Joana Revis

Objective voice analysis for dysphonic patients: a multiparametric protocol including acoustic and aerodynamic measurements.

The purpose was to determine the clinical value of a multiparametric objective voice evaluation protocol including acoustic and aerodynamic parameters measured mainly on a sustained /a/. This was done by comparison with perceptual analysis of continuous speech by a jury composed of 6 experienced listeners. Voice samples (continuous speech) from 63 male patients with dysphonia and 21 control subjects with normal voices were recorded and assesed by a jury of listeners. The jury was instructed to classify voice samples according to the G (overall dysphonia) component of the GRBAS score on a 4-point scale ranging from 0 for normal to 3 for severe dysphonia. Objective parameters were recorded on an EVA workstation. As usual with this type of system, parameters were measured mainly on a sustained /a/. Measured parameters included fundamental frequency (F0), intensity, jitter, shimmer, signal-to-noise ratio, Lyapunov coefficient (LC), oral airflow (OAF), maximum phonatory time (MPT), and vocal range (range). Estimated subglottic pressure (ESGP) was determined on a series of /pa/. Discriminant analysis was performed to detect correlation between jury classification and combinations of parameters. Results showed that a nonlinear combination of only six parameters (range, LC, ESGP, MPT, signal-to-noise ratio, and F0) allowed 86% concordance with jury classification. Discussion deals with the relative importance of the different objective parameters for discriminant analysis. Special emphasis is placed on two measurements rarely made in routine clinical workup, i.e., estimated subglottic pressure and Lyapunov coefficient.

Comparison of different voice samples for perceptual analysis.

Choice of voice sample material can influence perceptual judgments by a jury. The twofold purpose of this study was first to validate the pertinence of a sustained vowel for perceptual voice analysis in French speakers and second to test the hypothesis that use of only the stabilized portion of the vowel would lead to underestimation of dysphonia. Voice samples were recorded in 60 dysphonic patients and 20 normal controls. Three different sample materials were obtained for each subject, i.e. connected speech, a sustained vowel including both the initial and stable portion (complete sustained vowel), and a sustained vowel including only the stable portion (stabilized sustained vowel). The jury was composed of 7 experienced listeners. Jury consistency was measured as a percentage of agreeing judgments for the same subject. No difference in consistency was observed using the three sample materials. Judgments on stabilized sustained vowels were confirmed as less severe than judgments on connected speech. Judgments on complete sustained vowels were comparable to judgments on connected speech.

Correlation of Instrumental Voice Evaluation with Perceptual Voice Analysis Using a Modified Visual Analog Scale

Various rating scales have been used for perceptual voice analysis including ordinal (ORD) scales and visual analog (VA) scales. The purpose of this study was to determine the most suitable scale for studies using perceptual voice analysis as a gold standard for validation of objective analysis protocols. The study was carried out on 74 female voice samples from 68 dysphonic patients and 6 controls. A panel of 4 raters with experience in perceptual analysis was asked to score voices according to the G component (overall quality) of the GRBAS system. Two rating scales were used. The first was a conventional 4-point ORD scale. The second was a modified VA (mVA) scale obtained by transforming the VA scale into an ORD scale using a weighted conversion scheme. Objective voice evaluation was performed using the EVA® workstation. Objective measurements included acoustic, aerodynamic, and physiologic parameters as well as parameters based on nonlinear mathematics (e.g., Lyapunov coefficient). Instrumental measurements were compared with results of perceptual analysis using either the conventional ORD scale or mVA scale. Results demonstrate that correlation between perceptual and objective voice judgments is better using a mVA scale than a conventional ORD scale (concordance, 88 vs. 64%). Data also indicate that the mVA scale described herein improves the correlation between objective and perceptual voice analysis.

Objective Aerodynamic and Acoustic Measurement of Voice Improvement After Phonosurgery

Hypothesis: Objective analysis of the outcome of phonosurgery is needed to allow comparison of different surgical techniques or indications, or both. We tried to demonstrate that measurement of mean oral airflow during the production of a sustained vowel could be used in combination with acoustic measurements such as jitter or shimmer for assessment of voice improvement after phonosurgery.

Vocal flexibility and prosodic strategies in a professional impersonator

OBJECTIVES/HYPOTHESIS Voice imitation of a famous personality results in detection and reproduction of some vocal features, including spectral characteristics but also prosody, speech flow, or articulatory patterns. The objective of this study was to describe vocal flexibility in one of the best French impersonators and determine his strategies. STUDY DESIGN Prospective study. METHOD We have downloaded the recording of a political speech by former French President Jacques Chirac, who we have chosen for his very specific and recognizable voice. After transcription, we asked one professional impersonator and four control subjects to do several readings in their natural voice and in a spontaneous imitation task (ie, without listening to any of Chiracs recording). To facilitate the control subjects task, we made an additional recording after having them listen to the target sample. Using Praat freeware, we have compared several prosodic measurements taken on each sample: pitch, pitch range, articulatory speed, duration of pauses, and number of pauses. RESULTS Results showed significant modifications in the participants prosody and significant differences in the strategies used by the professional impersonator and the control group. CONCLUSION The professional impersonators imitation strategy lies in the reproduction of global characteristics and instant alignment of prosodic variations.

Influence de l’attaque sur l’analyse perceptive des dysphonies

Nous avons étudié l’analyse perceptive de la voix de 40 sujets dysphoniques et normaux avec la méthode GRBAS et par consensus de trois experts. Afin d’évaluer les effets de l’attaque sur l’évaluation du jury, nous lui avons présenté deux matériaux phonétiques pour chaque sujet: un /a/ tenu et le même /a/ tenu dont nous avons supprimé l’attaque. L’évaluation s’est déroulée à l’aveugle: les deux matériaux phonétiques étaient présentés au cours d’une même session dans un ordre aléatoire. Le jury d’écoute n’a pas remarqué la présence de /a/ tenus sans attaque. L’étude de l’influence de l’attaque sur la perception du jury a reposé sur le pourcentage de réponses identiques retrouvées sur les deux matériaux. Nos résultats ont montré que l’influence de l’attaque varie en fonction du niveau de dysphonie. L’attaque serait déterminante pour la discrimination des dysphonies intermédiaires (G1 et G2) et négligeable dans les cas de voix normales (G0) et de dysphonies sévères (G3).

Translation, Adaptation, and Preliminary Validation of Dacakis and Davies' “Transsexual Voice Questionnaire (Male to Female)” in French

Transgender MtF people (trans women) consult otorhinolaryngologists and vocologists with the aim of feminizing their voice and being consistently perceived as women. Treatment of these trans women always begins with a vocal assessment that is relatively unspecific as it was originally constructed for individuals with dysphonia. OBJECTIVES This study examines the subjective portion of the assessment and specifically the self-assessment questionnaire. There is no French-language questionnaire designed to identify the issues facing people who want voice feminization and quantify the impact of their voice disorder on their daily lives. We present a translation and adaption into French of the questionnaire developed by Dacakis et al [6]. METHODS This work follows the World Health Organization recommendations [12] regarding translation. Thirty-six Belgian and French trans women took part in this study. RESULTS The results show excellent repeatability and reliability, while the construct validity measures show that the items correlate with six areas of concern for trans women identified by Davies and Johnson [7] in a previous study. The domains are the following: effect of voice on ease of social interaction, effect of voice on emotions, relationship between voice and gender identity, effort and concentration required to produce voice, physical aspects of voice production, and pitch. Concurrent validity could not be measured owing to lack of sufficiently detailed stories. CONCLUSION The psychometric properties of the French version of the questionnaire are acceptable. The questionnaire can be used as is in daily clinical practice.