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Generally, phonation onset hardness has been similarly defined and categorized throughout literature. There are typically three categories: soft, breathy, and hard onset. Phonation onset hardness is relevant in both assessment and treatment of various voice disorders and is usually determined on an auditory-perceptual basis. However, as far as we know, reliability of clinical auditory-perceptual indications of phonation onset hardness has not been investigated yet. Therefore, this study aimed at evaluating intrarater as well as interrater reliability of auditory-perceptual assessment of phonation onset hardness by speech and language pathologists. After deidentification, the sentence-initial word [e.rst] was extracted from read text recordings of 20 subjects with various voice disorders and complaints. These 20 samples were purposefully selected to represent as much as possible the whole phonation onset hardness continuum. The auditory-perceptual rating protocol consisted of the paired comparison paradigm, in which all listeners were asked to perceptually compare phonation onset hardness of every fragment with the other 19 samples. This resulted in a ranking of the 20 samples, from hardest to softest phonation onset. Four speech and language pathologists agreed to compare phonation onset hardness according to this paradigm. The single-measures intraclass correlation coefficient (ICC) for absolute agreement was applied to determine the degree of reliability within as well as between raters. Intrarater ICC's showed acceptable reliability for two raters, yet poor reliability for the other two raters. Interrater ICC's demonstrated low reliability in general. Zooming in on the ratings shows that three of four evaluators agreed on which sample had the softest phonation onset, and that only two raters agreed on which recording had the hardest phonation onset. It can be concluded that there is considerable variability within and across raters when asked to indicate the word with the hardest phonation onset. This is the first study to approach auditory interpretation of phonation onset hardness with the paired comparison task. Questions are raised about the clinical utility of phonation onset hardness perception, the potential role of training, and the importance of a more objective yet clinically feasible measurement tool. [ABSTRACT FROM AUTHOR]

This study evaluated ratings of vocal strain and perceived listening effort by normal hearing participants while listening to speech samples produced by talkers with adductor spasmodic dysphonia (AdSD). In addition, objective listening effort was measured through concurrent pupillometry to determine whether listening to disordered voices changed arousal as a result of emotional state or cognitive load. Recordings of the second sentence of the "Rainbow Passage" produced by talkers with varying degrees of AdSD served as speech stimuli. Twenty naïve young adult listeners perceptually evaluated these stimuli on the dimensions of vocal strain and listening effort using two separate visual analogue scales. While making the auditory-perceptual judgments, listeners' pupil characteristics were objectively measured in synchrony with the presentation of each voice stimulus. Data analyses revealed moderate-to-high inter- and intra-rater reliability. A significant positive correlation was found between the ratings of vocal strain and listening effort. In addition, listeners displayed greater peak pupil dilation (PPD) when listening to more strained and effortful voice samples. Findings from this study suggest that when combined with an auditory-perceptual task, non-volitional physiologic changes in pupil response may serve as an indicator of listening and cognitive effort or arousal. [ABSTRACT FROM AUTHOR]

This study evaluated ratings of vocal strain and perceived listening effort by normal hearing participants while listening to speech samples produced by talkers with adductor spasmodic dysphonia (AdSD). In addition, objective listening effort was measured through concurrent pupillometry to determine whether listening to disordered voices changed arousal as a result of emotional state or cognitive load. Recordings of the second sentence of the “Rainbow Passage” produced by talkers with varying degrees of AdSD served as speech stimuli. Twenty naïve young adult listeners perceptually evaluated these stimuli on the dimensions of vocal strain and listening effort using two separate visual analogue scales. While making the auditory-perceptual judgments, listeners’ pupil characteristics were objectively measured in synchrony with the presentation of each voice stimulus. Data analyses revealed moderate-to-high inter- and intra-rater reliability. A significant positive correlation was found between the ratings of vocal strain and listening effort. In addition, listeners displayed greater peak pupil dilation (PPD) when listening to more strained and effortful voice samples. Findings from this study suggest that when combined with an auditory-perceptual task, non-volitional physiologic changes in pupil response may serve as an indicator of listening and cognitive effort or arousal.

Summary Objectives The purpose of this study was to explore the criterion-related concurrent validity of two standardized auditory-perceptual rating protocols and the Acoustic Voice Quality Index (AVQI) for measuring dysphonia severity in Korean speech. Methods Sixty native Korean subjects with various voice disorders were asked to sustain the vowel [a:] and to read aloud the Korean text “Walk.” A 3-second midvowel portion of the sustained vowel and two sentences (with 25 syllables) were edited, concatenated, and analyzed according to methods described elsewhere. From 56 participants, both continuous speech and sustained vowel recordings had sufficiently high signal-to-noise ratios (35.5 dB and 37 dB on average, respectively) and were therefore subjected to further dysphonia severity analysis with (1) “G” or Grade from the GRBAS protocol, (2) “OS” or Overall Severity from the Consensus Auditory-Perceptual Evaluation of Voice protocol, and (3) AVQI. Results First, high correlations were found between G and OS ( r S = 0.955 for sustained vowels; r S = 0.965 for continuous speech). Second, the AVQI showed a strong correlation with G ( r S = 0.911) as well as OS ( r P = 0.924). These findings are in agreement with similar studies dealing with continuous speech in other languages. Conclusions The present study highlights the criterion-related concurrent validity of these methods in Korean speech. Furthermore, it supports the cross-linguistic robustness of the AVQI as a valid and objective marker of overall dysphonia severity. [ABSTRACT FROM AUTHOR]

The purpose of the study was to identify a sub-set of spectral/cepstral-based analysis methods that would most effectively predict dysphonia severity (as estimated via auditory-perceptual analysis) in samples of continuous speech. Acoustic estimates of dysphonia severity were used as an objective treatment outcomes measure in a set of pre- vs post-treatment speech samples. Pre- and post-treatment continuous speech samples from 104 females with primary muscle tension dysphonia (MTD) were rated by listeners using a 100 point visual analogue scale (VAS) and analysed acoustically with spectral/cepstral-based measures. Stepwise linear regression produced a three-factor model consisting of the cepstral peak prominence (CPP); the mean ratio of low-to-high frequency spectral energy; and the standard deviation of the ratio of low-to-high frequency spectral energy that was strongly correlated with perceived dysphonia severity ratings (R = .85; R2 = .73). Mean differences between predicted vs perceptual ratings for pre- and post-treatment speech samples were < 6 points on the 100 point VAS; mean absolute differences between predicted and perceived ratings were < 16 points on the 100 point VAS (equivalent to within one scale value on commonly used 7-point equal-appearing interval rating scales). A multi-parameter acoustic model consisting of spectral/cepstral-based measures shows considerable promise as an objective measure of dysphonia severity in continuous speech, even across the diverse voice types and severities observed in pre- and post-treatment MTD speech samples. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this experiment was to assess the ability of an acoustic model composed of both time-based and spectral-based measures to track change following voice disorder treatment and to serve as a possible treatment outcomes measure. Method: A weighted, four-factor acoustic algorithm consisting of shimmer, pitch sigma, the ratio of low-to-high frequency spectral energy, and a measure of the cepstral peak was used to predict dysphonia severity in pre- and post-treatment vowel samples from 88 women with primary muscle tension dysphonia treated by manual circumlaryngeal therapy. Predicted severity ratings were also compared to mean perceived severity ratings determined by a group of judges. Results: Predicted severity scores were strongly associated with perceived dysphonia severity ratings for pretreatment, posttreatment, and change in dysphonia severity. Analyses of the agreement between predicted and perceptual severity ratings indicated that the majority of differences were within ± 1 standard deviation from the mean difference. Acoustic predictions of perceived severity were observed to be most accurate for the midportion of the 7-point equal-appearing interval severity scale. Conclusion: The acoustic model and predicted dysphonia severity scores show promise as a sensitive and objective outcomes measure, even with extremely perturbed pre-treatment voice samples that would be difficult to analyze using traditional time-based perturbation measures. [ABSTRACT FROM AUTHOR]

Purpose: Darley, Aronson, and Brown (1969a, 1969b) detailed methods and results of auditory-perceptual assessment for speakers with dysarthrias of varying etiology. They reported adequate listener reliability for use of the rating system as a tool for differential diagnosis, but several more recent studies have raised concerns about listener reliability using this approach. Method: In the present study, the authors examined intrarater and interrater agreement for perceptual ratings of 47 speakers with various dysarthria types by 2 listener groups (inexperienced and experienced). The entire set of perceptual features proposed by Darley et al. was rated based on a 40-s conversational speech sample. Results: No differences in levels of agreement were found between the listener groups. Agreement was within 1 scale value or better for 67% of the pairwise comparisons. Levels of agreement were lower when the average rating fell in the mid-range of the scale compared with samples that had an average rating near either of the scale endpoints; agreement was above chance level. No significant differences in agreement were found between the perceptual features. Discussion: The levels of listener agreement that were found indicate that auditory-perceptual ratings show promise during clinical assessment for identifying salient features of dysarthria for speakers with various etiologies. [ABSTRACT FROM AUTHOR]

This study aimed to verify the Acoustic Voice Quality Index (AVQI) version 3.01 and the Acoustic Breathiness Index (ABI) as tools for acoustic analyses in the Korean language. Concatenated voice samples of sustained vowels (SV) and continuous speech (CS) were collected from 151 subjects with dysphonia and 71 vocally healthy subjects. The overall voice disorder severity (grade [G] and overall severity [OS]) and breathiness severity (B) were subjected to an auditory-perceptual rating by three raters. First, we equalized the proportions of SV and CS with respect to the time lengths of the voice samples to improve the ecological validity. We then validated the AVQI and ABI in the Korean language, using our most recent dataset of 1,667 voice samples. Second, we compared the results of the acoustic analyses between the vocally healthy controls and the dysphonia groups. Third, we confirmed the concurrent validity and diagnostic accuracy using the Spearman rank-order correlation coefficient (r s) and various statistical methods (receiver operating characteristic curve, pairwise comparison, and likelihood ratio [LR] analyses). We observed strong inter-rater reliability for G, B, and OS. Moreover, we identified 26 standardized syllables in the CS samples (3 second voiced segments), which allowed the equalization of both voice tasks. A comparison of the two voice groups revealed statistically significant differences in the AVQI, ABI, G, B, and OS (all P < 0.01). Moreover, we identified strong correlations of the AVQI with G (r s > 0.88, P < 0.01) and OS (r s > 0.84, P < 0.01) and of ABI with B (r s > 0.87, P < 0.01). Finally, we confirmed cutoffs of 3.154 (sensitivity: 90%, specificity: 89%, LR+: 8.45, and LR-: 0.12) and 3.685 (sensitivity: 88%, specificity: 86%, LR+: 6.47, and LR-: 0.14) as optimal predictive powers for AVQI and ABI, respectively. As per our results, in a sample of Korean speakers, the AVQI and ABI exhibited strong concurrent validity for the quantification of dysphonia severity with respect to OS and B. We consider that analyses based on the AVQI and ABI will enable the discrimination and assessment of dysphonia in clinical practice. [ABSTRACT FROM AUTHOR]

This study investigated whether there are differences in the discriminatory power of cepstral analysis according to the voiced-segment extraction method and voice tasks used for identifying dysphonic and normophonic Korean individuals. A total of 2,863 subjects (2,595 subjects with and 268 subjects without dysphonia) were included in this study. The 3-second sustained vowel (SV) /a/ and one sentence of "Sanchaek" were edited and analyzed using Praat scripts. Cepstral analyses (cepstral peak prominence [CPP], smoothed cepstral peak prominence [CPPS], and low/high spectral ratio [LHRatio]) were performed using three voice tasks, namely, SV, continuous speech (CS), and extracted continuous speech (EXT) samples. Additionally, auditory-perceptual (A-P) assessments were performed by three speech language pathologists. Significant differences were found between dysphonic and normophonic voice groups for all cepstral parameters, except the LHRatio_EXT. Cepstral measurements of both SV and CS were highly correlated with A-P ratings. Furthermore, the diagnostic predictive power of CPP and CPPS for CS using the area under the receiver operating characteristic curve (AUC) was >0.919, the positive likelihood ratio (LR+) was ≥6.85, and the negative likelihood ratio (LR−) was ≤0.23. Additionally, for EXT, the AUC was >0.816, LR+ was 3.10, and LR− was ≤0.33. Both CS and EXT can predict dysphonia relatively well (r > 0.816). EXT showed lower predictability than the original sample (CS) analysis. Subsequent studies should implement voiced-segment extraction methods using various algorithms. [ABSTRACT FROM AUTHOR]