Publications

    K. L. Marks, J. Z. Lin, A. Fox, L. E. Toles, and D. D. Mehta, “Impact of non-modal phonation on estimates of subglottal pressure from neck-surface acceleration in healthy speakers,” Journal of Speech, Language, and Hearing Research, vol. 62, no. 9, pp. 3339-3358, 2019. Publisher's VersionAbstract

    Purpose

    The purpose of this study was to evaluate the effects of nonmodal phonation on estimates of subglottal pressure (Ps) derived from the magnitude of a neck-surface accelerometer (ACC) signal and to confirm previous findings regarding the impact of vowel contexts and pitch levels in a larger cohort of participants.

    Method

    Twenty-six vocally healthy participants (18 women, 8 men) were asked to produce a series of p-vowel syllables with descending loudness in 3 vowel contexts (/a/, /i/, and /u/), 3 pitch levels (comfortable, high, and low), and 4 elicited phonatory conditions (modal, breathy, strained, and rough). Estimates of Ps for each vowel segment were obtained by averaging the intraoral air pressure plateau before and after each segment. The root-mean-square magnitude of the neck-surface ACC signal was computed for each vowel segment. Three linear mixed-effects models were used to statistically assess the effects of vowel, pitch, and phonatory condition on the linear relationship (slope and intercept) between Ps and ACC signal magnitude.

    Results

    Results demonstrated statistically significant linear relationships between ACC signal magnitude and Ps within participants but with increased intercepts for the nonmodal phonatory conditions; slopes were affected to a lesser extent. Vowel and pitch contexts did not significantly affect the linear relationship between ACC signal magnitude and Ps.

    Conclusion

    The classic linear relationship between ACC signal magnitude and Ps is significantly affected when nonmodal phonation is produced by a speaker. Future work is warranted to further characterize nonmodal phonatory characteristics to improve the ACC-based prediction of Ps during naturalistic speech production.

    A. J. Ortiz, et al., “Automatic speech and singing classification in ambulatory recordings for normal and disordered voices,” The Journal of the Acoustical Society of America, vol. 146, no. 1, pp. EL22–EL27, 2019. Publisher's VersionAbstract
    Ambulatory voice monitoring is a promising tool for investigating phonotraumatic vocal hyperfunction (PVH), associated with the development of vocal fold lesions. Since many patients with PVH are professional vocalists, a classifier was developed to better understand phonatory mechanisms during speech and singing. Twenty singers with PVH and 20 matched healthy controls were monitored with a neck-surface accelerometer–based ambulatory voice monitor. An expert-labeled ground truth data set was used to train a logistic regression on 15 subject-pairs with fundamental frequency and autocorrelation peak amplitude as input features. Overall classification accuracy of 94.2% was achieved on the held-out test set.
    D. D. Mehta, V. M. Espinoza, M. Zanartu, J. H. Van Stan, and R. E. Hillman, “The difference between first and second harmonic amplitudes correlates between glottal airflow and neck-surface accelerometer signals during phonation,” The Journal of the Acoustical Society of America, vol. 145, no. 5, pp. EL386–EL392, 2019. Publisher's VersionAbstract
    Miniature high-bandwidth accelerometers on the anterior neck surface are used in laboratory and ambulatory settings to obtain vocal function measures. This study compared the widely applied L1–L2 measure (historically, H1–H2)—the difference between the log-magnitude of the first and second harmonics—computed from the glottal airflow waveform with L1–L2 derived from the raw neck-surface acceleration signal in 79 vocally healthy female speakers. Results showed a significant correlation (r = 0.72) between L1–L2 values estimated from both airflow and accelerometer signals, suggesting that raw accelerometer-based estimates of L1–L2 may be interpreted as reflecting glottal physiological parameters and voice quality attributes during phonation.
    J. P. Cortés, et al., “Ambulatory assessment of phonotraumatic vocal hyperfunction using glottal airflow measures estimated from neck-surface acceleration,” PLoS One, vol. 13, no. 12, pp. e0209017, 2018. Publisher's VersionAbstract
    Phonotraumatic vocal hyperfunction (PVH) is associated with chronic misuse and/or abuse of voice that can result in lesions such as vocalfold nodules. The clinical aerodynamic assessment of vocal function has been recently shown to differentiate between patients with PVH and healthy controls to provide meaningful insight into pathophysiological mechanisms associated with these disorders. However, all current clinical assessment of PVH is incomplete because of its inability to objectively identify the type and extent of detrimental phonatory function that is associated with PVH during daily voice use. The current study sought to address this issue by incorporating, for the first time in a comprehensive ambulatory assessment, glottal airflow parameters estimated from a neck-mounted accelerometer and recorded to a smartphone-based voice monitor. We tested this approach on 48 patients with vocal fold nodules and 48 matched healthy-control subjects who each wore the voice monitor for a week. Seven glottal airflow features were estimated every 50 ms using an impedance-based inverse filtering scheme, and seven high-order summary statistics of each feature were computed every 5 minutes over voiced segments. Based on a univariate hypothesis testing, eight glottal airflow summary statistics were found to be statistically different between patient and healthy-control groups. L1-regularized logistic regression for a supervised classification task yielded a mean (standard deviation) area under the ROC curve of 0.82 (0.25) and an accuracy of 0.83 (0.14). These results outperform the state-of-the-art classification for the same classification task and provide a new avenue to improve the assessment and treatment of hyperfunctional voice disorders.
    J. H. Van Stan, M. Maffei, M. L. V. Masson, D. D. Mehta, J. A. Burns, and R. E. Hillman, “Self-ratings of vocal status in daily life: Reliability and validity for patients with vocal hyperfunction and a normative group,” American Journal of Speech-Language Pathology, vol. 26, no. 4, pp. 1167-1177, 2017. Publisher's VersionAbstract

    PURPOSE:

    The aim of this study was to establish reliability and validity for self-ratings of vocal status obtained during the daily activities of patients with vocal hyperfunction (VH) and matched controls.

    METHOD:

    Eight-four patients with VH and 74 participants with normal voices answered 3 vocal status questions-difficulty producing soft, high-pitched phonation (D-SHP); discomfort; and fatigue-on an ambulatory voice monitor at the beginning, 5-hr intervals, and the end of each day (7 total days). Two subsets of the patient group answered the questions during a 2nd week after voice therapy (29 patients) or laryngeal surgery (16 patients).

    RESULTS:

    High reliability resulted for patients (Cronbach's α = .88) and controls (α = .95). Patients reported higher D-SHP, discomfort, and fatigue (Cohen's d = 1.62-1.92) compared with controls. Patients posttherapy and postsurgery reported significantly improved self-ratings of vocal status relative to their pretreatment ratings (d = 0.70-1.13). Within-subject changes in self-ratings greater than 20 points were considered clinically meaningful.

    CONCLUSIONS:

    Ratings of D-SHP, discomfort, and fatigue have adequate reliability and validity for tracking vocal status throughout daily lifein patients with VH and vocally healthy individuals. These questions could help investigate the relationship between vocal symptom variability and putative contributing factors (e.g., voice use/rest, emotions).

    J. H. Van Stan, D. D. Mehta, D. Sternad, R. Petit, and R. E. Hillman, “Ambulatory voice biofeedback: Relative frequency and summary feedback effects on performance and retention of reduced vocal intensity in the daily lives of participants with normal voices,” Journal of Speech, Language, Hearing Research, vol. 60, no. 4, pp. 853–864, 2017. Publisher's VersionAbstract

     

    Purpose Ambulatory voice biofeedback has the potential to significantly improve voice therapy effectiveness by targeting carryover of desired behaviors outside the therapy session (i.e., retention). This study applies motor learning concepts (reduced frequency and delayed, summary feedback) that demonstrate increased retention to ambulatory voice monitoring for training nurses to talk softer during work hours.

    Method Forty-eight nurses with normal voices wore the Voice Health Monitor (Mehta, Zañartu, Feng, Cheyne, & Hillman, 2012) for 6 days: 3 baseline days, 1 biofeedback day, 1 short-term retention day, and 1 long-term retention day. Participants were block-randomized into 3 different biofeedback groups: 100%, 25%, and Summary. Performance was measured in terms of compliance time below a participant-specific vocal intensity threshold.

    Results All participants exhibited a significant increase in compliance time (Cohen's d = 4.5) during biofeedback days compared with baseline days. The Summary feedback group exhibited statistically smaller performance reduction during both short-term (d = 1.14) and long-term (d = 1.04) retention days compared with the 100% feedback group.

    Conclusions These findings suggest that modifications in feedback frequency and timing affect retention of a modified vocal behavior in daily life. Future work calls for studying the potential beneficial impact of ambulatory voice biofeedback in participants with behaviorally based voice disorders.

     

    J. H. Van Stan, et al., “Integration of motor learning principles into real-time ambulatory voice biofeedback and example implementation via a clinical case study with vocal fold nodules,” American Journal of Speech-Language Pathology, vol. 26, no. 1, pp. 1-10, 2017. Publisher's VersionAbstract

     

    Purpose Ambulatory voice biofeedback (AVB) has the potential to significantly improve voice therapy effectiveness by targeting one of the most challenging aspects of rehabilitation: carryover of desired behaviors outside of the therapy session. Although initial evidence indicates that AVB can alter vocal behavior in daily life, retention of the new behavior after biofeedback has not been demonstrated. Motor learning studies repeatedly have shown retention-related benefits when reducing feedback frequency or providing summary statistics. Therefore, novel AVB settings that are based on these concepts are developed and implemented.

    Method The underlying theoretical framework and resultant implementation of innovative AVB settings on a smartphone-based voice monitor are described. A clinical case study demonstrates the functionality of the new relative frequency feedback capabilities.

    Results With new technical capabilities, 2 aspects of feedback are directly modifiable for AVB: relative frequency and summary feedback. Although reduced-frequency AVB was associated with improved carryover of a therapeutic vocal behavior (i.e., reduced vocal intensity) in a patient post-excision of vocal fold nodules, causation cannot be assumed.

    Conclusions Timing and frequency of AVB schedules can be manipulated to empirically assess generalization of motor learning principles to vocal behavior modification and test the clinical effectiveness of AVB with various feedback schedules.

     

    A. S. Fryd, J. H. Van Stan, R. E. Hillman, and D. D. Mehta, “Estimating subglottal pressure from neck-surface acceleration during normal voice production,” Journal of Speech, Language, and Hearing Research, vol. 59, no. 6, pp. 1335-1345, 2016. Publisher's VersionAbstract

    Purpose The purpose of this study was to evaluate the potential for estimating subglottal air pressure using a neck-surface accelerometer and to compare the accuracy of predicting subglottal air pressure relative to predicting acoustic sound pressure level (SPL).

    Method Indirect estimates of subglottal pressure (Psg′) were obtained from 10 vocally healthy speakers during loud-to-soft repetitions of 3 different /p/–vowel gestures (/pa/, /pi/, /pu/) at 3 pitch levels in the modal register. Intraoral air pressure, neck-surface acceleration, and radiated acoustic pressure were recorded, and the root-mean-square amplitude of the acceleration signal was correlated with Psg′ and SPL.

    Results The coefficient of determination between accelerometer level and Psg′ was high when data were pooled from all vowel and pitch contexts for each participant (r 2 = .68–.93). These relationships were stronger than corresponding relationships between accelerometer level and SPL (r 2 = .46–.81). The average 95% prediction interval for estimating Psg′ using accelerometer level was ±2.53 cm H2O, ranging from ±1.70 to ±3.74 cm H2O across participants.

    Conclusions Accelerometer signal amplitude correlated more strongly with Psg′ than with SPL. Future work is warranted to investigate the robustness of the relationship in nonmodal voice qualities, individuals with voice disorders, and accelerometer-based ambulatory monitoring of subglottal pressure.

    D. Mehta, J. Van Stan, and R. Hillman, “Relationships between vocal function measures derived from an acoustic microphone and a subglottal neck-surface accelerometer,” IEEE/ACM Transactions on Audio, Speech, and Language Processing, vol. 24, no. 4, pp. 659-668, 2016. Publisher's VersionAbstract

    Monitoring subglottal neck-surface acceleration has received renewed attention due to the ability of low-profile accelerometers to confidentially and noninvasively track properties related to normal and disordered voice characteristics and behavior. This study investigated the ability of subglottal necksurface acceleration to yield vocal function measures traditionally derived from the acoustic voice signal and help guide the development of clinically functional accelerometer-based measures from a physiological perspective. Results are reported for 82 adult speakers with voice disorders and 52 adult speakers with normal voices who produced the sustained vowels /A/, /i/, and /u/ at a comfortable pitch and loudness during the simultaneous recording of radiated acoustic pressure and subglottal necksurface acceleration. As expected, timing-related measures of jitter exhibited the strongest correlation between acoustic and necksurface acceleration waveforms (r 0:99), whereas amplitudebased measures of shimmer correlated less strongly (r 0:74). Additionally, weaker correlations were exhibited by spectral measures of harmonics-to-noise ratio (r 0:69) and tilt (r 0:57), whereas the cepstral peak prominence correlated more strongly (r 0:90). These empirical relationships provide evidence to support the use of accelerometers as effective complements to acoustic recordings in the assessment and monitoring of vocal function in the laboratory, clinic, and during an individual’s daily activities.

    J. H. Van Stan, D. D. Mehta, S. M. Zeitels, J. A. Burns, A. M. Barbu, and R. E. Hillman, “Average ambulatory measures of sound pressure level, fundamental frequency, and vocal dose do not differ between adult females with phonotraumatic lesions and matched control subjects,” Annals of Otology, Rhinology, and Laryngology, vol. 124, pp. 864-874, 2015.Abstract

    Objectives: Clinical management of phonotraumatic vocal fold lesions (nodules, polyps) is based largely on assumptions that abnormalities in habitual levels of sound pressure level (SPL), fundamental frequency (f0), and/or amount of voice use play a major role in lesion development and chronic persistence. This study used ambulatory voice monitoring to evaluate if significant differences in voice use exist between patients with phonotraumatic lesions and normal matched controls.Methods: Subjects were 70 adult females: 35 with vocal fold nodules or polyps and 35 age-, sex-, and occupation-matched normal individuals. Weeklong summary statistics of voice use were computed from anterior neck surface acceleration recorded using a smartphone-based ambulatory voice monitor.Results: Paired t tests and Kolmogorov-Smirnov tests resulted in no statistically significant differences between patients and matched controls regarding average measures of SPL, f0, vocal dose measures, and voicing/voice rest periods. Paired t tests comparing f0 variability between the groups resulted in statistically significant differences with moderate effect sizes.Conclusions: Individuals with phonotraumatic lesions did not exhibit differences in average ambulatory measures of vocal behavior when compared with matched controls. More refined characterizations of underlying phonatory mechanisms and other potentially contributing causes are warranted to better understand risk factors associated with phonotraumatic lesions.

    Y. - A. S. Lien, et al., “Voice relative fundamental frequency via neck-skin acceleration in individuals with voice disorders,” Journal of Speech, Language, and Hearing Research, vol. 58, no. 5, pp. 1482-1487, 2015. Publisher's VersionAbstract

    Abstract Purpose: This study investigated the use of neck-skin acceleration for relative fundamental frequency (RFF) analysis. Method: Forty individuals with voice disorders associated with vocal hyperfunction and 20 age- and sex-matched control participants were recorded with a subglottal neck-surface accelerometer and a microphone while producing speech stimuli appropriate for RFF. Rater reliabilities, RFF means, and RFF standard deviations derived from the accelerometer were compared with those derived from the microphone. Results: RFF estimated from the accelerometer had slightly higher intrarater reliability and identical interrater reliability compared with values estimated with the microphone. Although sensor type and the Vocal Cycle × Sensor and Vocal Cycle × Sensor × Group interactions showed significant effects on RFF means, the typical RFF pattern could be derived from either sensor. For both sensors, the RFF of individuals with vocal hyperfunction was lower than that of the controls. Sensor type and its interactions did not have significant effects on RFF standard deviations. Conclusions: RFF can be reliably estimated using an accelerometer, but these values cannot be compared with those collected via microphone. Future studies are needed to determine the physiological basis of RFF and examine the effect of sensors on RFF in practical voice assessment and monitoring settings.

    D. D. Mehta, et al., “Using ambulatory voice monitoring to investigate common voice disorders: Research update,” Frontiers in Bioengineering and Biotechnology, vol. 3, no. 155, pp. 1-14, 2015. Publisher's VersionAbstract

    Many common voice disorders are chronic or recurring conditions that are likely to result from inefficient and/or abusive patterns of vocal behavior, referred to as vocal hyperfunction. The clinical management of hyperfunctional voice disorders would be greatly enhanced by the ability to monitor and quantify detrimental vocal behaviors during an individual’s activities of daily life. This paper provides an update on ongoing work that uses a miniature accelerometer on the neck surface below the larynx to collect a large set of ambulatory data on patients with hyperfunctional voice disorders (before and after treatment) and matched-control subjects. Three types of analysis approaches are being employed in an effort to identify the best set of measures for differentiating among hyperfunctional and normal patterns of vocal behavior: (1) ambulatory measures of voice use that include vocal dose and voice quality correlates, (2) aerodynamic measures based on glottal airflow estimates extracted from the accelerometer signal using subject-specific vocal system models, and (3) classification based on machine learning and pattern recognition approaches that have been used successfully in analyzing long-term recordings of other physiological signals. Preliminary results demonstrate the potential for ambulatory voice monitoring to improve the diagnosis and treatment of common hyperfunctional voice disorders.

    J. H. Van Stan, D. D. Mehta, and R. E. Hillman, “The effect of voice ambulatory biofeedback on the daily performance and retention of a modified vocal motor behavior in participants with normal voices,” Journal of Speech, Language, and Hearing Research, vol. 58, no. 3, pp. 713-721, 2015. Publisher's VersionAbstract

    Purpose Ambulatory biofeedback has potential to improve carryover of newly established vocal motor behaviors into daily life outside of the clinic and warrants systematic research that is lacking in the literature. This proof-of-concept study was designed to establish an empirical basis for future work in this area by formally assessing whether ambulatory biofeedback reduces daily vocal intensity (performance) and the extent to which this change remains after biofeedback removal (retention). Method Six participants with normal voices wore the KayPENTAX Ambulatory Phonation Monitor for 3 baseline days followed by 4 days with biofeedback provided on odd days. Results Compared to baseline days, participants exhibited a statistically significant decrease in mean vocal intensity (4.4 dB) and an increase in compliance (16.8 percentage points) when biofeedback was provided above a participant-specific intensity threshold. After biofeedback removal, mean vocal intensity and compliance reverted back to baseline levels. Conclusions These findings suggest that although current ambulatory biofeedback approaches have potential to modify a vocal motor behavior, the modified behavior may not be retained after biofeedback removal. Future work calls for the testing of more innovative ambulatory biofeedback approaches on the basis of motor control and learning theories to improve retention of a desired vocal motor behavior.

    M. Ghassemi, et al., “Learning to detect vocal hyperfunction from ambulatory neck-surface acceleration features: Initial results for vocal fold nodules,” IEEE Transactions on Biomedical Engineering, vol. 61, no. 6, pp. 1668-1675, 2014. Publisher's VersionAbstract

    Voice disorders are medical conditions that often result from vocal abuse/misuse which is referred to generically as vocal hyperfunction. Standard voice assessment approaches cannot accurately determine the actual nature, prevalence, and pathological impact of hyperfunctional vocal behaviors because such behaviors can vary greatly across the course of an individual's typical day and may not be clearly demonstrated during a brief clinical encounter. Thus, it would be clinically valuable to develop noninvasive ambulatory measures that can reliably differentiate vocal hyperfunction from normal patterns of vocal behavior. As an initial step toward this goal we used an accelerometer taped to the neck surface to provide a continuous, noninvasive acceleration signal designed to capture some aspects of vocal behavior related to vocal cord nodules, a common manifestation of vocal hyperfunction. We gathered data from 12 female adult patients diagnosed with vocal fold nodules and 12 control speakers matched for age and occupation. We derived features from weeklong neck-surface acceleration recordings by using distributions of sound pressure level and fundamental frequency over 5-min windows of the acceleration signal and normalized these features so that intersubject comparisons were meaningful. We then used supervised machine learning to show that the two groups exhibit distinct vocal behaviors that can be detected using the acceleration signal. We were able to correctly classify 22 of the 24 subjects, suggesting that in the future measures of the acceleration signal could be used to detect patients with the types of aberrant vocal behaviors that are associated with hyperfunctional voice disorders.

    M. Zañartu, J. C. Ho, D. D. Mehta, R. E. Hillman, and G. R. Wodicka, “Subglottal impedance-based inverse filtering of voiced sounds using neck surface acceleration,” IEEE Transactions on Audio, Speech, and Language Processing, vol. 21, pp. 1929-1939, 2013.Abstract

    A model-based inverse filtering scheme is proposed for an accurate, non-invasive estimation of the aerodynamic source of voiced sounds at the glottis. The approach, referred to as subglottal impedance-based inverse filtering (IBIF), takes as input the signal from a lightweight accelerometer placed on the skin over the extrathoracic trachea and yields estimates of glottal airflow and its time derivative, offering important advantages over traditional methods that deal with the supraglottal vocal tract. The proposed scheme is based on mechano-acoustic impedance representations from a physiologically-based transmission line model and a lumped skin surface representation. A subject-specific calibration protocol is used to account for individual adjustments of subglottal impedance parameters and mechanical properties of the skin. Preliminary results for sustained vowels with various voice qualities show that the subglottal IBIF scheme yields comparable estimates with respect to current aerodynamics-based methods of clinical vocal assessment. A mean absolute error of less than 10% was observed for two glottal airflow measures—maximum flow declination rate and amplitude of the modulation component—that have been associated with the pathophysiology of some common voice disorders caused by faulty and/or abusive patterns of vocal behavior (i.e., vocal hyperfunction). The proposed method further advances the ambulatory assessment of vocal function based on the neck acceleration signal, that previously have been limited to the estimation of phonation duration, loudness, and pitch. Subglottal IBIF is also suitable for other ambulatory applications in speech communication, in which further evaluation is underway.

    D. D. Mehta, M. Zañartu, S. W. Feng, H. A. Cheyne II, and R. E. Hillman, “Mobile voice health monitoring using a wearable accelerometer sensor and a smartphone platform,” IEEE Transactions on Biomedical Engineering, vol. 59, no. 11, pp. 3090-3096, 2012. Publisher's VersionAbstract

    Many common voice disorders are chronic or recurring conditions that are likely to result from faulty and/or abusive patterns of vocal behavior, referred to generically as vocal hyperfunction. An ongoing goal in clinical voice assessment is the development and use of noninvasively derived measures to quantify and track the daily status of vocal hyperfunction so that the diagnosis and treatment of such behaviorally based voice disorders can be improved. This paper reports on the development of a new, versatile, and cost-effective clinical tool for mobile voice monitoring that acquires the high-bandwidth signal from an accelerometer sensor placed on the neck skin above the collarbone. Using a smartphone as the data acquisition platform, the prototype device provides a user-friendly interface for voice use monitoring, daily sensor calibration, and periodic alert capabilities. Pilot data are reported from three vocally normal speakers and three subjects with voice disorders to demonstrate the potential of the device to yield standard measures of fundamental frequency and sound pressure level and model-based glottal airflow properties. The smartphone-based platform enables future clinical studies for the identification of the best set of measures for differentiating between normal and hyperfunctional patterns of voice use.