The Impact of Languages and Cultural Backgrounds on Voice Quality Analyses.

OBJECTIVE: The aim of this study was to verify the influence of different cultural backgrounds and languages on the perception of voice quality. Another aim was to evaluate the correlation between clinical auditory-perceptual judgments with acoustic measurements, such as the acoustic voice quality index (AVQI) and the acoustic breathiness index (ABI), i.e., their effect on the concurrent validity. METHODS: Brazilian and European participants rated 2 culturally and linguistically different datasets (i.e., 150 Brazilian Portuguese and 218 German voice sample sets), with each dataset containing concatenated voice samples of continuous speech and sustained phonation. The raters evaluated the vocal quality in terms of the overall voice quality and breathiness. Intra- and interrater reliabilities were also tested. The psychometric qualities of the AVQI and the ABI (concurrent validity and diagnostic accuracy) were analyzed, considering the perceptual ratings of Brazilian and European participants for each dataset. RESULTS: Rater reliability decreased for nonnative participants when evaluating the nonnative dataset. Brazilian raters perceived the German voices as more severe, whereas German raters considered the overall voice quality of Brazilian voices as less severe than native raters. The concurrent validity of the AVQI and the ABI, i.e., the agreement with the auditory-perceptual evaluations, was high irrespectively of the group of participants. The diagnostic accuracy, which refers to the ability to identify a deviated voice, was higher, considering the perceptual evaluations of native listeners. CONCLUSIONS: Brazilian raters classified voice quality as more deviated, and the Brazilian voice samples were measured to be less severe (a possible language characteristic). Further studies are necessary to verify whether there was a task or sample consequence or if adjustments to the AVQI and ABI equations are required for Brazilian Portuguese.

The validity of the Acoustic Breathiness Index in the evaluation of breathy voice quality: A Meta-Analysis.

BACKGROUND: The evaluation of voice quality with acoustic measurements is useful to objectify the diagnostic process. Particularly, breathiness was highly evaluated and the Acoustic Breathiness Index (ABI) might have promising features. OBJECTIVE OF REVIEW: The goal of the present meta-analysis is to quantify, from existing cross-validation studies, the evidence for the diagnostic accuracy of ABI, including its sensitivity and specificity. TYPE OF REVIEW: Meta-analysis. SEARCH STRATEGY: We searched in MEDLINE, Google Scholar and Science Citation Index, and as manual search for the term Acoustic Breathiness Index from inception to February 2020. Studies were included that used equal proportion of continuous speech and sustained vowel segments, a recording hardware with a sufficient standard for voice signal analyses, the software Praat for signal processing and the customised Praat script, and two groups of subjects (vocally healthy and voice-disordered). Furthermore, the diagnostic accuracy of ABI was measured. EVALUATION METHOD: The primary outcome variable was ABI. The score ranged from 0 to 10 with varying thresholds according to different languages to determine the absence or presence of breathiness. A meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses of diagnostic test accuracy study guidelines. Data were extracted, and the risk of bias was assessed using the QUADAS-2 tool. The pooled sensitivity and specificity of ABI were determined using a summary receiver operating characteristic (SROC) approach to calculate also a weighted threshold value of ABI with its sensitivity and specificity. RESULTS: A total of 34 unique citations were screened, and 10 full-text articles were reviewed, including six studies. In total, 3603 voice samples were considered for further analysis separating into 467 vocally healthy and 3136 voice-disordered voice samples. The pooled sensitivity was 0.84 (95% CI, 0.83-0.85), and the pooled specificity was 0.92 (95% CI, 0.89-0.94). The area under the curve of the SROC curve of this analysis showed an excellent value of 0.94. The weighted ABI threshold was determined at 3.40 (sensitivity: 0.86, 95% CI, 0.84-0.87.; specificity: 0.90, 95% CI 0.88-0.92). CONCLUSIONS: The results confirm the ABI as robust and valid objective measure for evaluating breathiness.

GALP Qualifier Scale: Initial Considerations to Classify a Voice Problem.

OBJECTIVE: To propose a single qualifier scale for voice problems based on the International Classification of Functioning, Disability, and Health (ICF) that classifies a voice problem considering its multidimensionality. METHOD: A multicultural database was analyzed (280 subjects). The analyzed information was: the perceptual judgment of the overall voice quality (G); the acoustic analysis (A) with the Acoustic Voice Quality Index; the laryngeal diagnosis (L) and the patient self-assessment (P) using the Voice Handicap Index. The variables were categorized. A 2-step cluster analysis was performed to define groups with common characteristics. RESULTS: A 7-point qualifier scale, the GALP, was defined to generally classify levels of voice problems considering 4 dimensions of the voice evaluation. Each level of voice problem, that is, no problem, mild, moderate, severe, or complete voice problem, has its own possible outcome for G, A, L, and P that will change, or not, the overall level of voice problem. The extremes of the scale represent "no problem" at all when all parameters are normal, and "complete problem" when all parameters are altered. The 3 levels in between were defined by the cluster analysis (mild, moderate, and severe problem) and change according to the outcome of each evaluation (G, A, L, and P). Thus, changes in one parameter alone may or not contribute to the change of the level of voice problem. Also, there are 2 categories for cases that do not fit the classification (not specified) and for which some of the variables are missing (not applicable). CONCLUSION: The GALP scale was proposed to classify the level of voice problem. This approach considers important dimensions of voice evaluation according to the ICF. It is a potential tool to be used by different professionals, with different assessment procedures, and among different populations, clinicians, and study centers.

The Performance of the Acoustic Voice Quality Index and Acoustic Breathiness Index in Synthesized Voices.

OBJECTIVE: The aim of the present study was to investigate the performance of the Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) in synthesized voice samples. METHOD: The validity of the AVQI and ABI performances was analyzed in synthesized voice samples controlling the degree of predefined deviations for overall voice quality (G-scale) and breathiness (B-scale). A range of 26 synthesized voice samples with various severity degrees in G-scale with and without prominence of breathiness for male and female voices were created. RESULTS: ABI received higher validity in the evaluation of breathiness than AVQI. Furthermore, ABI evaluated accurately breathiness degrees without considering roughness effects in voice samples and confirmed the findings of other studies with natural voices. Furthermore, ABI was more robust than AVQI in the evaluation of severe voice-disordered voice samples. Finally, AVQI represented moreover overall voice quality with an emphasis of breathiness evaluation and less roughness although roughness had a necessary component in overall voice quality evaluation. CONCLUSION: AVQI and ABI are two robust measurements in the evaluation of voice quality. However, ABI received fewer errors than AVQI in the analyses of higher abnormalities in the voice signal. Disturbances of other subtypes of abnormal overall voice quality such as roughness were not demonstrated in the results of ABI.

Microphone and Audio Compression Effects on Acoustic Voice Analysis: A Pilot Study.

OBJECTIVE: This study aimed to analyze the effects of microphone and audio compression variables on voice and speech parameters acquisition. METHOD: Acoustic measures were recorded and compared using a high-quality reference microphone and three testing microphones. The tested microphones displayed differences in specifications and acoustic properties. Furthermore, the impact of the audio compression was assessed by resampling the original uncompressed audio files into the MPEG-1/2 Audio Layer 3 (mp3) format at three different compression rates (128 kbps, 64 kbps, 32 kbps). Eight speakers were recruited in each recording session and asked to produce four sustained vowels: two [a] segments and two [ɛ] segments. The audio was captured simultaneously by the reference and tested microphones. The recordings were synchronized and analyzed using the Praat software. RESULTS: From a set of eight acoustic parameters assessed (f0, F1, F2, jitter%, shimmer%, HNR, H1-H2, and CPP), three (f0, F2, and jitter%) were suggested as resistant regarding the microphone and audio compression variables. In contrast, some parameters seemed to be significantly affected by both factors: HNR, H1-H2, and CPP; while shimmer% was found sensitive only concerning the latter factor. Moreover, higher compression rates appeared to yield more frequent acoustic distortions than lower rates. CONCLUSION: Overall, the outcomes suggest that acoustic parameters are influenced by both the microphone selection and the audio compression usage, which may reflect the practical implications of these components on the acoustic analysis reliability.

Accuracy of Acoustic Voice Quality Index and Its Isolated Acoustic Measures to Discriminate the Severity of Voice Disorders.

OBJECTIVE: To evaluate the Acoustic Voice Quality Index (AVQI) and its isolated acoustic measures accuracy in discriminating voices with different degrees of deviation. METHODS: Two hundred and fifty-eight voice samples (160 dysphonic; 98 vocally healthy). Information regarding acoustic analysis and overall degree of deviation (G) were considered. The acoustic analysis consisted of the AVQI total score and its isolated acoustic measures: smoothed cepstral peak prominence (CPPs); harmonic-to-noise ratio (HNR); shimmer local and dB (Shim, ShdB); the general slope of the spectrum (Slope) and tilt of the regression line through the spectrum (Tilt). The auditory-perceptual judgment was the median G score of five voice specialists (Cohen's = 0.605-0.773; Fleiss = 0.370). Quadratic discriminant analysis and accuracy, sensitivity, and specificity of performance measures were used to investigate the discriminatory power of these measures. RESULTS: AVQI presented acceptable accuracy to differentiate voices with no vocal deviation and with vocal deviation (73.9%) and among the degrees of deviation (mild vs. moderate = 70.49%; mild vs. moderate = 71.39%; moderate vs. severe = 87.5%). No isolated acoustic measurement was consistent with differentiating voice quality among all degrees of deviation. A combination of five acoustic measures (CPPs, HNR, ShdB, Slope, Tilt) had the highest accuracy to differentiate between healthy and deviated voice (75.55%). Shimmer was more accurate to discriminate between voices with mild, moderate, and severe deviation; almost all isolated acoustic measurements were accurate to discriminate voices with moderate and severe deviation. The combination of acoustic measures presented higher accuracy (mild vs. moderate = 70.21%-74.29%; mild vs. moderate = 71.53%-76.11%; moderate vs. severe = 86%-95.50%). CONCLUSION: AVQI is an accepted tool to discriminate among different degrees of vocal deviation, and more accurate between voices with moderate and severe deviations. Isolated acoustic measures perform better when discriminating voices with a higher degree of deviation. A combination of acoustic parameters, with the same weight, is more accurate to discriminate different degrees of deviation, however, not consistent.

Validation of the Brazilian Portuguese CAPE-V Instrument-Br CAPE-V for Auditory-Perceptual Analysis.

INTRODUCTION: The Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) scale is a modern, clinical-scientific approach to voice analysis. It has been translated and culturally adapted to Brazilian Portuguese, but it still lacks validation. OBJECTIVE: To validate the Brazilian Portuguese version of the CAPE-V scale using the previously translated and culturally adapted version. METHOD: Forty voice samples were selected (30 dysphonic, 10 nondysphonic), and the degree of vocal deviation was evaluated by a committee of three voice specialists. Nine voice specialists judged the 40 voice samples plus 20% repetition (total of 48 samples) using the CAPE-V. To ensure construct validity of the CAPE-V, its analysis was compared to the Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) scale that was performed 48-72 hours later. Finally, the intra- and inter-rater reliability values were verified and the correlation between the nine judges and the previously defined evaluation was analyzed. RESULTS: The Brazilian CAPE-V presented significant intra (0.860-0.997) and inter-rater reliability values (0.707-0.964) for the overall degree and strong correlation with GRBAS (above 0.828). Deviant voice quality had greater consensus among raters than normal voices. A strong correlation was observed between the analysis of the nine raters and that of the committee. CONCLUSION: CAPE-V is an important diagnostic instrument that contributes to the standardization of vocal quality evaluation in several languages, including Brazilian Portuguese. Thus, its usefulness is neither related to a single language nor to a single set of raters.

Exploring The Validity of Acoustic Measurements and Other Voice Assessments.

OBJECTIVE: There are different parts of a battery of voice assessments to assess voice functions and voice quality. The objective assessment of voice quality using acoustics is recommended and two measurements such as the Acoustic Voice Quality index, 03.01 (AVQI) and the Acoustic Breathiness Index (ABI) are leading in this domain. The purpose of this study was to verify the validity between these two acoustic measurements and other dimensions of the voice assessments (the Voice Handicap Index-10 (VHI-10) and the laryngeal imaging evaluation of the larynx and vocal folds). METHODS: We used a retrospective database of 150 participants (37 vocally healthy participants and 113 dysphonic patients). To test the validity between the acoustic measurements and the other voice assessments the concurrent validity and diagnostic precision were analyzed using Pearson correlation coefficient and the receiver operating characteristic (ROC) statistics with likelihood ratios. RESULTS: The VHI-10 score presented moderate-significant correlations with the AVQI and the ABI, r= 0.477, P < 0.001 (r2= 0.228) and r= 0.426, P < 0.001 (r2=0.181), respectively. The larynx alteration presented low-significant correlations with the AVQI (r= 0.362, P < 0.001, r2= 0.131), and ABI (r= 0.371, P < 0.001, r2= 0.138), respectively. The area under the curve (AUC) of ROC was almost reasonable ranging from 0.701 to 0.737; except between ABI and VHI-10 (AUC= 0.689). The highest AUC was between the AVQI and VHI-10 at a threshold of 2.10; the highest specificity was between the ABI and VHI-10 at a threshold of 3.77. However, the lowest sensitivity was between ABI and VHI-10 while the lowest specificity was between the laryngeal diagnosis and the ABI. CONCLUSION: AVQI and ABI presented significantly lower concurrent validity and diagnostic precision when the reference is not the auditory-perceptual judgment of voice quality. However, AVQI seems to be for some validity aspects a more reasonable classifier of vocal handicap and laryngeal alteration than ABI. Both AVQI and ABI values can broaden their range of assessment for the clinical user, thus showing more relationships between the individual voice examination methods.

Influence of the Voice Sample Length in Perceptual and Acoustic Voice Quality Analysis.

OBJECTIVE: To analyze the variations that different voice sample length (VSL) has on the perceived degree of voice quality deviation and on the Acoustic Voice Quality Index (AVQI) accuracy. METHODS: Voices of 71 subjects (53 dysphonic; 18 vocally health) were recorded: numbers 1-20 (42 syllables) + vowel/a/. Three different VSL were edited: VSL_long, 1-20 + 3 seconds vowel/a/; VSL_cust, customized length, were voiced-segments of the continuous speech had the same length of the vowel (mean = 18.73 syllables corresponding to 3 seconds of only-voiced segments) + 3 seconds vowel/a/; VSL_short, 1-10 (15 syllables) + 3 seconds vowel/a/. Three voice specialists perceptually judged the overall voice quality (G); 3 sessions were performed to evaluate each VSL variant. AVQI's precision and Spearman correlation were assessed. RESULTS: The intra-rater reliability was "almost perfect" (kappa >0.826) for all evaluators in VSL_short; "substantial" (0.684) and "almost perfect" (0.897) in VSL_cust and "fair" (0.447) to "almost perfect" (1.000) in VSL_long. The inter-rater reliability was "moderate" (0.554) for VSL_long, "substantial" (0.622 and 0.618) for VSL_cust and VSL_short. The Gmean and AVQI_mean were perceived as more severe for longer samples and less severe for shorter samples. Considering the AVQI, VSL_short (r = 0.665) presented the higher correlation. VSL_cust presented the best area under the ROC curve (0.821). VSL_long and VSL_cust specificity was 100%, VSL_short specificity was 75%; higher sensitivity was observed for VSL_short (74%). CONCLUSION: The voice quality outcomes changes for different VSLs. Longer VSLs seem to be perceived as more deviated, shorter VSLs seem to be more reliable and have better correlation with the acoustic analysis. The AVQI best accuracy was found at a customized length. Thus, to increase the voice analysis reliability, standardized procedure must be followed, including a precise speech material control allowing comparison among clinics and voice-centers.

Validation of the acoustic breathiness index to the Brazilian Portuguese language.

OBJECTIVE: To assess the concurrent validity and the diagnostic accuracy of the Acoustic Breathiness Index (ABI) in Brazilian Portuguese. METHODS: The counting numbers 1-20 and the vowel /a/ of 150 subjects were recorded (37 vocally healthy and 113 with dysphonia). The analyzed samples were the counting number 1-11 and 3 s of the sustained vowel. Nine voice specialists performed the perceptual judgment of the degree of breathiness. The Spearman Correlation and the receiver operating characteristic (ROC) curve were used to assess ABI's concurrent validity and diagnosis accuracy. RESULTS: Results from five listeners were chosen for the study analyses due to moderate and substantial intra-rater reliability (Cohen's Kappa values = 0.520-0.772) and moderate inter-rater reliability (Fleiss Kappa = 0.353). The ABI presented a high concurrent validity (r = 0.746); 55.6% of the breathiness vocal deviation can be explained by the acoustic analysis (r2 = 0.556). The ROC curve presented good diagnostic accuracy (85.2%). At a threshold of 2.94, the sensitivity was 75.3% and the specificity was 93.4%. CONCLUSION: The ABI is a valid tool for screening and patient's follow-up regarding breathy vocal qualities in the Brazilian Portuguese language.

Reducing the GAP between science and clinic: lessons from academia and professional practice - part A: perceptual-auditory judgment of vocal quality, acoustic vocal signal analysis and voice self-assessment. / Reduzindo o GAP entre a ciência e a clínica: lições da academia e da prática profissional ­ parte A: julgamento perceptivo-auditivo da qualidade vocal, análise acústica do sinal vocal e autoavaliação em voz.

During the XXVIII Brazilian Congress of SBFa, 24 specialists met and, from a leading position on scientific research as a tool for connecting laboratory and clinic, five fronts of knowledge of the voice specialty were discussed as following: Perceptual-auditory judgment of vocal quality; 2. Acoustic analysis of the vocal signal; 3. Voice self-assessment; 4. Traditional techniques of therapy; 5. Modern techniques of electrostimulation and photobiomodulation (PBMT) in voice. Part "a" of this publication was associated with the consolidation of the analyses of the first three aspects. The trend in the perceptual-auditory judgment of vocal quality was related to the use of standard protocols. The acoustic evaluation of the vocal signal is accessible and can be done descriptively or by extraction of parameters, thus preferring multiparametric measures. Finally, the analysis of the individual himself closes this triad of voice documentation, which will be the basis for the conclusion of the evaluation, reference for monitoring progress, and evaluation of treatment results.

No XXVIII Congresso Brasileiro da SBFa, 24 especialistas reuniram-se e, a partir de um posicionamento condutor sobre pesquisa científica como ferramenta de conexão entre laboratório e clínica, cinco frentes de conhecimento da especialidade de voz foram discutidas: 1. Julgamento perceptivo-auditivo da qualidade vocal; 2. Análise acústica do sinal vocal; 3. Autoavaliação em voz; 4. Técnicas tradicionais de terapia; 5. Técnicas modernas de eletroestimulação e fotobiomodulação em voz. A parte "a" desta publicação é a consolidação das análises dos três primeiros aspectos. A tendência no julgamento perceptivo-auditivo da qualidade vocal é o uso de protocolos padrão. A avaliação acústica do sinal vocal é acessível e pode ser feita de modo descritivo ou por extração de parâmetros, preferindo-se medidas multiparamétricas. Finalmente, a análise do próprio indivíduo fecha essa tríade de documentação fonoaudiológica, que será base para a conclusão da avaliação, referência para monitoramento do progresso e avaliação de resultado de tratamento.

Reducing the gap between science and clinic: lessons from academia and professional practice - part B: traditional vocal therapy techniques and modern electrostimulation and photobiomodulation techniques applied to vocal rehabilitation. / Reduzindo o gap entre a ciência e a clínica: lições da academia e da prática profissional ­ parte B: técnicas tradicionais de terapia vocal e técnicas modernas de eletroestimulação e fotobiomodulação aplicadas à reabilitação vocal.

This text is the continuation of the XVIII SBFa Congress publication. In part "A" we presented the analyses on clinical vocal evaluation. Part "B" focuses on vocal rehabilitation: 4. Traditional techniques of vocal therapy; 5. Modern techniques of electrostimulation and photobiomodulation applied to vocal rehabilitation. The numerous studies on the various programs, methods, and techniques of traditional rehabilitation techniques, and many with high quality of evidence, allow us to consider such procedures relatively well described, safe, and with known effects, accounting for the treatment of various vocal disorders. The scientific evidence with traditional techniques is recognized worldwide. New fronts of evolution, with electrostimulation or photobiomodulation used to handle voice problems, seem to be promising as coadjutant approaches. There are more studies on electrostimulation in vocal rehabilitation than with photobiomodulation; however, scientific evidence for these two modern techniques is still limited. Knowledge and caution are required for the application of either technique.

O presente texto é a continuação da publicação referente ao XVIII Congresso da SBFa. Na parte "A" apresentamos análises sobre avaliação clínica vocal. O foco da parte "B" são aspectos de reabilitação vocal: 4. Técnicas tradicionais de terapia vocal; 5. Técnicas modernas de eletroestimulação e fotobiomodulação aplicadas à reabilitação. Os inúmeros estudos sobre os diversos programas, métodos ou técnicas tradicionais de reabilitação, muitos de elevada qualidade de evidência, permitem considerar tais procedimentos relativamente bem descritos, seguros e com efeitos conhecidos, dando conta do tratamento de diversos distúrbios vocais. As evidências científicas com as técnicas tradicionais são reconhecidas mundialmente. Novas frentes de evolução, como o uso da eletroestimulação ou fotobiomodulação em voz parecem ser promissoras como abordagens coadjuvantes. Há mais estudos sobre eletroestimulação em voz do que com fotobiomodulação, contudo, evidências científicas para essas duas técnicas modernas são ainda limitadas. Conhecimento e cautela são necessários para a aplicação de quaisquer técnicas.

Resonant Voice: Perceptual and Acoustic Analysis After an Intensive Lessac Kinesensic Training Workshop.

OBJECTIVE: To investigate whether actors' and actresses' voices post an Intensive Lessac Kinesensic Training Workshop - ILKTW can be perceptually identified as more resonant, and to assess if the Acoustic Voice Quality Index (AVQI), the Acoustic Breathing Index (ABI), and their acoustic measures are able to indicate the classified voices as more resonant. METHODS: Eight vocally healthy English first-language actors and actresses, participants of the same ILKTW, were asked to sustain the vowel /a/ and to read a piece of the Rainbow Passage, pre and postworkshop, at a self-selected habitual frequency and intensity. The readings were divided into initial and final parts, both with 34 syllables, and combined with the vowel /a/ (3s). The pre and postworkshop recordings (pairs of the initial and final parts followed by the /a/ vowel) of each participant were randomly presented to a voice expert who rated the samples as more resonant or similar. The same samples were analyzed using the AVQI and ABI scripts. RESULTS: 87,5% of the initial parts and 100% of the final in postworkshop were rated by the voice expert as more resonant. Tilt was higher for the postworkshop initial parts (P = 0.036), but a correlation with the perceptual rating wasn't found. HNR was higher (P = 0.018) and jitter was lower (P = 0.017) for the postworkshop final parts. The statistical analysis comparing the perceptive and acoustic data for the final samples couldn't be applied. CONCLUSION: It seems that the ILKTW has a positive impact on the development of a resonant voice and that the perceptual auditory rating was more effective to describe resonant voices than the AVQI, ABI, and its acoustic measures.

Validation of the Acoustic Voice Quality Index, Version 03.01, to the Brazilian Portuguese Language.

INTRODUCTION: Multiparametric indexes provide a more robust acoustic analysis of voice quality considering more than one acoustic parameter in the evaluation of sustained phonation and continuous speech. However, once the continuous speech is considered, differences among languages must be addressed. OBJECTIVE: To assess the concurrent validity and the diagnostic accuracy of the Acoustic Voice Quality Index version 03.01 (AVQI 03.01) in the Brazilian Portuguese. METHOD: The counting numbers 1-20 and the vowel /a/ of 150 subjects were used (37 nondysphonic; 113 with dysphonia). To reach higher precision of the AVQI, the length of the voiced parts of the continuous speech and the sustained vowel were equalized. Nine voice specialists performed the perceptual auditory judgment of the samples. However, only five listeners were chosen for further analysis based on their moderate to substantial intrarater reliability (Cohen's Kappa: 0.605-0.773) and their reasonable inter-rater reliability (Fleiss Kappa: 0.429). The index concurrent validity and diagnosis accuracy were analyzed with the Spearman correlation and the receiver-operating characteristic curve. RESULTS: The AVQI 03.01 concurrent validity was high (r = 0.716). The coefficient of determination demonstrated that 51% of the vocal deviation can be explained by the acoustic analysis (r2 = 0.512). The diagnostic accuracy was excellent (90.4%). At a threshold of 1.33, the AVQI sensitivity and specificity were 78.8% and 90.6%, respectively. CONCLUSION: The AVQI is a valid tool in the Brazilian Portuguese language. It can be used as a screening tool, for clinical follow-up and evaluation pre- and post-treatment/procedures. Voice specialist should be aware of false-negative and false-positive results of the AVQI, especially for screening purposes.

Acoustic Voice Quality Index and Acoustic Breathiness Index: Analysis With Different Speech Material in the Brazilian Portuguese.

OBJECTIVE: To analyze the Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) concurrent validity and diagnostic accuracy with different speech materials. METHODS: Voices of 53 subjects (40 dysphonic; 13 vocally health) were recorded: vowel /a/ + counting numbers 1-20 (42 syllables) + reading text (138 syllables). Numbers and text were edited in order to achieve 3 seconds of voiced segments, such as the vowel /a/ (average of 18.81 and 32.49 syllables; confidence interval of 1.87 and 2.30). The audio files were edited to have 17 syllables for numbers and 32 for text. Three voice specialists perceptually judge the overall voice quality (G) and the breathiness (B). AVQI's and ABI's precision and concurrent validity were assessed. RESULTS: The intra- and inter-rater reliability were high. Reading text presented higher concurrent validity (r) than automatic speech and excellent area under the receiver-operating characteristic curve for AVQI (0.963) and ABI (0.929). Counting numbers presented good area under the receiver-operating characteristic curve for AVQI (0.870) and excellent for ABI (0.924). Counting numbers produced higher sensitivity for ABI (95.2%) and reading text higher specificity for both indexes (AVQI = 100%; ABI = 90.90%). Reading text presented higher AVQI and ABI scores than numbers, therefore, reading seems to reveal more vocal deviations; however, perceptual judgment can be similar in both samples. CONCLUSIONS: Different speech materials may impact acoustic outcomes and certain voice characteristics may not be evident. Reading text offers higher diagnostic accuracy. Clinician and/or researchers must select and standardize the speech sample according to their goals.

Acoustic Voice Quality Index - AVQI for brazilian portuguese speakers: analysis of different speech material. / Acoustic Voice Quality Index - AVQI para o português brasileiro: análise de diferentes materiais de fala.

PURPOSE: This study aimed to verify the best speech material for the AVQI for Brazilian Portuguese language and identify the best validity results between the auditory perceptual judgment (APJ) and the AVQI score on different speech materials. METHODS: We recorded voice samples of 50 individuals (dysphonic and vocally healthy) of several continuous speech (cs) variants (i.e., months of the year, numbers 1 to 20, and CAPE-V sentences) and attached the vowel /a/ in each case. The recorded samples were edited to three different durations of cs variants plus vowel: D1-total speech material; D2-customized speech material without voiceless parts; D3-pre-defined cut-off point speech material. These samples were submitted to three voice experts who judged the overall voice quality; and the AVQI analysis. AVQI's precision and concurrent validity were evaluated considering a Gmean threshold of G<0.5 and G<0.68. RESULTS: The concurrent validity of AVQI and APJ ranged from r = 0.482 to r = 0.634. Numbers presented higher values for all durations. For G<0.5, the best sensitivity and area under the ROC curve was for CAPE-V sentences at D3 (57.8%; 72%). For G<0.68, numbers 1 to 10 had the best diagnostic accuracy and numbers 1 to 20 had the best sensitivity. CONCLUSION: Numbers from 1 to 10 had the best correlation results between APJ and AVQI. For G<0.5, sentences had the best diagnostic accuracy; while for G<0.68, numbers had the best diagnostic accuracy. Numbers are commonly used in the Brazilian clinic routine. According to the validity results and daily clinical practice in Brazil, we suggest the use of numbers as cs for concatenated voice samples of voice quality assessments.

OBJETIVO: Verificar a melhor amostra de fala para validação do AVQI para o português-brasileiro; identificar o contexto de fala com melhor correlação perceptivo-acústica e que possui maior acurácia diagnóstica com o AVQI. MÉTODO: Gravações de 50 sujeitos (disfônicos e vocalmente saudáveis), incluindo: vogal/a/; meses do ano; números (1 a 20) e repetição das frases do CAPE-V. As amostras de fala foram editadas para conter três diferentes durações mais vogal: D1-fala completa; D2-fala com 3s de segmentos sonoros; D3-fala com ponto de corte pré-determinado. Três avaliadores realizaram a análise perceptivoauditiva (APA) das amostras combinadas em 3 contextos seguidos da vogal e deram um único escore do desvio vocal (G:0 a 3). Verificou-se qual estímulo de fala possuía melhor correlação perceptivo-acústica considerando o Gmédio; analisou-se qual estímulo possuía melhor acurácia diagnóstica considerando como presença ou ausência G<0,5 e G<0,68. RESULTADOS: A correlação perceptivo-acústica variou de r = 0,482 a r = 0,634 (Correlação de Spearman); números apresentou os valores mais elevados. O AVQI foi altamente específico e pouco sensível. Considerando G<0,5, a melhor sensibilidade e valor da curva ROC foi para frases em D3 (0,578;0,72). Considerando G<0,68, houve boa acurácia diagnóstica para números de 1 a 10 e maior sensibilidade para números de 1 a 20. CONCLUSÃO: Melhor correlação perceptivo-acústica foi para números, 1 a 10. As frases do CAPE-V produziram melhor acurácia diagnóstica com G<0,5, números apresentou elevada acurácia diagnóstica com G<0,68. Números é bastante usual na clínica brasileira, logo, sugere-se seu uso para validação e análises do AVQI.

Learning factor influence on the perceptual-auditory analysis. / Influência do fator de aprendizagem na análise perceptivo-auditiva.

PURPOSE: To investigate the learning factor during a perceptual-auditory analysis of an unusual task in three different groups. METHODS: 269 listeners, divided into three groups: 73 voice specialists Speech Language Pathologists (EG), 84 voice specialists Speech Language Pathologists (NEG); and 112 non-speech pathologists in the Naive Group (NG). They all completed a listening session that included 18 synthesized and 18 human voices with different types and degrees of deviation (50% of repetition for intra-rater consistency analysis). The task was to classify the voices as human or synthesized. We analyzed the learning factor by comparing the initial error percentage, first 18 voices, with the final, last 18 voices. RESULTS: EG presented less error towards the end of the task (25.5%) than at the beginning (28.6%) with statistical difference (p = 0.024). The error percentage of the beginning and the end of the task did not differ for the NEG and the NG (NEG beginning = 36.5%, end = 35.3%; NG beginning = 38.3%, end = 37.7%). CONCLUSION: The EG was the only group to present evidence of learning factor. Therefore, it seems that professional experience positively influences the perceptual-auditory analysis, which reinforces the impact of its training to become a voice specialist. Moreover, the voice specialists seem to be more prepared and more susceptible to use learning strategies to improve their performance during a perceptual-auditory analysis task, even if unusual.

OBJETIVO: Investigar o fator de aprendizagem durante uma tarefa perceptivo-auditiva para três grupos diferentes em uma tarefa não usual. MÉTODO: 269 ouvintes, divididos em três grupos: 73 no grupo dos fonoaudiólogos especialistas em voz (GE), 84 no grupo dos fonoaudiólogos não especialistas em voz (GNE) e 112 no grupo leigo (GL), dos não fonoaudiólogos. Todos foram submetidos a uma sessão de escuta que incluiu 18 vozes humanas e 18 vozes sintetizadas com diferentes tipos e graus de desvio, mais 50% de repetição para avaliar a consistência intraindivíduo. A tarefa era classificar as vozes como humana ou sintetizada. Analisou-se o fator de aprendizagem pela comparação da porcentagem de erros do começo, primeiras 18 vozes, e do final, últimas 18 vozes, da sessão de escuta. RESULTADOS: O GE foi submetido ao fator de aprendizagem, apresentando menos erros no final da tarefa (25,5%), do que no começo (28,6%), com diferença estatística (p = 0,024). O GNE e o GL não apresentaram diferença da porcentagem de erros no começo e no final da tarefa (GNE começo = 36,5%; GNE final = 35,3%; GL começo = 38,3%; GL final = 37,7%). CONCLUSÃO: O GE foi o único grupo que apresentou indícios evidentes do fator de aprendizagem. Parece que a experiência profissional influencia de modo positivo a análise perceptivo-auditiva, reforçando o impacto de um treinamento para se tornar um especialista em voz. Ainda, o especialista em voz parece estar mais preparado e mais suscetível a utilizar estratégias de aprendizagem para melhorar sua performance durante uma tarefa perceptivo-auditiva mesmo que pouco usual.

Perceptual Error Analysis of Human and Synthesized Voices.

OBJECTIVE/HYPOTHESIS: To assess the quality of synthesized voices through listeners' skills in discriminating human and synthesized voices. STUDY DESIGN: Prospective study. METHODS: Eighteen human voices with different types and degrees of deviation (roughness, breathiness, and strain, with three degrees of deviation: mild, moderate, and severe) were selected by three voice specialists. Synthesized samples with the same deviations of human voices were produced by the VoiceSim system. The manipulated parameters were vocal frequency perturbation (roughness), additive noise (breathiness), increasing tension, subglottal pressure, and decreasing vocal folds separation (strain). Two hundred sixty-nine listeners were divided in three groups: voice specialist speech language pathologists (V-SLPs), general clinician SLPs (G-SLPs), and naive listeners (NLs). The SLP listeners also indicated the type and degree of deviation. RESULTS: The listeners misclassified 39.3% of the voices, both synthesized (42.3%) and human (36.4%) samples (P = 0.001). V-SLPs presented the lowest error percentage considering the voice nature (34.6%); G-SLPs and NLs identified almost half of the synthesized samples as human (46.9%, 45.6%). The male voices were more susceptible for misidentification. The synthesized breathy samples generated a greater perceptual confusion. The samples with severe deviation seemed to be more susceptible for errors. The synthesized female deviations were correctly classified. The male breathiness and strain were identified as roughness. CONCLUSION: VoiceSim produced stimuli very similar to the voices of patients with dysphonia. V-SLPs had a better ability to classify human and synthesized voices. VoiceSim is better to simulate vocal breathiness and female deviations; the male samples need adjustment.

Reduzindo o GAP entre a ciência e a clínica: lições da academia e da prática profissional - parte A: julgamento perceptivo-auditivo da qualidade vocal, análise acústica do sinal vocal e autoavaliação em voz / Reducing the GAP between science and clinic: lessons from academia and professional practice - part A: perceptual-auditory judgment of vocal quality, acoustic vocal signal analysis and voice self-assessment

RESUMO No XXVIII Congresso Brasileiro da SBFa, 24 especialistas reuniram-se e, a partir de um posicionamento condutor sobre pesquisa científica como ferramenta de conexão entre laboratório e clínica, cinco frentes de conhecimento da especialidade de voz foram discutidas: 1. Julgamento perceptivo-auditivo da qualidade vocal; 2. Análise acústica do sinal vocal; 3. Autoavaliação em voz; 4. Técnicas tradicionais de terapia; 5. Técnicas modernas de eletroestimulação e fotobiomodulação em voz. A parte "a" desta publicação é a consolidação das análises dos três primeiros aspectos. A tendência no julgamento perceptivo-auditivo da qualidade vocal é o uso de protocolos padrão. A avaliação acústica do sinal vocal é acessível e pode ser feita de modo descritivo ou por extração de parâmetros, preferindo-se medidas multiparamétricas. Finalmente, a análise do próprio indivíduo fecha essa tríade de documentação fonoaudiológica, que será base para a conclusão da avaliação, referência para monitoramento do progresso e avaliação de resultado de tratamento.

ABSTRACT During the XXVIII Brazilian Congress of SBFa, 24 specialists met and, from a leading position on scientific research as a tool for connecting laboratory and clinic, five fronts of knowledge of the voice specialty were discussed as following: Perceptual-auditory judgment of vocal quality; 2. Acoustic analysis of the vocal signal; 3. Voice self-assessment; 4. Traditional techniques of therapy; 5. Modern techniques of electrostimulation and photobiomodulation (PBMT) in voice. Part "a" of this publication was associated with the consolidation of the analyses of the first three aspects. The trend in the perceptual-auditory judgment of vocal quality was related to the use of standard protocols. The acoustic evaluation of the vocal signal is accessible and can be done descriptively or by extraction of parameters, thus preferring multiparametric measures. Finally, the analysis of the individual himself closes this triad of voice documentation, which will be the basis for the conclusion of the evaluation, reference for monitoring progress, and evaluation of treatment results.

Reduzindo o gap entre a ciência e a clínica: lições da academia e da prática profissional - parte B: técnicas tradicionais de terapia vocal e técnicas modernas de eletroestimulação e fotobiomodulação aplicadas à reabilitação vocal / Reducing the gap between science and clinic: lessons from academia and professional practice - part B: traditional vocal therapy techniques and modern electrostimulation and photobiomodulation techniques applied to vocal rehabilitation

RESUMO O presente texto é a continuação da publicação referente ao XVIII Congresso da SBFa. Na parte "A" apresentamos análises sobre avaliação clínica vocal. O foco da parte "B" são aspectos de reabilitação vocal: 4. Técnicas tradicionais de terapia vocal; 5. Técnicas modernas de eletroestimulação e fotobiomodulação aplicadas à reabilitação. Os inúmeros estudos sobre os diversos programas, métodos ou técnicas tradicionais de reabilitação, muitos de elevada qualidade de evidência, permitem considerar tais procedimentos relativamente bem descritos, seguros e com efeitos conhecidos, dando conta do tratamento de diversos distúrbios vocais. As evidências científicas com as técnicas tradicionais são reconhecidas mundialmente. Novas frentes de evolução, como o uso da eletroestimulação ou fotobiomodulação em voz parecem ser promissoras como abordagens coadjuvantes. Há mais estudos sobre eletroestimulação em voz do que com fotobiomodulação, contudo, evidências científicas para essas duas técnicas modernas são ainda limitadas. Conhecimento e cautela são necessários para a aplicação de quaisquer técnicas.

ABSTRACT This text is the continuation of the XVIII SBFa Congress publication. In part "A" we presented the analyses on clinical vocal evaluation. Part "B" focuses on vocal rehabilitation: 4. Traditional techniques of vocal therapy; 5. Modern techniques of electrostimulation and photobiomodulation applied to vocal rehabilitation. The numerous studies on the various programs, methods, and techniques of traditional rehabilitation techniques, and many with high quality of evidence, allow us to consider such procedures relatively well described, safe, and with known effects, accounting for the treatment of various vocal disorders. The scientific evidence with traditional techniques is recognized worldwide. New fronts of evolution, with electrostimulation or photobiomodulation used to handle voice problems, seem to be promising as coadjutant approaches. There are more studies on electrostimulation in vocal rehabilitation than with photobiomodulation; however, scientific evidence for these two modern techniques is still limited. Knowledge and caution are required for the application of either technique.