Nasalance, Nasal Airflow and Perceived Nasality in Carnatic Singers and Non-singers.

This study aims to compare the nasalance and nasal airflow between professional singers trained in Carnatic classical singing and non-singers. We also aimed to correlate perceived nasality with objective measurements of nasalance and nasal airflow. A total of 40 female participants (20 to 50 years) were involved in this study. The first group comprised 15 female professional Carnatic singers with a minimum of 10 years of classical training. The second group consisted of 25 non-singer females. These participants were compared on nasalance, nasal airflow and perceived nasality across three sets of stimuli (vowels, oral non-words, and nasal non-words) and three pitch-conditions (low, mid, and high). Correlations were also made between objective measures of nasalance and nasal airflow and perceived nasality. Mixed ANOVA showed a significant (P < 0.05) interaction in nasalance between pitch conditions and groups. Group differences were also observed in the nasalance scores of vowels, oral non-words, nasal non-words. There was a significant difference (P < 0.05) in nasalance with ascending pitch in singers and non-singers. A comparison of aerodynamic analysis of vowels, oral non-words, and nasal non-words between singers and non-singers suggested that nasal airflow was higher in singers. Perceptual nasality was significantly lower (P < 0.05) in Carnatic singers than non-singers. Correlations between objective measures of nasalance and nasal airflow and perceived nasality were not observed. Despite an increased airflow, nasality was lower in trained Carnatic singers than non-singers. Current findings suggest that vocal training impacts nasalance, nasal airflow and perceived nasality.

Effect of Anchor Voices and Listener Expertise on Auditory-Perceptual Judgments of Voice Quality Using the GRBAS Scale.

OBJECTIVES: This study aimed to determine the effect of anchor voices and listener expertise on auditory-perceptual judgment of voice quality using the GRBAS scale. METHODS: This study utilized a modified crossover design with counterbalancing. Anchor voices for each parameter of the GRBAS scale were chosen based on expert consensus. A total of 28 participants were divided into three groups based on their expertise. The first and second groups consisted of nine undergraduate (UG) and nine postgraduate (PG) students of speech-language pathology. The third group consisted of 10 practicing speech-language pathologists (SLPs). These participants carried out auditory-perceptual judgment of 60 dysphonic voice samples under two counterbalanced experimental conditions (with and without anchor voices). Each of the three groups was randomly divided into two subgroups to balance the experimental conditions. Interrater reliability for each subgroup was calculated using Krippendorff's α and 95% confidence intervals. RESULTS: For all the groups involved in the study, interrater reliability was higher when anchor voices aided perceptual judgment for most parameters of the GRBAS scale. For the different parameters of GRBAS, interrater reliability for the UG group varied from fair (20 < α ≤ 40) to moderate (40 < α ≤ 60). In contrast, it was fair (20 < α ≤ 40) to substantial (60 < α ≤ 80) for the PG group and moderate (40 < α ≤ 60) to substantial (60 < α ≤ 80) for the SLP group. Variations in reliability were the least for the SLP group compared to the UG and PG groups. However, there were overlaps in interrater reliability between the groups, as revealed by the 95% confidence intervals. CONCLUSIONS: Anchor voices help improve the auditory-perceptual judgment of voice quality, especially interrater reliability. Listener expertise is also shown to influence the interrater reliability of auditory-perceptual judgment of voice quality.

Psychometric Properties of the Voice Handicap Index-10 in Kannada.

OBJECTIVES: This study aimed to derive the 10-item voice handicap index in the Kannada language (VHI-K10) from the existing VHI-30 in Kannada (VHI-K30). We also aimed to examine several psychometric properties of the newly derived VHI-K10, such as internal consistency, reliability, concurrent validity, discriminant validity, and diagnostic accuracy. METHODS: Initially, VHI-K10 was derived from the existing VHI-K30 through item reduction, consistent with the recommendations for item reduction of the voice handicap index. This newly derived VHI-K10 was administered to 273 individuals (199 individuals with dysphonia and 74 individuals with normal voice quality). We also obtained phonation and reading samples from the participants. The obtained data were subjected to appropriate statistical analysis to determine several psychometric properties. RESULTS: The newly derived VHI-K10 was found to have a strong internal consistency (Cronbach's α = 0.93). We also found strong test-retest reliability for VHI-K10, with an intraclass correlation coefficient of 0.933. There was a strong statistically significant correlation between the VHI-K10 and the existing VHI-K30 for both individuals with dysphonia (ρ = 0.924, P < 0.001) and individuals with normal voice quality (ρ = 0.798, P < 0.001). However, the correlation of VHI-K10 with the auditory-perceptual measure of GRBAS was fair (ρ = 0.353, P < 0.001) for individuals with dysphonia and was not statistically significant for individuals with normal voice quality. Further, the diagnostic accuracy of VHI-K10 was found to be excellent, with an area under the curve (AROC) value of 0.926 with a cut-off point of ≥6.5, which was slightly superior to that of VHI-K30 (AROC = 0.909, cut-off point ≥21.5). CONCLUSIONS: The shortened 10-item version of the voice handicap index in Kannada is consistent with versions of the VHI-10 in other languages. This version of the VHI-10 in Kannada is found to be a robust tool with strong psychometric properties.

Prevalence of Voice Problems and Associated Risk Factors Among Tamil-Speaking Imams.

PURPOSE: Voice of Professional Voice Users (PVUs) are of particular interest to practicing Speech-Language Pathologists. There is a dearth of studies concerning the prevalence of voice disorders and the associated risk factors among Tamil-speaking Imams. We address this research gap using non-experimental survey research. METHODS: A questionnaire was framed by reviewing earlier literature. The derived questionnaire was administered to one hundred Tamil-speaking Imams actively involved in religious service in Tamil Nadu. We analyzed the obtained responses quantitatively and qualitatively. We also examined the effect of age on the prevalence of voice disorders and associated risk factors. RESULTS: Based on survey responses, the career prevalence of voice problems among Tamil-speaking Imams was as high as 89%, and the point prevalence was 64%. The general health status of the Imams were good. However, vocal health was not satisfactory. This study identified several factors that contribute to voice problems, such as constant use of loud voice, acid reflux, unhealthy vocal habits, and insufficient hydration. A positive aspect observed during this study was the absence of smoking and consumption of alcohol among Imams. Even though the Imams presented good awareness of the voice production mechanism, they reported not seeking medical help when facing a voice problem. Current findings report a minimal impact of age-related differences on associated risk factors for voice disorders among the Imams. CONCLUSIONS: Voice disorders are prevalent among Tamil-speaking Imams. Several risk factors leading to voice disorders among these individuals need to be addressed.

Effect of Voice Projection Training on Acoustic and Auditory-Perceptual Characteristics of Voice in Tamil-Speaking Imams.

BACKGROUND: Imams are professional voice users at risk of developing voice problems. Speech-Language Pathologists need to provide intervention programs to target risk factors associated with voice disorders and improve the voice quality of Imams. However, studies examining the effect of vocal training for Imams are limited in the literature. OBJECTIVES: This study attempted to document the acoustic and auditory-perceptual changes in the voices of Tamil-speaking Imams with a voice projection training program. METHODS: Eleven Tamil-speaking Imams participated in a voice projection training program. Voice samples were recorded at four specific time points before, during, and after the voice projection training. These recordings were subjected to various acoustic analyses (AVQI, Dr Speech, and MDVP) and auditory-perceptual analysis (CAPE-V) to determine the changes with the voice projection training. RESULTS: Auditory-Perceptual analysis carried out by five experienced SLPs suggested significant changes in the voice quality of the participants with voice projection training. High inter-rater reliability was observed across the judges as well. We observed positive changes in several acoustic measures indicated within AVQI, Dr Speech, and MDVP software. These primarily included changes in fundamental frequency, noise related measures (HNR, SNR), and perturbation measures. CONCLUSION: Voice projection training positively impacts the acoustic and auditory-perceptual characteristics of the voices of Tamil-speaking Imams.

Validation of Acoustic Breathiness Index (ABI) in the South Indian Population.

BACKGROUND: Acoustic Breathiness Index (ABI) is an acoustic model which equates to the auditory-perceptual (A-P) measure of breathiness. Globally, ABI has been validated in multiple languages. To date, empirical studies validating ABI in the South Indian population have not been carried out. Moreover, there is only minimal evidence on the impact of language and gender on ABI. OBJECTIVES: This study attempted to validate ABI in languages of Malayalam and Kannada with "B" and "G" of GRBAS. The authors also examined the influence of language and gender on ABI. METHODS: The authors retrospectively analyzed a dataset consisting of 160 voice samples (91 normophonic and 69 dysphonic). Five speech-language pathologists perceptually evaluated these samples on the GRBAS scale. PRAAT software was used to calculate ABI for each voice sample. The authors also determined the effects of language and gender on ABI. Following this, ABI's concurrent validity and diagnostic accuracy were examined relating to "B" and "G" of the GRBAS scale. RESULTS: The judges reached a moderate agreement on the perceptual evaluation of voice quality. The authors observed neither language nor gender differences in ABI. The concurrent validity of ABI was strong (r = 0.761) when correlated against "B". Further, evaluations revealed that an ABI value of >3.66 could distinguish between breathy and non-breathy voice samples with an area under the curve of 0.816 (Sensitivity = 61.73%; Specificity = 94.93%). On the other hand, the concurrent validity of ABI in correlation with "G" did not yield the optimal result. CONCLUSIONS: ABI is a valid acoustic tool for identifying breathiness in the languages of Malayalam and Kannada. ABI correlates better with "B" than "G" on the GRBAS scale. ABI is independent of language and gender.

Acoustic Voice Quality Index (AVQI) in the Measurement of Voice Quality: A Systematic Review and Meta-Analysis.

INTRODUCTION: Acoustic Voice Quality Index (AVQI) is a multiparametric construct of voice quality recognized for its clinical and research applications around the globe. This study aimed to review the validity and diagnostic accuracy of AVQI (v02&03) and determine the effects of age and gender. METHODS: This is a systematic review and meta-analysis registered with the PROSPERO registry. The authors searched two databases (PubMed and Cochrane Library database) for relevant studies. Studies selected for the systematic review were grouped based on study objectives. To determine the quality of the selected studies, the authors utilized the QUADAS-2 tool. RESULTS: Meta-analysis of seven studies on AVQIv02 revealed a diagnostic threshold ranging from 2.72 to 3.33 for AVQIv02. In comparison, eight studies investigating AVQIv03 suggested a diagnostic threshold ranging from 1.33 to 3.15 for AVQIv03. Altogether, these studies demonstrated a pooled sensitivity and specificity of 0.85 and 0.92 for AVQIv02 and 0.82 and 0.92 for AVQIv03. The Area under the Curve was slightly better for AVQIv03 (0.94) than AVQIv02 (0.92). Three studies investigating the effect of age and gender on AVQI had a consensus that AVQI is independent of gender. However, findings were contradictory about the impact of age on AVQI. CONCLUSIONS: AVQI is found to be a valid tool for the assessment of voice quality. AVQIv03 is slightly better than AVQIv02 in its diagnostic accuracy. AVQI is independent of gender. Because of the contradictory evidence, additional research on the effects of age on AVQI is necessary.

Comparison and Validation of Acoustic Voice Quality Index Version 2 and Version 3 among South Indian Population.

BACKGROUND: Acoustic Voice Quality Index (AVQI) has emerged in the recent past as a robust multiparametric voice quality evaluation tool. Two versions of AVQI derived using the program PRAAT have found extensive clinical and research applications. These versions have been validated in several languages around the world. However, no research reports are available on validation of AVQI in the South Indian population. Further, studies comparing the performance of the two versions of AVQI are limited in the literature. OBJECTIVES: This study was designed to validate and compare the two versions of AVQI (AVQIv02.02 and AVQIv03.01) in South Indian languages (Malayalam and Kannada). METHODS: A retrospective analysis of previously recorded voice samples was carried out on a total of 160 (91 normophonic and 69 dysphonic) voice samples. These samples were perceptually rated on a GRBAS scale by five experienced speech-language pathologists. Standardized Syllable Number (SSN) necessary to derive AVQIv03.01 was computed. Following this, these samples were analyzed to obtain the AVQIv02.02 and AVQIv03.01. The concurrent validity and diagnostic accuracy of these measures were then examined and compared. RESULTS: A moderate agreement was obtained across the judges on perceptual evaluation of voice quality. SSN in Malayalam and Kannada languages were identified to be 29 and 25 syllables respectively. Language differences were not observed on both versions of AVQI. The concurrent validity of AVQIv03.01 (r = 0.788) was superior to that of AVQIv02.02 (r = 0.655). Further, the threshold of differentiating normophonic and dysphonic samples were determined to be >3.45 for AVQIv02.02 and >2.45 for AVQIv03.01. CONCLUSIONS: AVQIv03.01 is superior to AVQIv02.02 in terms of its diagnostic accuracy and concurrent validity. Current findings also extend the application of AVQI as a robust tool for the evaluation of voice characteristics to the South Indian population.

Effect of Age and Gender on Acoustic Voice Quality Index Across Lifespan: A Cross-sectional Study in Indian Population.

BACKGROUND: The human voice is dynamic and changes throughout the life span. The effects of age and gender on acoustical measures of voice quality have been well established. Assessment of voice quality using multiparametric measures has been recommended over singleton measures. Acoustic Voice Quality Index (AVQI), which is a multiparametric measure of voice quality, has gained popularity in the recent past. Studies investigating the effect of age on AVQI are very limited especially across the life span. The majority of the studies involving AVQI have been carried out in the European and East Asian populations. There is a dearth of studies involving AVQI in the Indian population. OBJECTIVES: The present study was taken up to investigate the effects of age, gender on the AVQI version 02.02 in the Indian population. The present study also aimed to establish reference data for AVQI in the Indian population. METHOD: AVQI and its constituent parameters were obtained from a total of 200 participants (50 pediatrics, 100 adults and 50 older adults) with an equal number of males and females. Multivariate Analysis of Variance was carried out to check the significant differences across age group and gender for AVQI and its constituent parameters along with interaction effects. RESULTS: AVQI values obtained from the Indian population were slightly higher than those reported in the earlier literature for the European and East Asian populations. AVQI obtained by pediatric and older adult groups was found to be significantly higher when compared to that of adults. Significant age effects were also demonstrated by AVQI. The values of AVQI were found to be more stable in adults than in pediatric and older adult groups. AVQI values did not differ significantly across older adult and pediatric groups. Gender effects were not observed in AVQI. CONCLUSION: This is the first study to report changes in AVQI across the lifespan in the Indian population. The present study adds on to the literature the reference measures of AVQI for the Indian population. Findings of the present study suggest that age can have an impact on AVQI v.02.02 values; even though it is independent of gender.