologists are required to achieve an accurate diagnosis. OBJECTIVE This study sought to detect various vocal fold diseases through pathological voice recognition using artificial intelligence. METHODS We collected 29 normal voice samples and 527 samples of individuals with voice disorders, including vocal atrophy (n=210), unilateral vocal paralysis (n=43), organic vocal fold lesions (n=244), and adductor spasmodic dysphonia (n=30). The 556 samples were divided into two sets: 440 samples as the training set and 116 samples as the testing set. A convolutional neural network approach was applied to train the model and findings were compared with human specialists. RESULTS The convolutional neural network model achieved a sensitivity of 0.70, a specificity of 0.90, and an overall accuracy of 65.5% for distinguishing normal voice, vocal atrophy, unilateral vocal paralysis, organic vocal fold lesions, and adductor spasmodic dysphonia. Compared to human specialists, the overall accuracy was 58.6% and 49.1% for the two laryngologists, and 38.8% and 34.5% for the two general ear, nose, and throat doctors. CONCLUSIONS We developed an artificial intelligence-based screening tool for common vocal fold diseases, which possessed high specificity after training with our Mandarin pathological voice database. This approach has clinical potential to use artificial intelligence for general vocal fold disease screening via voice and includes a quick survey during a general health examination. It can be applied in telemedicine for areas that lack laryngoscopic abilities in primary care units.

Speaking with an alien voice: Flexible sense of agency during vocal production

Speakers monitor auditory feedback during speech production in order to correct for speech errors. The comparator model proposes that this process is supported by comparing sensory feedback to internal predictions of the sensory consequences of articulation. Additionally, this comparison process is proposed to support the sense of agency over vocal output. The current study tests this hypothesis by asking whether mismatching auditory feedback leads to a decrease in the sense of agency as measured by speakers’ responses to pitch-shifted feedback. Participants vocalized while auditory feedback was unexpectedly and briefly pitch-shifted. In addition, in one block, the entire vocalization’s pitch was baseline-shifted (‘alien voice’), while it was not in the other block (‘normal voice’). Participants compensated for the pitch shifts even in the alien voice condition, suggesting that agency was flexible. This is problematic for the classic comparator model, where a mismatching feedback would lead to a loss of agency. Alternative models are discussed in light of these findings, including an adapted comparator model and the inferential account, which suggests that agency is inferred from the joint contribution of several multisensory sources of evidence. Together, these findings suggest that internal representations of one’s own voice are more flexible than often assumed.

Effect of Voiced Segment Extraction on Voice of Vocal Cord Paralysis: Focused on Cepstral Analysis

Background and Objectives The purpose of this study was to investigate the effect of unvoiced segments on the cepstral analysis in patients with vocal cord paralysis (VCP).Subjects and Method A total 302 subjects (173 subjects with VCP and 129 normal voice subjects) participated in this study. The sustained vowel /a/ 2 seconds and one sentence of ‘Sanchaek’ were edited, and analyzed by Praat script. The cepstral analyses were performed using sustained vowel (SV), continuous speech (CS), and extracted continuous speech (EXT) samples. The auditory-perceptual (AP) rating was also completed by three raters.Results First, there were significant differences in all variables except low-to high spectral ratio(L/H ratio)_EXT between two groups. Second, cepstral peak prominence (CPP), smoothed cepstral peak prominence (CPPS), and L/H ratio showed significant differences in SV, CS, and EXT samples. Third, cepstral measurements were highly correlated with the AP ratings. Finally, the level of discrimination of dysphonia estimated from CPP and CPPS gotten from SV and CS values was more than area under the curve (AUC) of 0.941. AUC of 0.880 or more was also found in EXT.Conclusion In this study, we confirmed that both CS and EXT are highly predictive of pathologic speeches. Further study will also need to be validated for a more diverse group of voice disorders.

Hormonal Regulation of Normal Voice Production in Adolescence, a Review

Voice production is discussed based on the hormonal regulation of adolescence. The reason for the overview is that voice production is an integrated part of pathology-in many multi-handicapped cases, voice production is extremely important. In a search made by the Royal English Society of Medicine only few studies of adolescence included voice production, so we supplemented the overview with references from other trials. Testosterone is related to the lowering of voice in males, and oestradiol to the change in females. The interesting prediction function of serum hormone binding globulin (SHBG), for change in the fundamental frequency (F0 ) during reading in adolescence, is elucidated. Not only the lowering of the F0 but also a widening of the frequencies used during speech is seen. The lowest tone (in the voice profiles) is related to the hormonal development. Other androgens and oestrogens are discussed. The hormonal development of voice production is regulated from the hypothalamus probably related to growth hormone. Input is made mainly from the posterior superior temporal gyrus, insula, and the supplementary motor area to the primitive integrative vocalisation centre in the motor cortex. All these findings are important in the future, using advanced voice analysis and artificial intelligence methods to understand pathology.

The Nerve to Thyrohyoid Muscle as a Novel Donor Nerve for Laryngeal Reinnervation

Objectives: Recurrent laryngeal nerve (RLN) injury may be a consequence of surgical procedures of the skull base, neck, and chest, with adverse consequences to function and quality of life. Laryngeal reinnervation offers a potentially stable improvement in vocal fold position and tone. The classic donor nerve is the ansa cervicalis, but is not always available due to damage or sacrifice during previous neck surgeries. Our objective was to introduce the nerve to the thyrohyoid (TH) muscle as an alternate donor nerve for reinnervation, which has not previously been described. Methods: Case series of two patients using the TH nerve for laryngeal reinnervation after RLN injury, with description of surgical harvest. Results: Follow-up results are available for 10 months (one patient) and 3 years (one patient) demonstrating both subjective and objective improvement in function. GRBAS scores were reduced. Maximal phonation time was improved. Patient rating of voice was stable or improved postoperatively. One patient described significant preoperative dyspnea which was significantly improved postoperatively, from a score of 24 to 10 out of 40 on the dyspnea handicap index. VHI was improved in one patient, but scores elevated in the other, despite a change from “moderately severe impairment” to “normal voice” subjectively. Neither patient experienced significant complications from the procedure. Conclusion: Laryngeal reinnervation procedures provide good outcomes in pediatric patients. When ansa cervicalis is not available as a donor nerve, the nerve to TH provides a reasonable alternative.

EFFECT OF VISION AND HEARING IMPAIRMENT ON LIFE SPACE MOBILITY AMONG OLDER MEXICAN-AMERICANS

Background: Poor vision and hearing can restrict an older adult’s life space mobility (LSM). Our objective was to examine if poor vision and hearing differentially impact the decline in LSM over a 2-year period among older Mexican-Americans. Methods: Data came from waves 7 (2010/11) and 8 (2012/13) of the Hispanic EPESE. Our final sample included 452 participants aged &gt;79 years. Participants who said they could not recognize a person across the street, room, or arms-length were classified as having poor vision. Participants who said they could not understand a normal voice in a quiet room were classified as having poor hearing. Participants who decreased &gt;10 points on the Life-Space Assessment were classified as having a decline in LSM. Logistic regression was used to estimate the odds for a decline in LSM according to poor hearing and vision, controlling for baseline demographic and health characteristics. Results: Poor vision was associated with 2.70 (95% CI=1.37-5.62) greater odds for a decline in LSM. This association varied according to depressive symptoms. Poor vision was significantly associated with a decline in LSM for participants without high depressive symptoms (OR=5.04, 95% CI=2.00-15.5), but not for participants with depression (OR=0.63, 95% CI=0.12-3.13). The association between poor hearing and decline in LSM was not significant (OR=0.68, 95% CI=0.36-1.27). Conclusions: Poor vision is a risk factor for decline in LSM, especially for older Mexican-Americans who do not have high depressive symptoms. Poor hearing does not appear to be a risk factor for a decline in LSM for older Mexican-Americans.