Screening of Voice Pathologies: Identifying the Predictive Value of Voice Acoustic Parameters for Common Voice Pathologies.

BACKGROUND: Voice acoustic analysis is important for objectively assessing voice production and diagnosing voice disorders. AIM: This study aimed to investigate the sensitivity of various voice acoustic parameters in differentiating common voice pathology types. METHODS: Data from the publicly available Perceptual Voice Qualities Database were analyzed; the database includes recordings of participants with and without voice disorders. A wide range of acoustic parameters was estimated from the recordings, such as alpha ratio, harmonics-to-noise ratio (HNR), cepstral peak prominence smoothed (CPPS), pitch period entropy (PPE), fundamental frequency, jitter, shimmer, and sound pressure levels. The predictive capabilities of the parameters were evaluated using receiver operating characteristic curves. Linear regression analysis determined the associations between parameters and voice disorders. Principal component analysis was conducted to identify important parameters for distinguishing voice disorders. RESULTS AND CONCLUSION: This study has identified significant differences in acoustic parameters between those with and without voice disorders. Notably, the combination of five parameters-namely, PPE, shimmer, jitter, CPPS, and HNR-was identified as a strong predictor in voice disorder screening. These findings contribute substantially to the field of voice disorders, offering valuable insights for screening and diagnosis.

Individual Voice Dimensions' Prediction of Overall Dysphonia Severity on Two Auditory-Perceptual Scales.

BACKGROUND: Auditory-perceptual evaluation of dysphonic voice is an essential clinical activity that characterizes the nature of dysphonia and aids in planning its clinical management. Although there are multidimensional acoustic measures that correlate well with overall severity ratings, they tend to include measures that have only small or moderate correlations with individual voice characteristics frequently perceptually measured (e.g., breathiness or roughness). Given this difference between perceptual and acoustic measures, it is unclear how much individual voice characteristics contribute to a listener's perception of overall severity of dysphonia. PURPOSE: The purpose of this study was to explore individual voice characteristics' relative contribution to the rating of overall dysphonia severity and to explore sex-related differences. METHOD: Two hundred ninety-six voice samples were accessed from the Perceptual Voice Qualities Database. Roughness, breathiness, asthenia, strain, pitch, and loudness ratings from the Grade, Roughness, Breathiness, Asthenia, Strain and Consensus Auditory-Perceptual Evaluation of Voice scales were used to predict overall voice quality severity in linear regression with bootstrapped coefficients. RESULTS: Roughness, breathiness, and strain were the strongest predictors of overall severity. Asthenia and, to a lesser extent, pitch were also significant predictors of overall severity. Loudness was not a significant predictor. There were several sex-related differences noted, as well as differences related to the scale used. CONCLUSIONS: Breathiness, roughness, and strain were all important predictors of overall severity for all regressions. Clinicians should be aware of scale-related differences if they are using auditory-perceptual measures to choose voice therapy targets. Analyses accounting for perceptual strategy differences were recommended for future studies.

Perceptual Voice Qualities Database (PVQD): Database Characteristics.

OBJECTIVES: To develop a perceptual voice quality database for educational and research purposes. STUDY DESIGN: Development of a database. METHODS: A total of 296 high quality audio file recordings consisting of sustained /a/ and /i/ vowels and sentences from Consensus Auditory-Perceptual Evaluation of Voice were made in clinical environments. Nineteen experienced voice clinicians rated the audio samples using voice qualities from the Consensus Auditory-Perceptual Evaluation of Voice (without visual anchors) and GRBAS scales. RESULTS: The database includes samples of a wide range of voice quality severities across a wide range of speaker age and sex. Both inter- and intrarater reliabilities were established to be good for the database overall. CONCLUSIONS: The database is housed in the Mendeley Data online repository and is free for public use.

The Use of Auditory-Perceptual Training as a Research Method: A Summary Review.

OBJECTIVE: The purpose of this descriptive review was to document the current state of training to perform auditory-perceptual analysis as reported in the voice literature. METHODS: A review of the literature was performed. RESULTS: Thirty-six articles were included in the review. The theoretical basis of training, specific training methods employed, duration of training, stimuli used to train, vocal qualities trained, and the type of listeners used are reported. CONCLUSION: There is wide variation to training procedures used in research including auditory-perceptual evaluation of voice quality. In order to begin to discover how to best train listeners for research and clinical settings, attention to the training methods used in research is necessary. Further, these training methods must be explicitly acknowledged and described to allow for adequate evaluation of research findings, comparison across studies, and to determine for which populations results might be applicable. The conceptual framework outlined in this study is a starting point to review voice quality research and to design future studies for which auditory-perceptual evaluation is taught to listeners.

Learning Acoustic Assessment of Voice: An Action Research-Based SoTL Project.

The purpose of this action research, scholarship of teaching and learning study was to develop and integrate effective, student-informed teaching methods for voice acoustics instruction in a graduate speech-language pathology voice disorders course. An online focus group was used to determine what aspects of voice acoustics to include in the course as well as how these aspects were to be covered. A blend of face-to-face, technology-assisted, and practice-based teaching/learning activities resulted from the focused group and were employed in the course. An open-ended application question was used to measure student learning regarding application of voice acoustics to the understanding of human voice. A summative assessment of student recall and application of voice acoustics to speech-language pathology practice was also administered. Results showed significant, positive change pre- to post-course on the open-ended application question. Results of the summative assessment revealed that the largest distribution of student scores was in the 90%-100% range. While individual classes in different programs will differ, this project provides instructors with a baseline format from which to work to tailor acoustics instruction in their own classrooms.

Deep Learning for Voice Gender Identification: Proof-of-concept for Gender-Affirming Voice Care.

OBJECTIVES/HYPOTHESIS: The need for gender-affirming voice care has been increasing in the transgender population in the last decade. Currently, objective treatment outcome measurements are lacking to assess the success of these interventions. This study uses neural network models to predict binary gender from short audio samples of "male" and "female" voices. This preliminary work is a proof-of-concept for further work to develop an AI-assisted treatment outcome measure for gender-affirming voice care. STUDY DESIGN: Retrospective cohort study. METHODS: Two hundred seventy-eight voices from male and female speakers from the Perceptual Voice Qualities Database were used to train a deep neural network to classify voices as male or female. Each audio sample was mapped to the frequency domain using Mel spectrograms. To optimize model performance, we performed 10-fold cross validation of the entire dataset. The dataset was split into 80% training, 10% validation, and 10% test. RESULTS: Overall accuracy of 92% was obtained, both when considering the accuracy per spectrum and per patient metric. The accuracy of the model was higher for recognizing female voices (F1 score of 0.94) compared to male voices (F1 score of 0.87). CONCLUSIONS: This proof of concept study shows promising performance for further development of an AI-assisted tool to provide objective treatment outcome measurements for gender affirming voice care. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1611-E1615, 2021.

Competency-Based Education: Purposes and Promises.

Competency-based education (CBE) is described and the reported advantages to CBE are discussed. The need for a stronger evidence base to support CBE is acknowledged. As we continue to develop this evidence base, the practices of (1) focusing on outcomes and (2) being flexible in the time needed for trainee mastery of competencies hold promise and are consistent with good pedagogy. A model for clinical supervision that includes a focus on outcomes, as well as built-in acknowledgment of time for mastery, is briefly described.

Literature-Based Strategies for Clinical Fellow Mentorship.

In the field of communication sciences and disorders, some research and guidance exist on clinical fellowship supervision for the mentor; however, there is a dearth of literature on clinical fellowship supervision from the perspective of the clinical fellow. This article begins with why the clinical fellowship experience is necessary, and then discusses clinical fellow and mentor expectations and responsibilities, clinical fellow independence, mentor qualities, and issues related to the provision of feedback. The overall goal is to enhance clinical fellow mentors' knowledge base on the clinical fellowship experience through review of current literature on supervision and mentorship.

Lexical diversity and omission errors as predictors of language ability in the narratives of sequential Spanish-English bilinguals: a cross-language comparison.

PURPOSE: This study explored the utility of language sample analysis for evaluating language ability in school-age Spanish-English sequential bilingual children. Specifically, the relative potential of lexical diversity and word/morpheme omission as predictors of typical or atypical language status was evaluated. METHOD: Narrative samples were obtained from 48 bilingual children in both of their languages using the suggested narrative retell protocol and coding conventions as per Systematic Analysis of Language Transcripts (SALT; Miller & Iglesias, 2008) software. An additional lexical diversity measure, VocD, was also calculated. A series of logistical hierarchical regressions explored the utility of the number of different words, VocD statistic, and word and morpheme omissions in each language for predicting language status. RESULTS: Omission errors turned out to be the best predictors of bilingual language impairment at all ages, and this held true across languages. Although lexical diversity measures did not predict typical or atypical language status, the measures were significantly related to oral language proficiency in English and Spanish. CONCLUSION: The results underscore the significance of omission errors in bilingual language impairment while simultaneously revealing the limitations of lexical diversity measures as indicators of impairment. The relationship between lexical diversity and oral language proficiency highlights the importance of considering relative language proficiency in bilingual assessment.

Speech-language pathologists' informal learning in healthcare settings: behaviours and motivations.

The current research sought to identify the types of informal learning behaviours speech-language pathologists (SLPs) working in healthcare settings engage in as well as SLPs' motivations for engaging in informal learning. Twenty-four American Speech-Language-Hearing Association (ASHA)-certified SLPs participated in this qualitative study. Data collection consisted of computer-mediated interviews, online journaling, and a virtual focus group. These textual data were coded and collapsed into themes. All participant SLPs reported that they learned through collaboration (inter- and intra-disciplinary), worked with patients to learn through trial-and-error, and consulted non-peer-reviewed material on the internet as well as peer-reviewed research in order to learn informally in the workplace. Eighteen of the 24 participants reported being motivated to learn at work to meet a patient's need to meet therapy goals. Five of the 24 participants reported meeting their own personal learning needs was a motivating factor and 10 of the 24 participants reported learning informally to meet the needs of the healthcare organization/SLP profession. Results were compared to past research on SLPs' information retrieval behaviours. It was concluded that SLPs acknowledge their personal work-related gaps in knowledge and skills and actively seek to develop their knowledge and skill base through informal means.