Classification of Dysphonic Voice: Acoustic and Auditory-Perceptual Measures

The purpose of this study was (1) to determine the relationship between acoustic measures and auditory-perceptual dimensions of overall voice severity and pleasantness and (2) to evaluate the ability of acoustic and auditory-perceptual measures to discriminate normal from dysphonic voices. Thirty adult dysphonic speakers and six, age-matched normal control speakers were asked to provide oral reading samples of the Rainbow Passage. Acoustic analysis of the speech samples was used to identify abnormal phonatory events associated with dysphonia. The acoustic program calculated long-term average spectral measures, glottal noise measures, and those measures based on linear prediction (LP) modeling. Twelve adult listeners judged overall voice severity and pleasantness from the connected speech samples using direct magnitude estimation (DME) procedures. The acoustic measures accounted for 48% of overall voice severity and 40% of voice pleasantness for dysphonic speakers. The classification performance of the acoustic measures and auditory-perceptual measures was quantified using logistic regression analysis. When acoustic measures or auditory-perceptual measures were considered in isolation, classification was generally accurate and similar across measures. Classification accuracy improved to 100% when acoustic and auditory-perceptual measures were combined. These data provide further support for use of both auditory-perceptual evaluation and acoustic analyses for classifying and evaluating dysphonia.     

Multiparametric Evaluation of Dysphonic Severity

SUMMARY: In recent years, the multiparametric approach for evaluating perceptual rating of voice quality has been advocated. This study evaluates the accuracy of predicting perceived overall severity of voice quality with a minimal set of aerodynamic, voice range profile (phonetogram), and acoustic perturbation measures. One hundred and twelve dysphonic persons (93 women and 19 men) with laryngeal pathologies and 41 normal controls (35 women and six men) with normal voices participated in this study. Perceptual severity judgement was carried out by four listeners rating the G (overall grade) parameter of the GRBAS scale. The minimal set of instrumental measures was selected based on the ability of the measure to discriminate between dysphonic and normal voices, and to attain at least a moderate correlation with perceived overall severity. Results indicated that perceived overall severity was best described by maximum phonation time of sustained /a/, peak intraoral pressure of the consonant-vowel /pi/ strings production, voice range profile area, and acoustic jitter. Direct-entry discriminant function analysis revealed that these four voice measures in combination correctly predicted 67.3% of perceived overall severity levels.     

Vocal stability in functional dysphonic versus healthy voices at different times of voice loading

Functional (nonorganic) dysphonia is often characterized by vocal instability. The purpose of the prospective study was to examine whether there is a difference in vocal instability of functional dysphonic voices compared with healthy ones, this means whether electroglottographic perturbation values differ (1) between healthy and dysphonic voices and (2) between two subgroups of the dysphponic voices (hpertonic and hypotonic dysphonic voices). Twenty-three patients with hypertonic functional dysphonia, 9 with hypotonic functional dysphonia and 31 healthy nonsmokers, were each examined electroglottographically before (Ex 1), immediately after (Ex 2), and 1 hour after (Ex 3) voice loading. Perturbations of frequency, amplitude, quasi-open-quotient, and contact-index were calculated from the EGG signal. At all three times of examination, hypertonic dysphonic voices showed higher perturbations than healthy voices, and they had higher perturbations than hypotonic dysphonic voices before and 1 hour after voice loading. Hypotonic dysphonic voices showed higher perturbations than healthy voices only 1 hour after voice loading. Voice loading induced different reactions in dysphonic voices: Some voices showed increased perturbations, and others exhibited normal or even decreased perturbation immediately after voice loading. Examination of electroglottographic-derived perturbations immediately after voice loading seems not to be useful. Differentiation of hypertonic and hypotonic dysphonic voices was possible with an estimated sensitivity of 88.9% and a specificity of 87.0% by using the sum of the amplitude-perturbation and the quasi-open-quotient-perturbation measured before voice loading.     

Sources of listener disagreement in voice quality assessment

Traditional interval or ordinal rating scale protocols appear to be poorly suited to measuring vocal quality. To investigate why this might be so, listeners were asked to classify pathological voices as having or not having different voice qualities. It was reasoned that this simple task would allow listeners to focus on the kind of quality a voice had, rather than how much of a quality it possessed, and thus might provide evidence for the validity of traditional vocal qualities. In experiment 1, listeners judged whether natural pathological voice samples were or were not primarily breathy and rough. Listener agreement in both tasks was above chance, but listeners agreed poorly that individual voices belonged in particular perceptual classes. To determine whether these results reflect listeners' difficulty agreeing about single perceptual attributes of complex stimuli, listeners in experiment 2 classified natural pathological voices and synthetic stimuli (varying in f0 only) as low pitched or not low pitched. If disagreements derive from difficulties dividing an auditory continuum consistently, then patterns of agreement should be similar for both kinds of stimuli. In fact, listener agreement was significantly better for the synthetic stimuli than for the natural voices. Difficulty isolating single perceptual dimensions of complex stimuli thus appears to be one reason why traditional unidimensional rating protocols are unsuited to measuring pathologic voice quality. Listeners did agree that a few aphonic voices were breathy, and that a few voices with prominent vocal fry and/or interharmonics were rough. These few cases of agreement may have occurred because the acoustic characteristics of the voices in question corresponded to the limiting case of the quality being judged. Values of f0 that generated listener agreement in experiment 2 were more extreme for natural than for synthetic stimuli, consistent with this interpretation.     

Reliability of Speaking and Maximum Voice Range Measures in Screening for Dysphonia

Speech range profile (SRP) is a graphical display of frequency-intensity occurring interactions during functional speech activity. Few studies have suggested the potential clinical applications of SRP. However, these studies are limited to qualitative case comparisons and vocally healthy participants. The present study aimed to examine the effects of voice disorders on speaking and maximum voice ranges in a group of vocally untrained women. It also aimed to examine whether voice limit measures derived from SRP were as sensitive as those derived from voice range profile (VRP) in distinguishing dysphonic from healthy voices. Ninety dysphonic women with laryngeal pathologies and 35 women with normal voices, who served as controls, participated in this study. Each subject recorded a VRP for her physiological vocal limits. In addition, each subject read aloud the "North Wind and the Sun" passage to record SRP. All the recordings were captured and analyzed by Soundswell's computerized real-time phonetogram Phog 1.0 (Hitech Development AB, T?by, Sweden). The SRPs and the VRPs were compared between the two groups of subjects. Univariate analysis results demonstrated that individual SRP measures were less sensitive than the corresponding VRP measures in discriminating dysphonic from normal voices. However, stepwise logistic regression analyses revealed that the combination of only two SRP measures was almost as effective as a combination of three VRP measures in predicting the presence of dysphonia (overall prediction accuracy: 93.6% for SRP vs 96.0% for VRP). These results suggest that in a busy clinic where quick voice screening results are desirable, SRP can be an acceptable alternate procedure to VRP.     

Voice Care Knowledge Among Clinicians and People With Healthy Voices or Dysphonia

An important clinical component in the prevention and treatment of voice disorders is voice care and hygiene. Research in voice care knowledge has mainly focussed on specific groups of professional voice users with limited reporting on the tool and evidence base used. In this study, a questionnaire to measure voice care knowledge was developed based on "best evidence." The questionnaire was validated by measuring specialist voice clinicians' agreement. Preliminary data are then presented using the voice care knowledge questionnaire with 17 subjects with nonorganic dysphonia and 17 with healthy voices. There was high (89%) agreement among the clinicians. There was a highly significant difference between the dysphonic and the healthy group scores (P = 0.00005). Furthermore, the dysphonic subjects (63% agreement) presented with less voice care knowledge than the subjects with healthy voices (72% agreement). The questionnaire provides a useful and valid tool to investigate voice care knowledge. The findings have implications for clinical intervention, voice therapy, and health prevention.     

Spectral- and Cepstral-Based Measures During Continuous Speech: Capacity to Distinguish Dysphonia and Consistency Within a Speaker

Spectral- and cepstral-based acoustic measures are preferable to time-based measures for accurately representing dysphonic voices during continuous speech. Although these measures show promising relationships to perceptual voice quality ratings, less is known regarding their ability to differentiate normal from dysphonic voice during continuous speech and the consistency of these measures across multiple utterances by the same speaker. The purpose of this study was to determine whether spectral moments of the long-term average spectrum (LTAS) (spectral mean, standard deviation, skewness, and kurtosis) and cepstral peak prominence measures were significantly different for speakers with and without voice disorders when assessed during continuous speech. The consistency of these measures within a speaker across utterances was also addressed. Continuous speech samples from 27 subjects without voice disorders and 27 subjects with mixed voice disorders were acoustically analyzed. In addition, voice samples were perceptually rated for overall severity. Acoustic analyses were performed on three continuous speech stimuli from a reading passage: two full sentences and one constituent phrase. Significant between-group differences were found for both cepstral measures and three LTAS measures (P < 0.001): spectral mean, skewness, and kurtosis. These five measures also showed moderate to strong correlations to overall voice severity. Furthermore, high degrees of within-speaker consistency (correlation coefficients ≥0.89) across utterances with varying length and phonemic content were evidenced for both subject groups.     

Acoustic Signal Typing for Evaluation of Voice Quality in Tracheoesophageal Speech

SUMMARY: Because of the aperiodicity of many tracheoesophageal voices, acoustic analysis of the tracheoesophageal voice is less straightforward than that of the normal voice. This study presents the development and testing of an acoustic signal typing system based on visual inspection of a narrow-band spectrogram that can be used by researchers for classification of voice quality in tracheoesophageal speech. In addition to this classification system, a selection of acoustic measures [median fundamental frequency, standard deviation of fundamental frequency, jitter, percentage of voiced (%Voiced), harmonics-to-noise ratio (HNR), glottal-to-noise excitation (GNE) ratio, and band energy difference (BED)] was computed to provide more insight into the acoustic components of tracheoesophageal voice quality. For clinical relevance, relationships between the acoustic signal types and an overall judgment of the voice were investigated as well. Results showed that the four acoustic signal types form a good basis for performing more acoustic analyses and give a good impression of the overall quality of the voice.     

Analysis, synthesis, and perception of voice quality variations among female and male talkers

Voice quality variations include a set of voicing sound source modifications ranging from laryngealized to normal to breathy phonation. Analysis of reiterant imitations of two sentences by ten female and six male talkers has shown that the potential acoustic cues to this type of voice quality variation include: (1) increases to the relative amplitude of the fundamental frequency component as open quotient increases; (2) increases to the amount of aspiration noise that replaces higher frequency harmonics as the arytenoids become more separated; (3) increases to lower formant bandwidths; and (4) introduction of extra pole zeros in the vocal-tract transfer function associated with tracheal coupling. Perceptual validation of the relative importance of these cues for signaling a breathy voice quality has been accomplished using a new voicing source model for synthesis of more natural male and female voices. The new formant synthesizer, KLSYN88, is fully documented here. Results of the perception study indicate that, contrary to previous research which emphasizes the importance of increased amplitude of the fundamental component, aspiration noise is perceptually most important. Without its presence, increases to the fundamental component may induce the sensation of nasality in a high-pitched voice. Further results of the acoustic analysis include the observations that: (1) over the course of a sentence, the acoustic manifestations of breathiness vary considerably--tending to increase for unstressed syllables, in utterance-final syllables, and at the margins of voiceless consonants; (2) on average, females are more breathy than males, but there are very large differences between subjects within each gender; (3) many utterances appear to end in a "breathy-laryngealized" type of vibration; and (4) diplophonic irregularities in the timing of glottal periods occur frequently, especially at the end of an utterance. Diplophonia and other deviations from perfect periodicity may be important aspects of naturalness in synthesis.     

Perceptual evaluation of voice quality and its correlation with acoustic measurements

To determine whether a correlation exists between the Grade, Roughness, Breathiness, Aesthenia, Strain (GRBAS) scale (a subjective measure of voice) and the Multi-Dimensional Voice Program (MDVP) scale (an objective measure of voice). A retrospective review of 37 voice patients (12 male/25 female) was conducted. Each voice was perceptually evaluated using the GRBAS scale by an experienced speech pathologist and acoustically analyzed using the MDVP scale. Statistical analysis using a multivariate regression model identified a significant correlation between the noise-related parameters of MDVP and the components of the GRBAS scale. Grade correlated with voice turbulence index (VTI), noise harmonic ratio (NHR), and soft phonation index (SPI). Roughness correlated with NHR only. Breathiness correlated with SPI only. Aesthenia also correlated with SPI only. Of the 19 acoustic variables measured by the MDVP system, only three noise parameters significantly correlated with the GRBAS perceptual voice analysis. Perhaps "noise" is the perceived acoustical quality of the dysphonic voice. A voice quantifying measure such as a "voice index score" could be proposed using the GRBAS scoring and the three clinically relevant MDVP values following further studies.     

Comparison of fundamental frequency and perturbation measurements among three analysis systems

The need for standardization of procedures in approaches to voice measurement has been recently emphasized. The purpose of this study was to determine the extent to which the acoustic perturbation measurements from three different analysis systems agree when standardized recording and analysis procedures are used. High-quality acoustic voice recordings from 20 patients were analyzed. The results showed that, although fundamental frequency measurements were in strong agreement among the three systems tested, frequency and amplitude perturbation measurements were not in agreement. The underlying approaches to perturbation measurement appeared to be sufficiently different to produce different results. An argument is made for a standardized set of acoustic signals representing normal, dysphonic, and synthesized voices with known characteristics to facilitate testing of new acoustic analysis systems and confirm measurement accuracy and sensitivity.     

Acoustic Analysis of Pathological Voices Compressedwith MPEG System

The MPEG-1 Layer 3 compression schema of audio signal, commonly known as mp3, has caused a great impact in recent years as it has reached high compression rates while conserving a high sound quality. Music and speech samples compressed at high bitrates are perceptually indistinguishable from the original samples, but very little was known about how compression acoustically affects the voice signal. A previous work with normal voices showed a high fidelity at high-bitrate compressions both in voice parameters and the amplitude-frequency spectrum. In the present work, dysphonic voices were tested through two studies. In the first study, spectrograms, long-term average spectra (LTAS), and fast Fourier transform (FFT) spectra of compressed and original samples of running speech were compared. In the second study, intensities, formant frequencies, formant bandwidths, and a multidimensional set of voice parameters were tested in a set of sustained phonations. Results showed that compression at high bitrates (96 and 128 kbps) preserved the relevant acoustic properties of the pathological voices. With compressions at lower bitrates, fidelity decreases, introducing some important alterations. Results from both works, Gonzalez and Cervera and this paper, open up the possibility of using MPEG-compression at high bitrates to store or transmit high-quality speech recordings, without altering their acoustic properties.     

Harmonic-intensity analysis of normal and hoarse voices

Objective evaluation of normal and hoarse voices is performed considering the characteristic that hoarse voices show a prominent fundamental frequency intensity compared with harmonics in the voice spectrum. The relative harmonic intensity Hr, obtained from a stable portion of the sustained vowel/a/, is defined as the intensity of the second and higher harmonics expressed as a percentage of the total voice intensity. Ninety-five percent of the normal voices examined have Hr larger than the critical value of 67.2%, whereas 90% of the hoarse voices have Hr smaller than the critical value. The harmonic-intensity analysis thus provides good discrimination between normal and hoarse voices.     

Pitch strength of normal and dysphonic voices

Two sounds with the same pitch may vary from each other based on saliency of their pitch sensation. This perceptual attribute is called "pitch strength." The study of voice pitch strength may be important in quantifying of normal and pathological qualities. The present study investigated how pitch strength varies across normal and dysphonic voices. A set of voices (vowel /a/) selected from the Kay Elemetrics Disordered Voice Database served as the stimuli. These stimuli demonstrated a wide range of voice quality. Ten listeners judged the pitch strength of these stimuli in an anchored magnitude estimation task. On a given trial, listeners heard three different stimuli. The first stimulus represented very low pitch strength (wide-band noise), the second stimulus consisted of the target voice and the third stimulus represented very high pitch strength (pure tone). Listeners estimated pitch strength of the target voice by positioning a continuous slider labeled with values between 0 and 1, reflecting the two anchor stimuli. Results revealed that listeners can judge pitch strength reliably in dysphonic voices. Moderate to high correlations with perceptual judgments of voice quality suggest that pitch strength may contribute to voice quality judgments.     

Acoustic characteristics of rough voice: Subharmonics

This study investigates the relationship between rough voice and the presence of Subharmonics, which correspond to smaller yet distinct peaks located between two consecutive harmonic peaks in the power spectrum. Spectrum analysis was undertaken in 389 pathologic voices, of which 20 had subharmonics. Although all 20 voices had roughness perceptually, 8 had normal jitter and/or shimmer. The degree of roughness had a significant inverse relationship with the frequency of subharmonics. By digital signal processing, sound samples with various types of subharmonics were synthesized and perceptually analyzed. Power and frequency of subharmonics in the synthesized sound also had significant relationships with the degree of roughness. Rough voice is acoustically characterized not only by jitter and shimmer but also by the presence of subharmonics in the power spectrum. Subharmonics are important acoustic properties for objective evaluation of rough voices.     

Objective Indices of Perceived Vocal Strain

BackgroundA limited number of experiments have investigated the perception of strain compared to the voice qualities of breathiness and roughness despite its widespread occurrence in patients who have hyperfunctional voice disorders, adductor spasmodic dysphonia, and vocal fold paralysis among others.ObjectiveThe purpose of this study is to determine the perceptual basis of strain through identification and exploration of acoustic and psychoacoustic measures.MethodsTwelve listeners evaluated the degree of strain for 28 dysphonic phonation samples on a five-point rating scale task. Computational estimates based on cepstrum, sharpness, and spectral moments (linear and transformed with auditory processing front-end) were correlated to the perceptual ratings.ResultsPerceived strain was strongly correlated with cepstral peak prominence, sharpness, and a subset of the spectral metrics. Spectral energy distribution measures from the output of an auditory processing front-end (ie, excitation pattern and specific loudness pattern) accounted for 77–79% of the model variance for strained voices in combination with the cepstral measure.ConclusionsModeling the perception of strain using an auditory front-end prior to acoustic analysis provides better characterization of the perceptual ratings of strain, similar to our prior work on breathiness and roughness. Results also provide evidence that the sharpness model of Fastl and Zwicker (2007) is one of the strong predictors of strain perception.     

Model-based classification of nonstationary vocal fold vibrations

Classification of vocal fold vibrations is an essential task of the objective assessment of voice disorders. For historical reasons, the conventional clinical examination of vocal fold vibrations is done during stationary, sustained phonation. However, the conclusions drawn from a stationary phonation are restricted to the observed steady-state vocal fold vibrations and cannot be generalized to voice mechanisms during running speech. This study addresses the approach of classifying real-time recordings of vocal fold oscillations during a nonstationary phonation paradigm in the form of a pitch raise. The classification is based on asymmetry measures derived from a time-dependent biomechanical two-mass model of the vocal folds which is adapted to observed vocal fold motion curves with an optimization procedure. After verification of the algorithm performance the method was applied to clinical problems. Recordings of ten subjects with normal voice and ten dysphonic subjects have been evaluated during stationary as well as nonstationary phonation. In the case of nonstationary phonation the model-based classification into "normal" and "dysphonic" succeeds in all cases, while it fails in the case of sustained phonation. The nonstationary vocal fold vibrations contain additional information about vocal fold irregularities, which are needed for an objective interpretation and classification of voice disorders.     

Voice field measurements—a new method of examination: the influence of hearing on the human voice

There are various methods to evaluate voice parameters. Original software was used to assess the voice quality by the staff of AUDIO-Fon centr Brno, Czech Republic. A group of hereditary deaf persons was examined. Deaf persons have all of the biological conditions to make voice except for the possibility of acoustic feedback. We examined the voices of 35 persons (20 men and 15 women) with hereditary profound hearing impairments, and we compared voice parameters with the voice of intact persons. To measure we used special software called voice field measurements (VFMs). The program graphically records voice frequency and intensity. VFM is an objective method that enables the assessment of basic physical voice characteristics. It is suitable for the examination of both intact and disturbed voice. The voice of the deaf has a higher basic voice frequency in men as well as in women. This type of voice production, ie, childlike voice, which is fixed only by a motor stereotype, is much more demanding for a mature larynx. Hearing influences both the voice development and speech production. The voice of persons with hearing impairments has a higher basic voice frequency regardless of their sex. This type of voice production, which is fixed only by a motor stereotype, ie, child voice, is much more demanding for a larynx of an adult. Thus, phonation of deaf people is more demanding and their voice production needs greater effort. Deaf people, despite an intact phonic apparatus, cannot produce more than one type of voice. They cannot modulate their voices concerning the frequency and dynamics. They cannot change their voices continually. The voice is limited in both of these parameters (frequency and dynamics). If a deaf person wants to change a voice characteristic, it is possible only by discontinuous changes-"skipping."     

The revised Australian fiberscopic profile

The Australian Fiberscopic Profile (AFP) was developed for use in a previous study of normal voices to provide standard documentation for examining the larynx under continuous light. The AFP is being used currently in five specialized voice clinics in Australia to collect data on dysphonic voices. After use with 40 clients it became obvious that a revision with clearer definitions of the parameters was needed to make it a more useful clinical tool.