Toward Enhanced Voice-Related Self-Reports: Translation, Cross-Cultural Adaptation, and Validity.

PURPOSE: This article provides a commentary on voice-related self-reports and presents various shortcomings endemic in the development and validation of these measures. Emphasis is placed on issues of construct validity, translation, and cross-cultural adaptation. Finally, a demonstration is provided to elucidate the importance of cross-cultural adaptation. METHODS: An example of a voice-related self-report that lacks cross-cultural adaptation is provided, and a linguistic translation and cross-cultural adaptation process is outlined and demonstrated. A bilingual voice scientist, a bilingual speech-language pathologist (SLP), and two experts in voice-related self-reports completed a multistep linguistic translation and cross-cultural adaptation process and obtained back-translations from five SLPs native to the self-report's source culture. RESULTS: Analyses of the back-translations demonstrated that the mean BiLingual Evaluation Understudy (BLEU) scores of the adapted items were higher overall than the back-translations of the original English items. CONCLUSIONS: Unvalidated translations of voice-related self-reports are commonly used as a baseline to further translate the measure, and this deteriorates cross-cultural health equity. Cross-cultural adaptation is a crucial, but often overlooked process when translating and adapting self-reports. The present article calls for standardized methodologies with an emphasis on the necessity of careful translation methods and cultural adaptation processes.

Sensorimotor Integration in Patients with Voice Disorders: A Scoping Review of Behavioral Research.

BACKGROUND: In recent years, research has determined that impaired sensorimotor integration is a contributor to the formation of voice symptoms and voice disorders. A scoping review is undertaken to explore the current state of scientific research regarding behavioral examinations of sensorimotor integration impairments in patients. SUMMARY: Following the guidelines of the PRISMA Extension for Scoping Reviews, five online databases identified papers published 2000-2023, from which 17 publications were selected that used sensorimotor integration paradigms with voice-related acoustics as an outcome variable in individuals diagnosed with a voice disorder. Across the 17 studies, sensorimotor integration was behaviorally examined via auditory-motor paradigms in 315 patients with voice disorders and 344 controls. Broadly, patients with vocal hyperfunction demonstrated impaired auditory-motor and somatosensory-motor integration. Patients with unilateral vocal fold paralysis demonstrated impaired sensorimotor integration attributed to changes in the primary brain areas of speech motor control. Patients with laryngeal dystonia demonstrated varying results, with no conclusive evidence regarding sensorimotor integration in behavioral voicing tasks. Patients with Parkinson's disease demonstrated varying results as well, with a general trend of increased dependance on the feedback control system of voice production. Patients with ataxic dysarthria demonstrated that auditory feedback control was impaired possibly due to inaccurate error estimation and correction arising from the damage to their cerebellar pathways. Finally, patients with cerebellar degeneration demonstrated disruptions in both feedback and feed-forward control. KEY MESSAGES: Sensorimotor integration in the context of voice disorders is an important consideration in understanding how different sensory streams operate in healthy voice production, and how sensory feedback can be optimized in clinical treatments of voice disorders. The present scoping review reveals that behavioral research has focused primarily on auditory-motor integration paradigms, and this supports the possibility of a disconnect between these behavioral studies and existing theoretical conceptualizations of vocal motor control. .

Self-Reported Voice-Related Quality of Life in Cochlear Implant Users

Objective: The aim of this study was to identify if cochlear implant (CI) users are perceiving a decrease in life quality due to voice problems. This study evaluated 43 CI user's perception of their voice and how it affects their quality of life through a survey. Approach: Forty-three CI users responded to a survey regarding their demographics, details about their CI, the Hearing Health Quick Test (HHQT), the Voice Related Quality of Life (V-RQOL), and the Voice Handicap Index-10 (VHI-10). The survey responses were analyzed using univariate linear regression analysis. Results: Few of the CI users scored below the cut off for normal voice related quality of life. CI users averaged 93.4 out of 100 on the V-RQOL and only four scored abnormally for the VHI-10. Lower scores on the V-RQOL were correlated with the participants having an associate degree and with participants visiting friends, family, and neighbors less often due to hearing loss. The VHI-10 scores were correlated with gender, education levels, difficulty in social situations due to hearing loss, noise exposure, and tinnitus. Limitations of the study: The small n was the primary limitation of this study. Originality: This study was one of the first to examine the voice-related quality of life in CI users. Conclusions: Overall, respondents did not perceive much voice-related difficulty. However, they were more likely to perceive voice-related difficulty if they experienced difficulty hearing in noise and avoided social situations due to hearing loss.

Objetivo: Este estudio identificó si los usuarios de implantes cocleares (IC) están percibiendo una disminución en la calidad de su vida debido a problemas de voz. Además, evaluó la percepción de la voz de 43 usuarios de IC y cómo afecta su calidad de vida a través de una encuesta. Enfoque: Cuarenta y tres usuarios de IC respondieron a una encuesta sobre su demografía, detalles sobre su IC, la Hearing Health Quick Test (HHQT), la Voice Related Quality of Life (V-RQOL) y el Voice Handicap Index-10 (VHI-10). Las respuestas de la encuesta se analizaron mediante un análisis de regresión lineal univariado. Resultados: Pocos usuarios de IC puntuaron por debajo del límite para calidad de vida relacionada con la voz. El promedio V-RQOL fue de 93,4/100; solo 4 participantes tuvieron puntuación anormal en VHI-10. Las bajas puntuaciones en V-RQOL se correlacionaron con título de asociado y menos visitas por pérdida auditiva; las puntuaciones VHI-10, con sexo, educación, dificultad en situaciones sociales, exposición al ruido y tinnitus. Limitaciones del estudio: La pequeña n fue la principal limitación de este estudio. Originalidad: Este estudio fue uno de los primeros en examinar la calidad de vida relacionada con la voz en usuarios de CI. Conclusiones: En general, los encuestados no percibieron mucha dificultad relacionada con la voz. Sin embargo, era más probable que percibieran dificultades relacionadas con la voz si tenían dificultades para oír en ruido y evitaban situaciones sociales debido a la pérdida auditiva.

Clinical Utility and Validation of the Acoustic Voice Quality and Acoustic Breathiness Indexes for Voice Disorder Assessment in English Speakers.

BACKGROUND: While several acoustic voice metrics are available for clinical voice assessment, there remains a significant need for reliable and ecologically valid tools. The Acoustic Voice Quality Index version 03.01 (AVQI-3) and Acoustic Breathiness Index (ABI) hold potential due to their comprehensive assessment approach, incorporating diverse voice aspects. However, these tools still need to be validated in English-speaking populations. METHODS: This study assessed the discriminatory accuracy and validity of AVQI-3 and ABI in 197 participants, including 148 with voice disorders. Voice samples were collected, followed by AVQI-3 and ABI calculations. Additionally, auditory-perceptual assessments were conducted by a panel of speech-language pathologists. RESULTS: AVQI-3 and ABI effectively identified disordered voice quality, evidenced by high accuracy (AUCs: 0.84, 0.89), sensitivity, and specificity (thresholds: AVQI-3 = 1.17, ABI = 2.35). Strong positive correlations were observed with subjective voice quality assessments (rs = 0.72, rs = 0.77, p < 0.001). CONCLUSIONS: The study highlights AVQI-3 and ABI as promising instruments for clinically assessing voice disorders in U.S. English speakers, underscoring their utility in clinical practice and voice research.

Investigating the Impact of Visual Input on Voice Production in Virtual Reality.

OBJECTIVE: This study explored the independent effects of visual input on voice production using virtual reality. Specifically, its effects on acoustic voice parameters and vocal status ratings, with the hypothesis that larger (a virtual lecture hall and theater compared to an office) and more full virtual rooms (75% of the capacity compared to 45%) would result in changes to the voice parameters and vocal status ratings. METHODS: Voice production from 30 vocally healthy participants was recorded in six virtual reality conditions. After each condition, the participants provided vocal status ratings. The voice recordings were processed to calculate mean and standard deviation of sound pressure level and fundamental frequency, mean pitch strength, time dose, and cepstral peak prominence smoothed. The effects of the virtual reality conditions on these voice acoustic parameters and the vocal status ratings were analyzed. RESULTS: The full virtual reality rooms resulted in significantly higher vocal fatigue and vocal discomfort ratings. The larger virtual reality rooms were significantly related to increases in mean and the standard deviation of sound pressure level, mean pitch strength, and cepstral peak prominence smoothed. CONCLUSIONS: This study demonstrated that visual size and visual fullness input during speech tasks have distinct effects on voice production and self-reported vocal status. Visual size is related to voice acoustic outcomes, while visual fullness is related to self-reported outcomes.

Do-It-Yourself Voice Dosimeter Device: A Tutorial and Performance Results.

PURPOSE: Voice dosimeters gather voice production data in the daily lives of individuals with voice disorders. Additionally, voice dosimeters aid in understanding the pathophysiology of voice disorders. Previously, several voice dosimeters were commercially available. However, these devices have been discontinued and are not available to clinicians and researchers alike. In this tutorial, instructions for a low-cost, easy-to-assemble voice dosimeter are provided. This do-it-yourself (DIY) voice dosimeter is further validated based on performance results. METHOD: Ten vocally healthy participants wore the DIY voice dosimeter. They produced a sustained /a/ vowel and read a text with three different vocal efforts. These tasks were recorded by the DIY voice dosimeter and a reference microphone simultaneously. The expanded uncertainty of the mean error in the estimation of four voice acoustic parameters as measured by the DIY dosimeter was performed by comparing the signals acquired through the reference microphone and the dosimeter. RESULTS: For measures of sound pressure level, the DIY voice dosimeter had a mean error of -0.68 dB with an uncertainty of 0.56 dB. For fundamental frequency, the mean error was 1.56 Hz for female participants and 1.11 Hz for male participants, with an uncertainty of 0.62 Hz and 0.34 Hz for female and male participants, respectively. Cepstral peak prominence smoothed and L1 minus L2 had mean errors (uncertainty) of -0.06 dB (0.27 dB) and 2.20 dB (0.72 dB). CONCLUSION: The mean error and uncertainties for the DIY voice dosimeter are comparable to those for the most accurate voice dosimeters that were previously on the market.

The Effects of Room Acoustics on Self-reported Vocal Fatigue: A Systematic Review.

PURPOSE: The main objective of the present systematic review is to quantify the relationship between the room acoustics and self-reported vocal fatigue. METHODS: A comprehensive literature search and systematic review were conducted using PubMed/MEDLINE, Science Direct, Web of Science, EBSCO, and Scopus databases. Two inclusion criteria were defined: (1) description of a relationship between the room acoustics and self-reported vocal fatigue; and (2) reporting of raw data and/or a statistic of the association between the variables. Risk of bias in the included studies was assessed via the Quality Assessment Tool for Quantitative Studies Effective Public Health Practice Project. The occurrences and frequencies of the most common parameters in the literature are presented, and a quantitative summary of their relationships is reported. RESULTS: In total, 12 publications met the inclusion criteria. The most relevant measures of self-reported vocal fatigue were the Vocal Fatigue Index (n = 3), Vocal Signs and Symptoms Questionnaire (n = 1), and vocal fatigue visual analog scales (n = 2). The most relevant room acoustic parameters include noise conditions (n = 6) and reverberation time (n = 2). The relationships between the room acoustic parameters and self-reported vocal fatigue are quantified and reported while maintaining the concepts stated in the original articles and outlining their similarities. CONCLUSION: Overall, background noise and reverberation time were determined to be the most significant independent variables associated with self-reported vocal fatigue. A primary limitation of the evidence was inconsistent measures of self-reported vocal fatigue.

Voice Biofeedback via Bone Conduction Headphones: Effects on Acoustic Voice Parameters and Self-Reported Vocal Effort in Individuals With Voice Disorders.

PURPOSE: This study explores sidetone amplification (amplified playback of one's own voice) provided via bone conduction in participants with voice disorders. The effects of bone conduction feedback on acoustic voice parameters and vocal effort ratings are examined. METHODS: Speech samples of 47 participants with voice disorders were recorded in three auditory feedback conditions: two with sidetone amplification delivered via bone conduction and one condition with no alteration of the feedback. After each task, the participants rated their vocal effort on a visual analog scale. The voice recordings were evaluated by a speech-language pathologist through the GRBAS scale and processed to calculate the within-participant centered sound pressure level (SPL) values, the mean pitch strength (PS), the time dose (Dt%), and cepstral peak prominence smoothed (CPPS). The effects of the feedback conditions on these acoustic parameters and vocal effort ratings were analyzed. RESULTS: The high sidetone amplification condition resulted in a statistically significant decrease in the within-participant centered SPL values and mean pitch strength across all participants. The feedback conditions had no statistically significant effects on the vocal effort ratings, time dose (Dt%), or CPPS. CONCLUSIONS: This study provides an evidence that bone conduction sidetone amplification contributes to a consistent adaptation in the within-participant centered SPL values (ΔSPL) in patients with vocal hyperfunction, glottal insufficiency, and organic/neurological laryngeal pathologies compared to conditions with no feedback.

Daily Phonotrauma Index: An Objective Indicator of Large Differences in Self-Reported Vocal Status in the Daily Life of Females With Phonotraumatic Vocal Hyperfunction.

PURPOSE: The purpose of this study is to evaluate if the Daily Phonotrauma Index (DPI) can quantitatively discriminate large differences in overall vocal status in the daily life of patients with phonotraumatic vocal hyperfunction (PVH). METHOD: For 1-4 weeks, 23 females with PVH wore an ambulatory voice monitor and answered three vocal status questions (i.e., difficulty producing soft, high-pitched phonation; discomfort; and fatigue) at the beginning, at 5-hr intervals, and the end of each day. DPI values were obtained for each patient's time periods of worst and best self-rated vocal status, and data for the group were analyzed for significant changes using a linear mixed-effects regression model. RESULTS: The DPI was significantly lower during periods self-rated as "best vocal status" compared to during periods self-rated as "worst vocal status" (mean difference in DPI = 0.53) with a medium-to-large effect size (Cohen's d = -0.68). CONCLUSIONS: In a group of patients with phonotraumatic lesions, the DPI indicated lower potential for phonotrauma during time periods of better vocal status compared to time periods of worse vocal status. Assuming that a large portion of variance in vocal status for patients with PVH is associated with the extent to which voicing is phonotraumatic, these results support the validity of obtaining estimates of DPI for much shorter time periods (i.e., an estimate every 2 min of voicing) than previous studies (i.e., a single estimate for the entire day or week). Future work can investigate the DPI's use for in-clinic assessment/treatment and ambulatory biofeedback and can gain further insights into phonatory mechanisms that underlie DPI via comparisons with other physiologically relevant measures and computational vocal fold modeling.

Singing Voice Quality: The Effects of Maxillary Dental Arch and Singing Style.

INTRODUCTION: In classical singing techniques, it is common to manipulate the vocal tract to channel airflow to increase voice quality and volume. Technique varies according to the style of the music, the voice type, and range of a given singer. Although these practices are intentional, fixed physiological aspects of a singer's vocal instrument also play an extremely impactful role in determining voice quality. OBJECTIVES: In the present study, the relationship between the dimensions of the maxillary dental arch and voice quality were examined in professional singers. METHODS: The dimensions of the palate were measured from the maxillary dental casts of 14 female singers. Audio recordings were made for the same participants while singing a sustained /a/ singing vowel, a glissando, the song "Are You Sleeping", and a selected song from their personal repertoire. The dimensions of the palate were measured from maxillary dental casts. From the recordings, two parameters were calculated: (1) the Singing Power Ratio (SPR) and (2) A2 A1 ratio. Higher SPR values indicate a stronger ring in the voice, typical of operatic singing style, while higher A2 A1 ratio values are associated with the belting singing style. RESULTS: Singers with larger frontal palate depth, smaller posterior palate depth, larger frontal palate width, and smaller posterior palate width seem to be more suitable for an operatic singing style. Singers who had larger overall depth and width of the palate measurements produced an increased second harmonic, typical of the belting style. CONCLUSIONS: When considering a singer's ability to produce vocalizations successfully, physiological structure is an increasingly important factor. The present study discovered that palate depth and width are associated with statistically significant differences in SPR and A2/A1 parameters. These parameters correlate with two styles of singing, operatic, and belting respectively.

Reproducibility of Voice Parameters: The Effect of Room Acoustics and Microphones.

INTRODUCTION: Computer analysis of voice recordings is an integral part of the evaluation and management of voice disorders. In many practices, voice samples are taken in rooms that are not sound attenuated and/or sound-proofed; further, the technology used is rarely consistent. This will likely affect the recordings, and therefore, their analyses. OBJECTIVES: The objective of this study is to compare various acoustic outcome measures taken from samples recorded in a sound-proofed booth to those recorded in more common clinic environments. Further, the effects from six different commonly used microphones will be compared. METHODS: Thirty-six speakers were recorded while reading a text and producing sustained vowels in a controlled acoustic environment. The collected samples were reproduced by a Head and Torso Simulator and recorded in three clinical rooms and in a sound booth using six different microphones. Newer measures (eg, Pitch Strength, cepstral peak prominence, Acoustic Voice Quality Index), as well as more traditional measures (eg Jitter, Shimmer, harmonics-to-noise ratio and Spectrum Tilt), were calculated from the samples collected with each microphone and within each room. RESULTS: The measures which are more robust to room acoustic differences, background noise, and microphone quality include Jitter and smooth cepstral peak prominence, followed by Shimmer, Acoustic Voice Quality Index, harmonics-to-noise ratio, Pitch Strength, and Spectrum Tilt. CONCLUSIONS: The effect of room acoustics and background noise on voice parameters appears to be stronger than the type of microphone used for the recording. Consequently, an appropriate acoustical clinical space may be more important than the quality of the microphone.