Severity of voice disorders: integration of perceptual and acoustic data in dysphonic patients

Abstract

DescritoresThe vocal deviation from the vowel /ε/ was evaluated by consensus between three speech language pathologists, using a Visual Analog Scale. We extracted the mean and standard deviation (SD) of the fundamental frequency (F 0 ), jitter, shimmer, and Glottal-to-Noise Excitation Ratio (GNE). Results: Mean F 0 was negatively correlated with the degree of roughness and positively with the degree of tension. The F 0 SD was positively correlated with the overall, roughness, tension, and instability grades. The jitter and shimmer were positively correlated with all perceptual parameters. Only the GNE distinguished between healthy and dysphonic voices and rated the degree of breathiness. The shimmer separated rough voices from not rough voices. The mean F 0 was helpful to determine the degree of phonatory tension and to separate rough voices from breathy and strained voices. Conclusion:There is a correlation between the acoustic and auditory perceptual measures. The shimmer, the GNE, and F 0 SD can be used to detect roughness, breathing, and strain, respectively. The GNE and mean F 0 are useful to classify the degree of breathiness and strain, respectively. The mean F 0 distinguished between rough, breathy, and strained voices, with rough voices more severe compared to the other two. RESUMO INTRODUCTION Voice is multidimensional(1) and its production is related to anatomic, physiological, emotional, organic, environmental, and behavioral features. Voice evaluation, therefore, must be based on these principles, with mapping of voice production and correlation with such features for one to take a truly comprehensive view of dysphonia.The purpose of voice evaluation is to analyze voice quality, that is, whether the voice is healthy or not; to diagnose voice disorders, to monitor any disease or function progression, to evaluate prognosis, and to identify possible risks to develop a disorder (2) . Overall, studies on voice evaluation and diagnosis have attempted to answer three essential clinical questions (2) : what is the measure to determine presence/absence of any voice disorder (diagnosis)? Is there evidence that the test used in evaluation can determine the nature (etiology) of a voice disorder? What is the measure capacity to determine the severity of a voice disorder?In a study (3) conducted with experienced speech language pathologists in the United States, all the 53 interviewees reported using auditoryperceptual measurements in voice evaluation followed by analysis of body posture and movements, and by dynamic voice evaluation. These subjective methods were substantially more used than objective evaluations by acoustic measurements only.However, in a systematic review, most studies (60%) on voice evaluation in patients with voice disorders used acoustic measurements and focused on presence/absence of a disorder (78%). Few articles (18%) have investigated the ability of a measurement to measure the severity of voice disorder (2) . Also, most studies have used an image of larynx as reference to define the p...

Performance of Phonatory Deviation Diagrams in Synthesized Voice Analysis

“…The density of PDD points is mainly affected by the standard deviation of the measurements used to generate the PDD (jitter, shimmer, correlation, and GNE) [53]. In general, a higher ratio of deviant voices with an amplified density was expected with the use of a PDD, similar to the findings of another study [14], because voices with a higher degree of deviation tend to have higher standard deviations for perturbation and noise measurements [11]. However, in the present study, we found a greater proportion of deviated voice signals with a concentrated density.…”

“…Other studies [10, 11] have already indicated that these measurements are valid for assessing voice quality deviations and that using combined measurements may improve the differentiation between signals with and without a voice deviation [23]. It is also noteworthy that studies must be performed to assess and develop voice assessment resources that enhance the capacity to differentiate between NVVQ and deviant signals, particularly considering that these resources should be useful in differentiating normal from deviant voice signals, even in the presence of high variability in the severity of voice disorder.…”

“…Therefore, to overcome this limitation, using validated and tested signals is recommended, where the relationship between the acoustic, physiological, and biomechanical parameters used to produce these signals and the auditory effect generated by the manipulation of these parameters is known [43]. Synthesized voices must have a correlation between acoustic and auditory-perceptual parameters [39], representing a model of what occurs with human signals [11], and should sound as natural as possible to listeners [44]. …”

Acurácia das medidas acústicas tradicionais e formânticas na avaliação da qualidade vocal

“…Jitter evaluates perturbations in the frequency of the neighboring vibration cycles (11,18) and is the measure most correlated with GG (17) and sensitive to the presence of voice deviations. This explains its increase in individuals with moderate voice deviations in this study.…”

“…Notably, acoustic analysis does not replace auditory-perceptual analysis but rather integrates the auditory and physiological levels (6)(7)(8) . A combination of acoustic and perceptual auditory measures increases the accuracy in determining the presence or absence of a voice disorder and the intensity of the deviation present (17,18) .…”