Auditory-Perceptual and Acoustic Assessment in Measuring Dysphonia Severity of Vocal Fold Nodules

성대결절 환자의 음성장애에 대한 청지각적 및 음향학적 평가

  • 김근효 (부산대학교병원 이비인후과 음성언어치료실) ;
  • 권순복 (부산대학교 인문대학 언어정보학과)
  • Received : 2017.10.11
  • Accepted : 2017.11.15
  • Published : 2018.01.28


The purpose of this study was to investigate the relationship between the differences in the acoustic measurements (AVQI) and the auditory-perceptual assessments (GRBAS, CAPE-V) of the normal and vocal fold nodules. For this purpose, Total 335 voice samples were analyzed acoustically and three raters performed auditory-perceptual assessments. in the results, AVQI, G, and OS scores of the normal group were lower than those of the vocal fold nodules group. The correlations between the G scale and the OS scale were highly correlated, and the correlation between the AVQI, and auditory-perceptual results (G and OS) was also high value. The threshold values for discriminating AVQI, G, and OS between the two groups were ${\leq}4.06$, ${\leq}1$, and ${\leq}26$, respectively, and the predictive diagnostic power was 0.840, 0.860, and 0.848. In conclusion, AVQI and auditory-perceptual evaluation can improve potentiality the screening of vocal fold nodules and help to determine the diagnosis and treatment plan of voice disorders.


Vocal Fold Nodules;GRBAS;CAPE-V;Praat


  1. K. Verdolini-Marston, M. Sandage, and I. R. Titze, "Effect of hydration treatments on laryngeal nodules and polyps and related voice measures," Journal of Voice, Vol.8, No.1, pp.30-47, 1994.
  2. 권순복, 김용주, 조철우, 전계록, 이병주, 왕수건, "성대결절 환자에서 액센트 치료법의 효과," 음성과학, 제8권, 제4호, pp.87-98, 2001.
  3. 김성태, 정옥란, "다중음성치료기법 (SK-MVTT)이 성대결절 환자의 음성개선에 미치는 효과: 액센트 기법과의 비교 연구," 음성과학, 제11권, 제4호, pp.101-120, 2004.
  4. 이옥분, 김소연, "음성장애 청지각적 평가를 위한 등간척도법 비교," 언어치료연구, 제18권, pp.1-15, 2009.
  5. 이명순, 신혜정, "모음과 연속 구어에 대한 청지각평가와 음향학적 분석에 대한 비교," 언어치료연구, 제19권, pp.17-37, 2010.
  6. M. Hirano, "Psyco-acoustic evaluation of voice," Clinical Examination of Voice: Disorders of Human Communication, pp.81-84, 1981.
  7. S. N. Awan, N. Roy, M. E. Jett, G. S. Meltzner, and R. E. Hillman, "Quantifying dysphonia severity using a spectral / cepstral-based acoustic index: Comparisons with auditoryperceptual judgements from the CAPE-V," Clinical Linguistics & Phonetics, Vol.24, pp.742-758, 2010.
  8. P. Carding, E. Carlson, R. Epstein, L. Mathieson, and C. Shewell, "Formal perceptual evaluation of voice quality in the United Kingdom," Logopedics Phoniatrics Vocology, Vol.25, No.3, pp.133-138, 2000.
  9. S. N. Awan and L. L. Lawson, "The effect of anchor modality on the reliability of vocal severity ratings," Journal of Voice, Vol.23, No.3, pp.341-352, 2009.
  10. B. Barsties, M. Beers, L. Ten Cate, K. Van Ballegooijen, L. Braam, M. De Groot, M. Van Der Kant, C. Kruitwagen, and Y. Maryn, "The effect of visual feedback and training in auditory-perceptual judgment of voice quality," Logopedics Phoniatrics Vocology, Vol.42, No.1, pp.1-8, 2017.
  11. Y. Maryn, P. Corthals, P. Van Cauwenberge, N. Roy, and M. De Bodt, "Toward improved ecological validity in the acoustic measurement of overall voice quality: Combining continuous speech and sustained vowels," Journal of Voice, Vol.24, No.5, pp.540-555, 2010.
  12. Y. Maryn, M. De Bodt, and N. Roy, "The Acoustic Voice Quality Index: toward improved treatment outcomes assessment in voice disorders," Journal of Communication Disorders, Vol.43, No.3, pp.161-174, 2010.
  13. B. Barsties and Y. Maryn, "Der Acoustic Voice Quality Index in Deutsch," HNO, Vol.60, No.8, pp.715-720, 2012.
  14. Y. Maryn, M. De Bodt, B. Barsties, and N. Roy, "The value of the Acoustic Voice Quality Index as a measure of dysphonia severity in subjects speaking different languages," European Archives of Oto-Rhino-Laryngology, Vol.271, No.6, pp.1609-1619, 2014.
  15. E. Kankare, B. Barsties, Y. Maryn, I. Ilomäki, A. Laukkanen, J. Tyrmi, L. Rantala, M. Asikainen, E. Rorarius, and M. Siirila, "A preliminary study of the Acoustic Voice Quality Index in Finnish speaking population," PEVOC - Pan-European Voice Conference, p.218, 2015.
  16. K. Hosokawa, B. Barsties, T. Iwahashi, M. Iwahashi, C. Kato, S. Iwaki, H. Sasai, A. Miyauchi, N. Matsushiro, and H. Inohara, "Validation of the acoustic voice quality index in the Japanese language," Journal of Voice, Vol.31, No.2, pp.260.e1-260.e9, 2017.
  17. Y. Maryn, H. Kim, and J. Kim, "Auditory-perceptual and acoustic methods in measuring dysphonia severity of Korean speech," Journal of Voice, Vol.30, No.5, pp.587-594, 2016.
  18. D. R. Ingrisano, C. K. Perry, and K. R. Jepson, "Environmental noise: a threat to automatic voice analysis," American Journal of Speech-Language Pathology, Vol.7, No.1, pp.91-96, 1998.
  19. D. D. Deliyski, H. S. Shaw, and M. K. Evans, "Adverse effects of environmental noise on acoustic voice quality measurements," Journal of Voice, Vol.19, No.1, pp.15-28, 2005.
  20. Y. Maryn and D. Weenink, "Objective Dysphonia Measures in the Program Praat: Smoothed Cepstral Peak Prominence and Acoustic Voice Quality Index," Journal of Voice, Vol.29, No.1, pp.35-43, 2015.
  21. F. L. Wuyts, M. S. De Bodt, and P. H. Van de Heyning, "Is the reliability of a visual analog scale higher than an ordinal scale? An experiment with the GRBAS scale for the perceptual evaluation of dysphonia," Journal of Voice, Vol.13, No.4, pp.508-517, 1999.
  22. M. P. Karnell, S. D. Melton, J. M. Childes, T. C. Coleman, S. A. Dailey, and H. T. Hoffman, "Reliability of clinician-based (GRBAS and CAPE-V) and patient-based (V-RQOL and IPVI) documentation of voice disorders," Journal of Voice, Vol.21, No.5, pp.576-590, 2007.
  23. K. Nemr, M. Simoes-Zenari, G. F. Cordeiro, D. Tsuji, A. I. Ogawa, M. T. Ubrig, and M. H. M. Menezes, "GRBAS and Cape-V scales: high reliability and consensus when applied at different times," Journal of Voice, Vol.26, No.6, pp.812.e17-812.e22, 2012.
  24. V. Uloza, T. Petrauskas, E. Padervinskis, N. Ulozaitė, B. Barsties, and Y. Maryn, "Validation of the acoustic voice quality index in the Lithuanian language," Journal of Voice, Vol.31, No.2, pp.257.e1-257.e11, 2017.
  25. 김정완, "뇌졸중 환자의 말, 언어장애 선별에 대한 검사자간 신뢰도 및 훈련효과," 한국콘텐츠학회논문지, 제11권, 제9호, pp.407-413, 2011.
  26. V. Reynolds, A. Buckland, J. Bailey, J. Lipscombe, E. Nathan, S. Vijayasekaran, R. Kelly, Y. Maryn, and N. French, "Objective assessment of pediatric voice disorders with the acoustic voice quality index," Journal of Voice, Vol.26, No.5, pp.672.e1-672.e7, 2012.
  27. B. Barsties and Y. Maryn, "External validation of the Acoustic Voice Quality Index version 03.01 with extended representativity," Annals of Otology, Rhinology & Laryngology, Vol.125, No.7, pp.571-583, 2016.
  28. L. Eskenazi, D. G. Childers, and D. M. Hicks, "Acoustic correlates of vocal quality," Journal of Speech, Language, and Hearing Research, Vol.33, No.2, pp.298-306, 1990.
  29. S. N. Awan, N. Roy, and C. Dromey, "Estimating dysphonia severity in continuous speech: application of a multi-parameter spectral/cepstral model," Clinical Linguistics & Phonetics, Vol.23, No.11, pp.825-841, 2009.
  30. S. Y. Lowell, R. H. Colton, R. T. Kelley, and Y. C. Hahn, "Spectral- and cepstral-based measures during continuous speech: capacity to distinguish dysphonia and consistency within a speaker," Journal of Voice, Vol.25, No.5, pp.e223-232, 2011.
  31. S. N. Awan, N. Roy, and S. M. Cohen, "Exploring the relationship between spectral and cepstral measures of voice and the Voice Handicap Index (VHI)," Journal of Voice, Vol.28, No.4, pp.430-439, 2014.
  32. 최예린, "한국 남성의 단모음 [아, 에, 이, 오, 우]에 대한 음향음성학적 기반연구," 한국콘텐츠학회논문지, 제10권, 제6호 pp.373-377, 2010.