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Introduction: In this study, the correlations between traditional acoustic measures (TAMs) and cepstral analysis (CA) were explored in Persian. Methods: This investigation was a cross-sectional study including 179 dysphonic (n = 141) and normophonic (n = 38) speakers. The TAMs (jitter, shimmer, and noise-to-harmonic ratio) and CA (cepstral peak prominence and cepstral peak prominence smoothed) values were obtained during vowel prolongation, reading a standard sentence, and a nonstandard running speech sample using Praat software. The difference of acoustic measures between normophonic and dysphonic speakers and intercorrelation among acoustic measures and correlation between the acoustic measures and perceived dysphonia levels were analyzed with independent t test, Mann-Whitney U test, Pearson, Spearman, and Kendall’s Tau-b correlation tests using IBM SPSS Statistics. Results: The findings showed that dysphonic speakers had higher TAM values and lower CA values than normophonic speakers (p < 0.05). In dysphonic speakers, a large correlation was discovered among all acoustic measurements (r = 0.52–0.96; p < 0.05), while in various perceived dysphonic speakers, there was a correlation of varying strength (r = 0.25–0.97; p < 0.05). Ultimately, there was a significant small-to-large correlation between the acoustic measures and perceived dysphonia levels (r = 0.34–0.58; p < 0.05). Conclusion: This research demonstrated that Persian speakers with dysphonia experienced a rise in TAM and a corresponding reduction in CA. In the future, multi-parametric indices can be developed using both TAM and CA to include various aspects of vocal production and yield a single, comprehensive value. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyse the relationship between automatic vowel articulation index (aVAI) and direct magnitude estimation (DME) among speakers with Parkinson's disease (PD) and healthy controls. We further analysed the potential of aVAI to serve as an objective measure of speech impairment in the clinical setting. Method: Speech samples from native Finnish speakers were utilised. Expert raters utilised DME to scale the intelligibility of speech samples. aVAI scores for PD speakers and healthy control speakers were analysed in relationship to DME speech intelligibility ratings and, among PD speakers, disease stage utilising nonparametric statistical analysis. Result: Mean DME intelligibility ratings were lower among PD speakers compared to healthy controls. Mean aVAI scores were nearly the same between speaker groups. DME intelligibility ratings and aVAI were strongly correlated within the PD speaker group. aVAI and DME intelligibility ratings were moderately correlated with disease stage as measured by the Hoehn and Yahr scale. Conclusion: aVAI was observed to be a promising tool for analysing vowel articulation in PD speakers. Further research is warranted on the application of aVAI as an objective measure of severity of speech impairment in the clinical setting, with varying patient populations and speech samples. [ABSTRACT FROM AUTHOR]

While extensive research exists on the variations in voice quality measures among different languages, the impact of bilingualism on voice characteristics has been relatively understudied in the literature. This study explores the divergences among monolingual and bilingual speakers in various voice quality measures. The participants were adult Greek monolingual and adult Albanian-Greek sequential bilingual speakers, who permanently lived in Greece. All speakers participated in a controlled sentence production task, which targeted the Greek vowels. Acoustic measures such as fundamental frequency (F0), first four formants (F1–F4), duration, jitter, shimmer, harmonics-to-noise ratio (HNR), and intensity were elicited from the speech samples. Differences were identified in the majority of voice parameters for certain vowels, implying that the vocal characteristics of bilinguals may demonstrate distinct adaptations compared to those of monolinguals in certain instances. Jitter displayed the most pronounced differences across vowels, followed by F2, shimmer, and HNR, with F3, F4, and duration showing relatively fewer distinctions. It is established that sequential bilingual speakers may exhibit variations from monolingual speakers across multiple acoustic parameters and that voice quality parameters can also manifest as sound-specific. These findings hold practical significance for the evaluation and therapeutic interventions tailored to bilingual individuals within clinical settings.

Telepractice offers the opportunity to receive care at home without risk of exposure to healthcare acquired infections, especially during a pandemic. Hence, establishing the reliability of the diagnosis of dysphonia via a smartphone is fundamental to providing an alternative service delivery model. A total of 20 participants participated in the study. Recordings of sentence-based voice samples were done using a standardized microphone and the software used in labs and on smartphones. Comparisons were made of acoustic and perceptual voice in real-time and recorded samples speech in persons with typical vs pathological voice. Results revealed no significant differences perceptually between real-time voice and recorded voice in individuals with typical and pathological voices. In acoustic analysis, there was no significant difference in Fundamental frequency (F0) and Auditory Voice Quality Index (AVQI) between real-time voice and recorded voice in individuals with typical and pathological voice.

Telepractice offers the opportunity to receive care at home without risk of exposure to healthcare acquired infections, especially during a pandemic. Hence, establishing the reliability of the diagnosis of dysphonia via a smartphone is fundamental to providing an alternative service delivery model. A total of 20 participants participated in the study. Recordings of sentence-based voice samples were done using a standardized microphone and the software used in labs and on smartphones. Comparisons were made of acoustic and perceptual voice in real-time and recorded samples speech in persons with typical vs pathological voice. Results revealed no significant differences perceptually between real-time voice and recorded voice in individuals with typical and pathological voices. In acoustic analysis, there was no significant difference in Fundamental frequency (F0) and Auditory Voice Quality Index (AVQI) between real-time voice and recorded voice in individuals with typical and pathological voice. [ABSTRACT FROM AUTHOR]

Background: The assessment of voice quality can be evaluated perceptually with standard clinical practice, also including acoustic evaluation of digital voice recordings to validate and further interpret perceptual judgments. The goal of the present study was to determine the strongest acoustic voice quality parameters for perceived hoarseness and breathiness when analyzing the sustained vowel [a:] using a new clinical acoustic tool, the VOXplot software. Methods: A total of 218 voice samples of individuals with and without voice disorders were applied to perceptual and acoustic analyses. Overall, 13 single acoustic parameters were included to determine validity aspects in relation to perceptions of hoarseness and breathiness. Results: Four single acoustic measures could be clearly associated with perceptions of hoarseness or breathiness. For hoarseness, the harmonics-to-noise ratio (HNR) and pitch perturbation quotient with a smoothing factor of five periods (PPQ5), and, for breathiness, the smoothed cepstral peak prominence (CPPS) and the glottal-to-noise excitation ratio (GNE) were shown to be highly valid, with a significant difference being demonstrated for each of the other perceptual voice quality aspects. Conclusions: Two acoustic measures, the HNR and the PPQ5, were both strongly associated with perceptions of hoarseness and were able to discriminate hoarseness from breathiness with good confidence. Two other acoustic measures, the CPPS and the GNE, were both strongly associated with perceptions of breathiness and were able to discriminate breathiness from hoarseness with good confidence. [ABSTRACT FROM AUTHOR]

Abstract Background Frailty is a common issue in the aging population. Given that frailty syndrome is little discussed in the literature on the aging voice, the current study aims to examine the relationship between frailty and vocal biomarkers in older people. Methods Participants aged ≥ 60 years visiting geriatric outpatient clinics were recruited. They underwent frailty assessment (Cardiovascular Health Study [CHS] index; Study of Osteoporotic Fractures [SOF] index; and Fatigue, Resistance, Ambulation, Illness, and Loss of weight [FRAIL] index) and were asked to pronounce a sustained vowel /a/ for approximately 1 s. Four voice parameters were assessed: average number of zero crossings (A1), variations in local peaks and valleys (A2), variations in first and second formant frequencies (A3), and spectral energy ratio (A4). Results Among 277 older adults, increased A1 was associated with a lower likelihood of frailty as defined by SOF (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.74–0.96). Participants with larger A2 values were more likely to be frail, as defined by FRAIL and CHS (FRAIL: OR 1.41, 95% CI 1.12–1.79; CHS: OR 1.38, 95% CI 1.10–1.75). Sex differences were observed across the three frailty indices. In male participants, an increase in A3 by 10 points increased the odds of frailty by almost 7% (SOF: OR 1.07, 95% CI 1.02–1.12), 6% (FRAIL: OR 1.06, 95% CI 1.02–1.11), or 6% (CHS: OR 1.06, 95% CI 1.01–1.11). In female participants, an increase in A4 by 0.1 conferred a significant 2.8-fold (SOF: OR 2.81, 95% CI 1.71–4.62), 2.3-fold (FRAIL: OR 2.31, 95% CI 1.45–3.68), or 2.8-fold (CHS: OR 2.82, 95% CI 1.76–4.51, CHS) increased odds of frailty. Conclusions Vocal biomarkers, especially spectral-domain voice parameters, might have potential for estimating frailty, as a non-invasive, instantaneous, objective, and cost-effective estimation tool, and demonstrating sex differences for individualised treatment of frailty.

Introduction: Despite its clinical significance, few studies have explored the applicability of the validated Arabic version of the Voice Handicap Index (VHI-Arab) in professional voice users, especially singers. The correlation between VHI-Arab scores and acoustic measures in this targeted group remains unclear. The aim of this study was to explore Arab Kuwaiti prospective professional singers' perception of voice handicap using the validated VHI-Arab. Additionally, we examined the association between VHI-Arab scores and acoustic measures such as fundamental frequency (F0), shimmer, jitter, and signal-to-noise ratio. Methods: VHI-Arab scores and acoustic measures of 100 adult prospective professional singers (50 females and 50 males) were compared with those of 100 adult controls (50 females and 50 males). Results: Female prospective professional singers differed significantly from female controls in terms of functional and physical subscale scores, total VHI-Arab scores, and shimmer and jitter values. Male prospective professional singers showed significant differences neither in VHI-Arab scores nor in acoustic measures; however, their shimmer values showed significant a difference. There was no correlation between VHI-Arab scores and acoustic measures. Conclusion: Kuwaiti prospective professional singers did not perceive their voice as handicapped. Female prospective professional singers had a better perception of their voice compared with female controls. The results of the current study suggest that the perception of voice handicap and acoustic measures are different attributes that do not correlate. [ABSTRACT FROM AUTHOR]

Background: Frailty is a common issue in the aging population. Given that frailty syndrome is little discussed in the literature on the aging voice, the current study aims to examine the relationship between frailty and vocal biomarkers in older people.Methods: Participants aged ≥ 60 years visiting geriatric outpatient clinics were recruited. They underwent frailty assessment (Cardiovascular Health Study [CHS] index; Study of Osteoporotic Fractures [SOF] index; and Fatigue, Resistance, Ambulation, Illness, and Loss of weight [FRAIL] index) and were asked to pronounce a sustained vowel /a/ for approximately 1 s. Four voice parameters were assessed: average number of zero crossings (A1), variations in local peaks and valleys (A2), variations in first and second formant frequencies (A3), and spectral energy ratio (A4).Results: Among 277 older adults, increased A1 was associated with a lower likelihood of frailty as defined by SOF (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.74-0.96). Participants with larger A2 values were more likely to be frail, as defined by FRAIL and CHS (FRAIL: OR 1.41, 95% CI 1.12-1.79; CHS: OR 1.38, 95% CI 1.10-1.75). Sex differences were observed across the three frailty indices. In male participants, an increase in A3 by 10 points increased the odds of frailty by almost 7% (SOF: OR 1.07, 95% CI 1.02-1.12), 6% (FRAIL: OR 1.06, 95% CI 1.02-1.11), or 6% (CHS: OR 1.06, 95% CI 1.01-1.11). In female participants, an increase in A4 by 0.1 conferred a significant 2.8-fold (SOF: OR 2.81, 95% CI 1.71-4.62), 2.3-fold (FRAIL: OR 2.31, 95% CI 1.45-3.68), or 2.8-fold (CHS: OR 2.82, 95% CI 1.76-4.51, CHS) increased odds of frailty.Conclusions: Vocal biomarkers, especially spectral-domain voice parameters, might have potential for estimating frailty, as a non-invasive, instantaneous, objective, and cost-effective estimation tool, and demonstrating sex differences for individualised treatment of frailty. [ABSTRACT FROM AUTHOR]

Research on gesture production has emphasized the strong relationship between speech and gesture. Studies have explored whether the inability to gesture is detrimental to speech at different levels. However, findings are still inconclusive and research that focuses on a complete set of acoustic prosodic measures, including F0 and intensity are lacking. Also, studies have used very controlled tasks but evidence is lacking about spontaneous speech. The present study investigates the effects of restraining hand gestures on semi-spontaneous narrative speech. Twenty native Italian speakers described the content of short comic strips to a listener in two conditions: Non-Restraining gestures (N); Restraining gestures (R) (i.e., the speakers had to sit on their hands). The following speech variables were examined: speech length (number of words and speech length in seconds), disfluencies (filled pauses, self-corrections, repetitions, insertions, interruptions) and prosodic properties related to speech rate, F0 and intensity. Overall, the results showed that speakers' inability to gesture does not significantly affect their narrative speech performance in terms of speech length, fluency and acoustic features. When repeating the analysis with the exclusion of the participants who gestured very little in the N condition, however, a slightly different pattern of results emerged; this leaves open the possibility that the inability to gesture may impact individuals differently, depending on the extent to which they rely on gesture when speaking. Further work is needed to shed more light on the role of gestures on the prosodic level of speech production which also takes into account individuals' communicative and cognitive inclinations. • The study investigates whether restraining speakers from gesturing affects their narrative speech in terms of fluency and prosodic features. • The data is collected from semi-spontaneous speech rather than controlled tasks. • The study suggests that restraining hand gestures may not impact individual's speech fluency, discourse length, F0 and intensity measures. • The study also investigates the possibility that individuals that naturally gesture more while speaking are more affected by the inability to gesture. • The study suggests that the inability to gesture may impact individuals differently, depending on the extent to which they rely on gesture when speaking. [ABSTRACT FROM AUTHOR]

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• L1 Spanish vowels are more dynamic than L2 Spanish vowels. • Amount of formant change fails to characterize L1 and L2 Spanish vowels. • Direction of formant movement differentiates L1 from L2 Spanish vowels. The present study describes the nature of the dynamic spectral changes of Spanish vowels /a e o/ produced by 10 native Spanish (L1) speakers and 13 native English speakers learning Spanish as a second language (L2). The investigation seeks to identify variations in formant change through the application of both two- and three-point measures, evaluating their efficacy in capturing the formant dynamics of Spanish vowels. F1 and F2 formant dynamic variations were assessed in a set of acoustic measures, including Vector Length (VL), Trajectory Length (TL) and Formant Velocity (FV). Results show that L1 Spanish vowels are more dynamic than L2 Spanish vowels produced by native English speakers, challenging the traditional view that Spanish vowels are rather static. Moreover, the findings indicate that two- and three-point measures yield similar results for most vowels regarding the amount of formant change, rendering them ineffective in accurately describing Spanish vowels. The main difference between L1 and L2 Spanish vowels lies not in the magnitude of formant change, but in the direction of such change. Consequently, a measure that incorporates the direction of formant movement, such as FV, emerges as a more suitable acoustic characterization for both L1 and L2 Spanish vowels. [ABSTRACT FROM AUTHOR]

Objectives: Voice therapy has been the primary treatment for voice feminization in transfemale patients due to concerns that surgery worsens voice quality. We aim to determine the impact of Wendler glottoplasty on acoustic measures of voice.Study Design: Retrospective case series.Methods: Transgender female patients treated for vocal feminization with Wendler glottoplasty at a single tertiary care center were identified. Pre- and postoperative measures were taken with the Kay Elemetrics Real-Time Pitch, Analysis of Dysphonia in Speech and Voice, and Multidimensional Voice Program.Results: Twenty-eight patients were included in this study. There were no statistically significant changes in fundamental frequency variation, peak amplitude variation, soft phonation index, noise-to-harmonics ratio, cepstral peak prominence, or cepstral spectral index of dysphonia at a significance level of P < .05. Average speaking fundamental frequency (SF0) increased from 143 Hz after voice therapy to 163 Hz after surgery (P = .0009). Lower range decreased in 61% and increased in 26% of patients. Upper range decreased in 52% and increased in 48% of patients.Conclusions: Wendler glottoplasty does not worsen voice quality based on acoustic measures. Although most patients experience an increase in average SF0, effects on vocal range are variable with approximately half of patients experiencing a reduction and half experiencing an increase in upper pitch limit.Level Of Evidence: 4 Laryngoscope, 131:583-586, 2021. [ABSTRACT FROM AUTHOR]

Reducing noise in the working environment is currently important, both in terms of meeting the obligation to comply with limit and action values, but also in terms of increasing the quality of the working environment. Workers in industrial production are often exposed to excessive noise. The reduction of noise in the working environment can in some cases be achieved in relatively simple ways, mainly by implementing measures that prevent the spread of noise along the transmission path. The first task in designing noise reduction modifications is to know the current state of the acoustic situation. Noise abatement measures will improve the working environment for employees and reduce the overall impact on human health. An important part is the proposal of measures to reduce noise with the subsequent implementation of these measures. During the design of the measures, it is necessary to take into account the suitability of the materials, the design solution and the financial complexity. After the implementation of the measures, noise measurements are performed and the effectiveness of the implemented measures is evaluated. [ABSTRACT FROM AUTHOR]

In this study, we examined changes in the voice quality of a transgender client who had previously undergone male-to-female (MtF) transition. We conducted a longitudinal phonetic analysis after obtaining recordings from our client before and after undergoing laser-assisted voice adjustment (LAVA) surgery. The following acoustic parameters were compared: fundamental frequency (F0) measures, local jitter, shimmer, harmonic to noise ratio, phonation time, and long-term average spectrum. We assumed that the voice would not change significantly as a result of previous hormonal and vocal therapy, and that its timbre would be closer to female values after LAVA surgery. Since the client was on hormone therapy before the surgery, the average values of F0 corresponded to the values of a normal female voice (190.1 Hz), and, after surgery, the voice became significantly higher in phonation (235.6 Hz). Before surgery, the voice was high for a male voice during reading (mean F0 = 150.19 Hz for non-fricative text (NT) and mean F0 = 158.06 Hz for fricative text (FT)). After surgery, the voice exhibited higher F0 values (F = 184.72 Hz for NT and F0 = 191.87 Hz for FT). Before surgery, the voice was average high for a male voice during spontaneous speech (F = 119.90 Hz), while after surgery the F0 was 161.33 Hz during spontaneous speech, which is somewhat lower than the average pitch values of the female voice, but its timbral quality is more feminine. Since spontaneous speech is very important for comparison vocal timbre, we can conclude that the 42 Hz difference observed is notable. Although the minimal and maximal values of F0 based on phonation were significantly higher after surgery (p < 0.001), the range was limited. The total results of the F0 measures are higher than expected, while the shortened phonation time points to the need for voice therapy. Considering all our results, we can conclude that it is important to discuss a client's profession before considering LAVA surgery. [ABSTRACT FROM AUTHOR]

This article explores the role of pharmacists and pharmaceuticals in vocal health. Pharmacists are highly trained medical professionals that are easily accessible and are subject matter experts in pharmacotherapy. There are multiple types of drug, herbal, and dietary products with varying regulatory processes and safety profiles, so consumers can utilize the pharmacist to assist them with choosing the correct type of product for their medical needs. Pharmacists can also assist consumers with navigating drug products, as well as herbal and dietary products, that can have impacts on voice and speech. There are many medications and other products that can have negative impacts on the voice, but there are often viable alternatives that can be substituted based on the consumer's individual medical needs and preferences. Necessary medical care or medications should not be avoided due to a fear of a potential negative impact on the voice. Generally, for voice maintenance and improvement, it is recommended to avoid herbal products that claim to provide voice relief; instead, clinical studies have shown that using nasal irrigation, systemic hydration, and steam inhalation in the appropriate manner is good for throat irritation, voice maintenance and can improve voice quality related acoustic measures. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the acoustic and articulatory movement parameters underlying lexical stress production in children with apraxia of speech (CAS), children with articulation/phonological delay (i.e. speech delay, SD), and children with typical speech-language development (TD). We examined whether there were group differences in these instrumental measures of stress production. Method: Participants were 24 children (seven CAS, eight SD, nine TD) between three and seven years of age. Acoustic and kinematic measures, including acoustic duration, peak and average fundamental frequency, and jaw movement duration and displacement, were taken from perceptually accurate productions of a strong-weak form. Relative stress analyses were conducted using the Pairwise Variability Index (PVI). Result: There was a significant difference between the CAS and TD groups in the PVI for movement duration, with the CAS group showing a smaller movement duration contrast between stressed and unstressed syllables. There were no significant group differences for displacement or any of the acoustic variables. Conclusion: The kinematic findings suggest reduced temporal control for lexical stress production in children with CAS. This finding surfaced during analyses of perceptually accurate productions but suggests a possible basis for lexical stress errors in CAS that could be explored in future studies. [ABSTRACT FROM AUTHOR]

Numerous studies have reported on the high accuracy of using voice tasks for the remote detection and monitoring of Parkinson’s Disease (PD). Most of these studies, however, report findings on a small number of voice recordings, often collected under acoustically controlled conditions, and therefore cannot scale at large without specialized equipment. In this study, we aimed to evaluate the potential of using voice as a population-based PD screening tool in resource-constrained settings. Using the standard telephone network, we processed 11,942 sustained vowel /a/ phonations from a US-English cohort comprising 1078 PD and 5453 control participants. We characterized each phonation using 304 dysphonia measures to quantify a range of vocal impairments. Given that this is a highly unbalanced problem, we used the following strategy: we selected a balanced subset (n = 3000 samples) for training and testing using 10-fold cross-validation (CV), and the remaining (unbalanced held-out dataset, n = 8942) samples for further model validation. Using robust feature selection methods we selected 27 dysphonia measures to present into a radial-basis-function support vector machine and demonstrated differentiation of PD participants from controls with 67.43% sensitivity and 67.25% specificity. These findings could help pave the way forward toward the development of an inexpensive, remote, and reliable diagnostic support tool for PD using voice as a digital biomarker.

Introduction: Many transsexual women seek to feminise their voice through pitch elevation surgeries so that it becomes congruent with their gender identity. This study aims to determine the safety and effectiveness of Wendler glottoplasty (WG) in vocal feminisation through the assessment of acoustic and aerodynamic parameters of the voice, as well as voice-related quality of life (QoL) in male-to-female transsexuals., Material and Methods: We retrospectively reviewed the medical records of transsexual women who underwent WG for voice feminisation at our institution between 2016 and 2023. All acoustic and aerodynamic analyses, a voice self-assessment, and a videolaryngostroboscopic evaluation were performed in the immediate preoperative period and at the follow-up visit 6 weeks after the procedure., Results: A total of 11 patients with a mean age of 32.73 years were included. After WG, there was a significant fundamental frequency and speaking fundamental frequency increase of 109.64 Hz and 83.48 Hz, respectively (p < 0.001), representing an average rise by 9.71 semitones and 8.36 semitones (STs), respectively. No significant differences were found between the mean pre- and postoperative values of fundamental frequencies, frequency range, upper limit of the frequency range of spoken voice, and maximum phonation time. Contrarily, the mean lower limit of frequency range rose by 75.56 Hz (p < 0.001), representing an average increase of 10.56 STs. None of the assessed spirometric parameters changed significantly after WG (p > 0.05). The mean overall Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL) scores significantly improved after the surgery, decreasing by 24.54 points (p = 0.008) and 11.5 points (p = 0.001), respectively. A significant improvement was observed in the functional and emotional domains of VHI. Additionally, significantly fewer patients considered the overall quality of their voice to be "poor" after WG., Conclusions: WG constitutes an effective method of surgical voice feminisation in male-to-female transsexuals with concurrent improvement in their voice-related QoL. Furthermore, it remains a safe procedure without persistent complications and negative influence on the acoustic-aerodynamic measures of the voice.

Diphthong is a single sound produced when two vowels are paired together in a sequence. The present study aimed to analyse the various acoustic characteristics of Kannada diphthongs /αI/ and /α../ in word initial, medial and final position. 30 native Kannada speaking children (15 male; 15 female) in the age range of 8-12 years participated in this study. Participants were instructed to repeat back Kannada words for diphthongs /αI/ and /α../ (in word initial, medial and final position) after the examiner. Speech samples were recorded and subjected to acoustic analysis using Praat software to extract Acoustic parameters; onglide duration / offglide duration / total duration (/αI/ & /α.../)/ formant transition trajectories (F1 & F2)/ formant transition duration. Understanding the acoustic characteristics of Kannada diphthong and gender differences is the subject of discussion of this paper. [ABSTRACT FROM AUTHOR]

Acoustic analysis is widely used for assessing and monitoring vocal function. Dermatoglyphics is a method that analyzes genetic fingerprint markers, and uses that information for predicting physical skills related to anaerobic (explosive strength and speed) and aerobic (motor coordination and resistance) mechanisms. Therefore, it can be used as an indicator for individualized vocal training. To characterize the dermatoglyphic profiles and their relation to acoustic measures in voice professionals. A cross-sectional study involving 79 voice professionals. Acoustic analysis was performed using the PRAAT software. Mean intensity, fundamental frequency (F0), and cepstral peak prominence (CPP) value were extracted from the sustained vowel /a/. Fingerprints were collected using a Watson mini-integrated biometric scanner, and were quantified by design predominance, delta index (D10), total ridge count (TRC), and dermatoglyphic profile. The acoustic measures were analyzed descriptively and compared, considering the subjects' dermatoglyphic profiles. The confidence levels ranged from 90% to 95%. Most subjects exhibited anaerobic dermatoglyphic profiles (P = 0.004) and low TRC (p < 0.001). Higher F0 (P = 0.061), intensity (P = 0.065), and CPP (P = 0.073) were found for anaerobics (P < 0.001). There was a weak and negative correlation between TRC and intensity (P = 0.026), as well as between F0 (P = 0.017) and CPP (P = 0.069). Anaerobic profiles were predominant. The values of F0, intensity, and CPP increased for the anaerobics. There was a weak negative correlation between the TRC and intensity, F0, and CPP measures. Dermatoglyphics could have been seen as an interesting tool in the voice assessment and training direction for voice professionals. [ABSTRACT FROM AUTHOR]

Highlights • The role of spectral tilt in sentence prominence was investigated. • Estimators for tilt of glottal source spectrum and surface spectrum were compared. • Multidimensional representations for spectral tilt were also investigated. • Robustness of different tilt estimators was tested for noisy and coded speech. • Experiments were conducted on both French and Dutch speech data. Abstract Linguistic prominence in speech is known to correlate with the acoustic measures of energy, F0, and duration. In contrast, the role of spectral tilt in the realization of prominence has remained more inconsistent between previous empirical investigations. This may be partially due to the lack of a standard method for quantifying spectral tilt or due to difficulties in estimating the acoustical source of spectral tilt, the glottal flow, from continuous speech. These issues have rendered interpretations and comparisons between studies difficult. In addition, (i) little is known about the robustness of tilt estimators for prominence detection in the case when speech is not clean but corrupted, as in real life, by environmental noise or telephone transmission (i.e. degradation caused by bandpass filtering and quantization noise). Moreover, (ii) little attention has been paid to multidimensional representations of source spectrum that can potentially incorporate more information about the phonation style than purely scalar measures. In this work, we study spectral tilt in signaling prominence in spoken Dutch and French under different levels of additive noise, and for telephone-band coded speech, and compare several one-dimensional tilt measures that have been previously encountered in the literature as well as multidimensional tilt measures. We also compare spectral tilt measures with other standard acoustic correlates for prominence, namely, energy, F0, and duration. Our results provide further empirical support for the finding that tilt is a systematic correlate of prominence in Dutch, that the role is smaller in French, and that energy, F0, and duration appear still to be the most robust features for discriminating prominent and non-prominent words. In addition, our results show that there are notable differences between different tilt measures at different levels of noise, and that multidimensional representations for tilt improve class separability from the scalar measures. [ABSTRACT FROM AUTHOR]

Summary Objectives The purposes of this study were to (1) determine and compare the diagnostic accuracy of a single acoustic measure, smoothed cepstral peak prominence (CPPS), to predict voice disorder status from connected speech samples using two software systems: Analysis of Dysphonia in Speech and Voice ( ADSV ) and Praat ; and (2) to determine the relationship between measures of CPPS generated from these programs. Study Design This is a retrospective cross-sectional study. Methods Measures of CPPS were obtained from connected speech recordings of 100 subjects with voice disorders and 70 nondysphonic subjects without vocal complaints using commercially available ADSV and freely downloadable Praat software programs. Logistic regression and receiver operating characteristic (ROC) analyses were used to evaluate and compare the diagnostic accuracy of CPPS measures. Relationships between CPPS measures from the programs were determined. Results Results showed acceptable overall accuracy rates (75% accuracy, ADSV ; 82% accuracy, Praat ) and area under the ROC curves (area under the curve [AUC] = 0.81, ADSV ; AUC = 0.91, Praat ) for predicting voice disorder status, with slight differences in sensitivity and specificity. CPPS measures derived from Praat were uniquely predictive of disorder status above and beyond CPPS measures from ADSV ( χ 2 (1) = 40.71, P  < 0.001). CPPS measures from both programs were significantly and highly correlated ( r  = 0.88, P  < 0.001). Conclusions A single acoustic measure of CPPS was highly predictive of voice disorder status using either program. Clinicians may consider using CPPS to complement clinical voice evaluation and screening protocols. [ABSTRACT FROM AUTHOR]

This work presents a description and an analysis of an attitudinal corpus recorded in Brazilian Portuguese by 21 speakers. The interpretation of their performances across 17 situations, by L1 speakers of Brazilian Portuguese, is studied thanks to a free-labelling experiment. The grouping of expressions is then related to acoustic parameters of prosody. The interpretation of these descriptions is done in the light of literature on expression of affect in voice, and theories of symbolic use of voice in spoken interactions (Ohala's Frequency Code, and Gussenhoven's Effort Code). Results show that the main dimensions of meaning retrieved by the listeners may be summarized as: positive valence, assertive and dubitative expressions. These dimensions do correlate with the acoustical measures. [ABSTRACT FROM AUTHOR]

This experimental study of consecutive interpreting investigates whether: (1) there is any correlation between assessments of its fluency and accuracy; (2) judged fluency can be predicted from computer-based measurements like articulation rate. Ten raters judged six criteria of accuracy and fluency in two consecutive interpretations of the same recorded source speech, from Chinese A into English B, by 12 trainee interpreters (seven undergraduates, five MA students). The recorded interpretations were examined with the speech analysis tool PRAAT. From a computerized count of the pauses thus detected, together with disfluencies identified by raters, 12 acoustic measures of fluency were calculated. The advanced students were more fluent than the beginners; both groups were less fluent in the initial interpretation. Statistical analysis shows: (1) a strong positive correlation between judged accuracy and judged fluency; (2) strong correlations between judged fluency and objective fluency variables; (3) the usefulness of effective speech rate (number of syllables, excluding disfluencies, divided by total duration of speech production and pauses) as a predictor of judged fluency. Other important determinants of judged fluency were the number of filled pauses, articulation rate, and mean length of pause. Potential for developing automatic fluency assessment in consecutive interpreting is discussed, as are possible training implications. [ABSTRACT FROM AUTHOR]

Se expone el sistema de codificación de Patrones de Cualidad Vocal (PCV) y su estudio de confiabilidad. El objetivo fue crear un sistema que permitiese identificar y codificar PVC por medio de una valoración auditiva entrenada. El diseño fue exploratorio-descriptivo y de enfoque mixto, con una muestra intencionada de 12 episodios de cambio extraídos de 3 psicoterapias. Mediante técnicas cualitativas fueron descritos 6 PCV: Reporte, Conectado, Afirmativo, Reflexión, Emocional-Expresivo y Emocional-Contenido. Posteriormente, por medio del coeficiente kappa de Cohen se analizó el grado de concordancia entre jueces independientes en la codificación de los PCV, sobre un total de 516 segmentos, correspondientes a 457 turnos de habla. El sistema mostró una alta confiabilidad inter-jueces y, entre sus ventajas, la posibilidad de analizar procesos psicoterapéuticos, sin importar su orientación teórica o enfoque, y su aplicabilidad al estudio de los PCV empleados por terapeutas y pacientes.The coding system Vocal Quality Patterns (VQP) and a reliability study are presented. The aim was to create a system to identify and codify VQP using a trained hearing assessment. The design was descriptive-exploratory, employing a mixed approach, with a convenience sample of 12 episodes of change extracted from 3 psychotherapies. Qualitative techniques were used to describe 6 VQP: Report, Connected, Affirmative, Reflection, Emotional-Expressive and Emotional-Restrained. Subsequently, by Cohen's kappa coefficient the degree of agreement between independent judges, for the coding of the VQP for a total of 516 segments, corresponding to 457 talking turns, was examined. The system showed high inter-rater reliability and, among its advantages, it presents the possibility of analyzing psychotherapeutic processes, regardless of theoretical orientation or approach, and its applicability to the study of VQP used by therapists and patients.

Objective: This paper sought to examine perceptual and acoustic characteristics in Korean female voices, focusing on the 'breathy' quality as a function of aging. In addition, we aimed to investigate if the three selected measures, H1-H2, H1-A1, and H1-A3, demonstrated any changes along a sustained vowel production. Participants and Methods: A total of 42 participants were assigned to two age groups, young women and elderly women. All participants were asked to sustain /a/ as long and as steadily as possible. Perceptual judgments of breathiness were made on the GRBAS scale and by a direct magnitude estimation technique, while three acoustic parameters, H1-H2, H1-A1, and H1-A3, were measured at five measurement time points during the sustained vowel test. Results: Results indicated that the H1-H2 and H1-A1 values were significantly lower for elderly women compared to young women, although no difference in the perceptual estimation of breathiness was found between the age groups. Among the acoustic measures, only H1-A1 was significantly regressed against the perceptual estimate of breathiness. In addition, no significant acoustic difference in the measures was found across the five measurement points. Conclusion: Our findings suggest that the aging voice might not be universally characterized by the breathy quality, which hints at the need for further research on ethnic diversity in vocal quality. [ABSTRACT FROM AUTHOR]

Aims: The study explores how speech measures may be linked to language profiles in participants with Alzheimer's disease (AD) and how these profiles could distinguish AD from changes associated with normal aging. Methods: We analysed simple sentences spoken by older adults with and without AD. Spectrographic analysis of temporal and acoustic characteristics was carried out using the Praat software. Results: We found that measures of speech, such as variations in the percentage of voice breaks, number of periods of voice, number of voice breaks, shimmer (amplitude perturbation quotient), and noise-to-harmonics ratio, characterise people with AD with an accuracy of 84.8%. Discussion: These measures offer a sensitive method of assessing spontaneous speech output in AD, and they discriminate well between people with AD and healthy older adults. This method of evaluation is a promising tool for AD diagnosis and prognosis, and it could be used as a dependent measure in clinical trials. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose To assess the effects of speech therapy on the acoustic characteristics of speech in a group of cleft lip and palate patients. Materials and methods In this experimental pilot study, eight patients with unilateral cleft lip and palate participated in the 13-month period of speech therapy. They had some exercises in the class and at home to reduce the hypernasality of speech. Using an acoustic software named Praat, three formants (F1, F2, F3) of speech sounds /b /, /p /, /f /, /v /, /k /, and /g / were obtained pre and post speech therapy. We used paired samples t-test to compare the acoustic variables of each consonant before and after the therapy. Results No significant differences were found between the pre- and posttherapy acoustic measures for fricative consonants /f /, /v / and stop consonants /k / and /g/. However, a statistically significant improvement in hypernasality of labial consonants /b / and /p / was observed after the speech therapy. Conclusions The present study underlines the role of a speech therapist in a complete cleft care team, in order to take care of the speech improvement of the patient and to motivate the parents to help the speech development of their child. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The present study examined how effectively listeners'' perceptions of gender could be changed from male to female for male-to-female (MTF) transgender (TG) clients based on the voice signal alone, immediately after voice therapy and at long-term follow-up. Short- and long-term changes in masculinity and femininity ratings and acoustic measures of speaking fundamental frequency (SFF) and vowel formant frequencies were also investigated. Design: Prospective treatment study. Method: Five MTF TG clients, five control female speakers, and five control male speakers provided a variety of speech samples for later analysis. The TG clients then underwent 8 weeks of voice therapy. Voice samples were collected immediately at the termination of therapy and again 15 months later. Two groups of listeners were recruited to evaluate gender and provide masculinity and femininity ratings. Results: Perceptual results revealed that TG subjects were perceived as female 1.9% of the time in the pretest, 50.8% of the time in the immediate posttest, and 33.1% of the time in the long-term posttest. The TG speakers were also perceived as significantly less masculine and more feminine in the immediate posttest and the long-term posttest compared with the pre-test. Some acoustic measures showed significant differences between the pretest and the immediate posttest and long-term posttest. Conclusions: It appeared that 8 weeks of voice therapy could result in vocal changes in MTF TG individuals that persist at least partially for up to 15 months. However, some TG subjects were more successful with voice feminization than others. [Copyright &y& Elsevier]

Summary: Objective: The purpose of this study was to determine the effect of task type on fundamental frequency (F 0) and the short-term repeatability of average airflow values in preschool/kindergarten-age children. Study Design: Prospective, experimental. Methods: Thirty healthy children (age 4.0–5.11 years) were included in this study. Participants completed three tasks (sustained vowel, counting, and storytelling) used to elicit measurements of F 0. With a 10-minute interval, participants also completed two trials of sustained /a/ at a comfortable pitch and loudness level for the measurement of average airflow rate. F 0 and intensity of the vowel production were recorded for both trials. Results: A repeated measures analysis of variance revealed a significant main effect for task type elicitation on F 0 values (P =0.0003). A significant difference between elicitation tasks for F 0 was observed in the comparison of the counting and storytelling task (P <0.0001). A paired t test revealed no significant difference in average airflow rate across two trials (P =0.872). The change in F 0 and intensity was measured across the trials, and separate analyses of covariance revealed that these changes did not significantly influence average airflow values, (P =0.809) and (P =0.365), respectively. Conclusions: The results of this study demonstrated that F 0 may be influenced by task type in young children. Average airflow values appear to be stable over a short time period. This information is important in determining methods of evaluation and the reliability of instrumental measures in young children with voice disorders. [Copyright &y& Elsevier]

Objectives: We sought to determine whether spectral- and cepstral-based acoustic measures were effective in distinguishing dysphonic-strained voice quality from normal voice quality and whether these measures were related to auditory-perceptual ratings of strain severity. Methods: Voice samples from 23 speakers with dysphonia characterized predominantly by strained voice quality and 23 speakers with normal voice were acoustically analyzed. Measures related to the prominence of the cepstral peak and the ratio of low- to high-frequency spectral energies, as well as the variation of each, were computed from continuous speech and a sustained vowel. Correlations to perceptually rated strain severity were determined. Results: Measures related to the cepstrum were the strongest discriminators between dysphonic-strained voice and normal voice. Variation in the ratio of low- to high-frequency spectral energies also significantly differentiated the two speaker groups. All measures were significantly correlated with perceptually rated strain severity, including an acoustic severity index that incorporated both cepstral- and spectral-based measures. Conclusions: Cepstral- and spectral-based measures that have been previously studied in dysphonia characterized by breathiness and roughness are effective in distinguishing strained dysphonia from normal voice quality. The utility of these acoustic measures is supported by their moderate-to-high relationship with perceptually rated strain severity. [ABSTRACT FROM AUTHOR]

The coding system Vocal Quality Patterns (VQP) and a reliability study are presented. The aim was to create a system to identify and codify VQP using a trained hearing assessment. The design was descriptive-exploratory, employing a mixed approach, with a convenience sample of 12 episodes of change extracted from 3 psychotherapies. Qualitative techniques were used to describe 6 VQP: Report, Connected, Affirmative, Reflection, Emotional-Expressive and Emotional-Restrained. Subsequently, by Cohen's kappa coefficient the degree of agreement between independent judges, for the coding of the VQP for a total of 516 segments, corresponding to 457 talking turns, was examined. The system showed high inter-rater reliability and, among its advantages, it presents the possibility of analyzing psychotherapeutic processes, regardless of theoretical orientation or approach, and its applicability to the study of VQP used by therapists and patients. [ABSTRACT FROM AUTHOR]

Purpose: This study examined acoustic predictors of speech intelligibility in speakers with several types of dysarthria secondary to different diseases and conducted classification analysis solely by acoustic measures according to 3 variables (disease, speech severity, and dysarthria type). Method: Speech recordings from 107 speakers with dysarthria due to Parkinson's disease, stroke, traumatic brain injury, and multiple system atrophy were used for acoustic analysis and for perceptual judgment of speech intelligibility. Acoustic analysis included 8 segmental/suprasegmental features: 2nd formant frequency slope, articulation rate, voiceless interval duration, 1st moment analysis for fricatives, vowel space, F0, intensity range, and Pairwise Variability Index. Results: The results showed that (a) acoustic predictors of speech intelligibility differed slightly across diseases and (b) classification accuracy by dysarthria type was typically worse than by disease type or severity. Conclusions: These findings were discussed with respect to (a) the relationship between acoustic characteristics and speech intelligibility and (b) dysarthria classification. [ABSTRACT FROM AUTHOR]

Swedish has a complicated prosodic system, compared, for example, with English. A large proportion of Swedish children with language impairment (LI) have prosodic problems to some extent. There are few descriptions in the literature of prosody intervention, which means that clinicians must rely on their overall linguistic and therapeutic knowledge when designing intervention for prosodic problems. The aim of the present study is to design an intervention package for prosodic problems in children and to evaluate this intervention. The article reports a single subject multiple baselines case study. The participant was a boy (aged 4 years and 6 months) with prosodic problems, mainly on word level but also on phrase and discourse level. The intervention was devised to address his problems and focused on word level prosody. The intervention was carried out over 6 weeks, comprising six 60-minute sessions. Post-intervention assessments were carried out immediately after intervention and 9 weeks later. The participant improved his overall prosodic skills significantly, as assessed by a procedure designed to capture prosody at word, phrase and discourse level. An evaluation of a spontaneous speech sample was also made by a panel of three experienced listeners, and they found some improvement in the participant’s prosody in connected speech, although this was not significant. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate current neck tension palpation rating systems to determine interrater reliability and possible correlation with necksurface electromyography (sEMG, collected from three electrode recording locations) and to measure the third formant for /a/ during various vocal behaviors. This prospective study examined the neck muscle tension of 16 participants before and after a single session of voice therapy. Interrater reliability and relationships between palpation ratings and objective measures of sEMG (anterior neck) and the third formant for /a/ were assessed using Pearson''s correlations (r). Interrater reliability was relatively low as measured by Pearson''s correlations, although Wilcoxon signed-rank test results were similar as those in a previous study. Correlations between palpation ratings and sEMG and between ratings of laryngeal height and the third formant for /a/ were generally low. Correlations increased between anterior neck sEMG and ratings of suprahyoid muscle tension when examined in a reduced set of individuals with higher interrater reliability. Palpation rating scales do not reliably capture changes that may occur in neck muscle tension of typical voice therapy patients over one session. Consequently, little can be concluded from correlations between sEMG and palpation ratings. [Copyright &y& Elsevier]

Purpose: This study tested the hypothesis that individuals with vocal hyperfunction would show decreases in relative fundamental frequency (RFF) surrounding a voiceless consonant. Method: This retrospective study of 2 clinical databases used speech samples from 15 control participants and women with hyperfunction-related voice disorders: 82 prior to treatment (muscle tension dysphonia, n = 22; vocal fold nodules, n = 30; vocal fold polyps, N = 30) and 18 before and after surgical removal of vocal fold nodules or polyps. Acoustic samples were analyzed with respect to the RFF at the offset and onset of voicing surrounding a voiceless consonant. Results: Individuals with vocal hyperfunction in a large clinical sample showed significant lowering of offset and onset RFF compared with controls. Voicing offset and onset RFFs were not significantly changed by the removal of vocal fold lesions in the surgical group. Conclusions: Altered offset and onset RFF in patients with hyperfunction-related voice disorders can be interpreted as a by-product of heightened levels of laryngeal muscle tension. Measurement of RFF during voice offset and onset has potential for use as a simple, noninvasive measure of vocal hyperfunction. [ABSTRACT FROM AUTHOR]

This paper revisits the modeling of acoustic perceptions of breathy voice (BY) quality for automatic assessment of perturbations in pathologic speech. Several acoustic measures related with the signal periodicity, harmonic components, and aspiration noise are studied to predict breathiness judgments performed on sustained vowel phonations. A novel comprehensive automatic measure is proposed that provides the highest correlation index (88.5%) with breathiness judgment performed by trained specialists on simulated and recorded utterances. The new measure reveals the most relevant aspects of BY quality and provides a vehicle to obtain reliable objectives judgments of such speech perturbation. [ABSTRACT FROM AUTHOR]

Summary: The purpose of this study was to investigate the usefulness of the Dysphonia Severity Index (DSI) as an objective multiparametric measurement in assessing dysphonia. The DSI was compared with the score on Grade of the GRBAS scale. Investigated was also whether the DSI is related to severity of dysphonia, which was represented by different diagnosis groups. Furthermore, it was investigated whether the DSI can differentiate between a group of patients and a control group. A total of 294 patients with different voice pathologies were included. A control group consisted of 118 volunteers without any voice complaints. The voices of all participants were perceptually evaluated on Grade, and the DSI was measured. The groups of patients with voice complaints have a lower DSI and higher scores on Grade than the control group. The DSI was significantly lower when the score on Grade was higher. The DSI discriminates between patients with nonorganic voice disorders, vocal fold mass lesions, and vocal fold paresis/paralysis. To determine whether the DSI discriminates between patients and controls, the sensitivity and specificity for different DSI cutoff points were calculated. With a DSI cutoff of 3.0, maximum sensitivity (0.72) and specificity (0.75) were found. We conclude that the DSI is a useful instrument to objectively measure the severity of dysphonia. [Copyright &y& Elsevier]

Summary: The objectives of this prospective and exploratory study are to determine: (1) naïve listener preference for gender in tracheoesophageal (TE) speech when speech severity is controlled; (2) the accuracy of identifying TE speaker gender; (3) the effects of gender identification on judgments of speech acceptability (ACC) and naturalness (NAT); and (4) the acoustic basis of ACC and NAT judgments. Six male and six female adult TE speakers were matched for speech severity. Twenty naïve listeners made auditory-perceptual judgments of speech samples in three listening sessions. First, listeners performed preference judgments using a paired comparison paradigm. Second, listeners made judgments of speaker gender, speech ACC, and NAT using rating scales. Last, listeners made ACC and NAT judgments when speaker gender was provided coincidentally. Duration, frequency, and spectral measures were performed. No significant differences were found for preference of male or female speakers. All male speakers were accurately identified, but only two of six female speakers were accurately identified. Significant interactions were found between gender and listening condition (gender known) for NAT and ACC judgments. Males were judged more natural when gender was known; female speakers were judged less natural and less acceptable when gender was known. Regression analyses revealed that judgments of female speakers were best predicted with duration measures when gender was unknown, but with spectral measures when gender was known; judgments of males were best predicted with spectral measures. Naïve listeners have difficulty identifying the gender of female TE speakers. Listeners show no preference for speaker gender, but when gender is known, female speakers are least acceptable and natural. The nature of the perceptual task may affect the acoustic basis of listener judgments. [Copyright &y& Elsevier]

Purpose: Many researchers have studied the acoustics, physiology, and perceptual characteristics of the voice source, but despite significant attention, it remains unclear which aspects of the source should be quantified and how measurements should be made. In this study, the authors examined the relationships among a number of existing measures of the glottal source spectrum, along with the association of these measures to overall spectral shapes and to glottal pulse shapes, to determine which measures of the source best capture information about the shapes of glottal pulses and glottal source spectra. Method: Seventy-eight different measures of source spectral shapes were made on the voices of 70 speakers. Principal components analysis was applied to measurement data, and the resulting factors were compared with factors similarly derived from oral speech spectra and glottal pulses. Results: Results revealed high levels of duplication and overlap among existing measures of source spectral slope. Further, existing measures were not well aligned with patterns of spectral variability. In particular, existing spectral measures do not appear to model the higher frequency parts of the source spectrum adequately. Conclusion: The failure of existing measures to adequately quantify spectral variability may explain why results of studies examining the perceptual importance of spectral slope have not produced consistent results. Because variability in the speech signal is often perceptually salient, these results suggest that most existing measures of source spectral slope are unlikely to be good predictors of voice quality. [ABSTRACT FROM AUTHOR]

Summary: This study was designed to examine the relationship between the Voice Handicap Index (VHI) and acoustic measures of voice samples common in clinical practice. Fifty participants, 38 women and 12 men, ranging in age from 19 to 80 years, with a mean age of 49 years, served as participants. Of these 50 participants, 17 participants could be included in the acoustic analysis of voice based on measures of error calculated with the TF32 software. All participants completed the VHI and provided voice samples including three trials of the sustained vowel /A/ at a comfortable loudness level as well as a connected speech sample consisting of the Zoo Passage. Acoustic measures were made with TF32 and Cool Edit software and included fundamental frequency, jitter %, shimmer %, signal-to-noise ratio, mean root-mean-square intensity, fundamental frequency standard deviation, aphonic periods, and breath groups. Results indicate that these measures were not predictive of overall VHI score, and no cohesive or predictable pattern was identified when comparing individual measures with overall VHI or with each subscale item. Likely contributions to this lack of correlation and subsequent clinical implications are discussed, as well as the direction for further research. [Copyright &y& Elsevier]