Acoustic voice quality index as a potential tool for voice screening

A1 Journal article (refereed)

Internal Authors/Editors

Publication Details

List of Authors: Maryam Faham, Anne-Maria Laukkanen, Tero Ikävalko, Leena Rantala, Ahmed Geneid, Sofia Holmqvist-Jämsén, Kaarina Ruusuvirta, Sirpa Pirilä
Publisher: Elsevier
Publication year: 2020
Journal: Journal of Voice



To diminish the risk of voice disorders in people who are highly dependent
on their voices, such as teachers, vocal screening is important already
at the beginning of such individuals’ professional studies. A reliable,
specified screening tool is needed. The Acoustic Voice Quality Index
(AVQI) has been found to differentiate normal voices from abnormal
voices and to serve as a treatment outcome measure. This study
investigated whether AVQI could be a screening tool in combination with
auditory- and self-perception of the voice to discriminate normal from
slightly poor voices.

Type of Study



128 female teaching students (mean age 26.39 years, SD 9.80 years) with
no diagnosed voice disorders participated in this study. They read
aloud a text in Finnish, sustained the vowel /a:/, and filled the Voice
Handicap Index (VHI) questionnaire. Voice samples were recorded with an
AKG C544L headset microphone, iFocusrite soundcard, and Praat software
using a 44100 sample rate and 16-bit amplitude quantization. Five expert
voice therapists evaluated the samples to determine the grade of
dysphonia (G) using a scale of 0–0.5 (=normal), 0.5–1 (=mild), 1–2
(=moderate), and 2–3 (=severe). Three medial seconds of [a:] and the
first 31 syllables of the text were analyzed using AVQI script version
03.01 in Praat (5.3.55). The analysis gives one AVQI score per
participant (scale 0–10). The AVQI threshold of normal and disordered
voices for Finnish speakers is 1.83; a Gmean = 0.0–0.5 and
VHI score <19 were considered normal. Statistical analysis was done
using the receiver operating characteristic (ROC) curve, Spearman's
correlation coefficient, and the independent samples t test.


According to the AVQI results, the area under the curve (AROC)
was 0.554, which is fair. The Youden index gave a cutoff value of 0.30
with a sensitivity of 85% and a specificity of 81.1%. There were weak
but significant correlations between Gmean and AVQI and two AVQI parameters, smoothed cepstral peak prominence and harmonic-to-noise ratio (r = 0.27; −-0.24; −0.20, respectively; |P < 0.05); and between total VHI and AVQI score and cepstral peak prominence (r = 0.21; 0.20, respectively; P < 0.05). Furthermore, the AVQI scores differed significantly between the groups with a VHI total score <19 and ≥19.


did not differentiate between voices that had been perceptually judged
as normal or slightly abnormal, but a combination of perceptual
assessment in the form of AVQI and VHI could better screen slightly
deviant voices.

Last updated on 2020-30-09 at 02:12