Reliable Jitter and Shimmer Measurements in Voice Clinics: The Relevance of Vowel, Gender, Vocal Intensity, and Fundamental Frequency Effects in a Typical Clinical Task

Brockmann, Meike; Drinnan, Michael; Storck, Claudio; Carding, Paul

doi:10.1016/j.jvoice.2009.07.002

Cited by 186 publications

(132 citation statements)

References 47 publications

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“…The effects of gender, vowel, and fo accounted for up to 6% of measurement differences and thus were statistically smaller by comparison 22 . To date, it is not clear if these effects also apply to other indices of vocal perturbation or irregularity such as HNR.…”

Section: Introductionmentioning

confidence: 83%

“…In clinical measurements, usually patients are asked to produce sustained phonation of the vowel /a/, /i/ or /u/ with "comfortable pitch and loudness" 4,7,22 . Under these measurement conditions, vowel effects have been documented in a number of works in individuals with and without voice disorders.…”

Section: Introductionmentioning

confidence: 99%

“…Under these measurement conditions, vowel effects have been documented in a number of works in individuals with and without voice disorders. For this reason, the current recommendation is to use the standard vowel /a/ in clinical practice 7,[22][23][24][25] .…”

Section: Introductionmentioning

confidence: 99%

“…Differences in measured speaking voice pitch (fo) and loudness (voice SPL) have been shown to significantly affect measurements of jitter and shimmer in vocally healthy individuals 4,22,28 . Usually we expect a natural covariation of voice fo and SPL in measurements of speaking voice range profiles, with an association of higher voice SPL and increased fo [29][30][31] .…”

Section: Introductionmentioning

confidence: 99%

“…To date, it is not clear if these effects also apply to other indices of vocal perturbation or irregularity such as HNR. Also, this relation has been only investigated in vocally healthy adults and children 4,7,22,23,35 . Therefore, the main aims of the present work were to study SPL-related effects on jitter, shimmer, and HNR in individuals with and without diagnosed voice disorders, while also considering the influence of age and occupation-related voice use level.…”

Section: Introductionmentioning

confidence: 99%

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Acoustic Perturbation Measures Improve with Increasing Vocal Intensity in Individuals With and Without Voice Disorders

2018

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OBJECTIVE: In vocally healthy children and adults, speaking voice loudness differences can significantly confound acoustic perturbation measurements. This study examines the effects of voice sound pressure level (SPL) on jitter, shimmer, and harmonics-to-noise ratio (HNR) in adults with voice disorders and a control group with normal vocal status. STUDY DESIGN: This is a matched case-control study. METHODS: We assessed 58 adult female voice patients matched according to approximate age and occupation with 58 vocally healthy women. Diagnoses included vocal fold nodules (n = 39, 67.2%), polyps (n = 5, 8.6%), and muscle tension dysphonia (n = 14, 24.1%). All participants sustained the vowel /a/ at soft, comfortable, and loud phonation levels. Acoustic voice SPL, jitter, shimmer, and HNR were computed using Praat. The effects of loudness condition, voice SPL, pathology, differential diagnosis, age, and professional voice use level on acoustic perturbation measures were assessed using linear mixed models and Wilcoxon signed rank tests. RESULTS: In both patient and normative control groups, increasing voice SPL correlated significantly (P < 0.001) with decreased jitter and shimmer, and increased HNR. Voice pathology and differential diagnosis were not linked to systematically higher jitter and shimmer. HNR levels, however, were statistically higher in the patient group than in the control group at comfortable phonation levels. Professional voice use level had a significant effect (P < 0.05) on jitter, shimmer, and HNR. CONCLUSIONS: The clinical value of acoustic jitter, shimmer, and HNR may be limited if speaking voice SPL and professional voice use level effects are not controlled for. Future studies are warranted to investigate whether perturbation measures are useful clinical outcome metrics when controlling for these effects. Study Design: Matched case-control study Methods: 58 adult female voice patients, matched according to approximate age and occupation with 58 vocally healthy women, were assessed. Diagnoses included vocal fold nodules (n:39, 67.2%), polyps (n:5, 8.6%), and muscle tension dysphonia (MTD; n:14, 24.1%). All participants sustained the vowel /a/ at soft, comfortable, and loud phonation levels. Acoustic voice SPL, jitter, shimmer, and HNR were computed using Praat. The effects of loudness condition, voice SPL, pathology, differential diagnosis, age, and professional voice use level on acoustic perturbation measures were assessed using linear mixed models and Wilcoxon signed-rank tests.Results: In both patient and normative control groups, increasing voice SPL correlated significantly (p<0.001) with decreased jitter and shimmer, and increased HNR. Voice pathology and differential diagnosis were not linked to systematically higher jitter and shimmer. HNR levels, however, were statistically higher in the patient versus control group at comfortable phonation levels. Professional voice use level had a significant effect (p<0.05) on jitter, shimmer, and HNR.Conclusions: The clinical value of ac...

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Section: Introductionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acoustic Perturbation Measures Improve with Increasing Vocal Intensity in Individuals With and Without Voice Disorders

2018

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What do these sounds tell us about the therapeutic alliance: Acoustic markers as predictors of alliance

Nof

Amir

Goldstein

et al. 2020

Clin Psychology and Psychoth

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Predicting the trajectories of alliance formation that the patient is likely to establish with the therapist during treatment, even before their first meeting, can help prevent the potentially harmful consequences of deterioration in alliance, such as poor outcome and premature dropout. The present study aimed to examine the ability of four pretreatment acoustic markers to predict the alliance that is likely to be formed in the course of treatment: F0 span, speech rate, pause proportion and jitter. Data from 560 observations of 38 patients were collected as part of an ongoing randomized clinical trial of short‐term psychotherapy for major depressive disorder. The acoustic markers were measured using high‐quality recordings at baseline, before the patient and therapist ever met or had any type of communication. A multilevel model was used to examine the ability of the four acoustic markers to predict the slopes of alliance formation in the course of treatment, all markers being introduced in the same model. The clinical utility of the acoustic markers was explored in two case studies. The model explained 22% of the variance in alliance formation. Higher levels of both jitter and pause proportion at baseline predicted less strengthening of the alliance in the course of treatment. The findings, which should be replicated in larger samples, suggest that much of the therapeutic alliance can be predicted based on the acoustic characteristics of the patient's voice in the first 3 min of their intake, before they even meet their therapist.

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The Efficacy of the Manual Circumlaryngeal Therapy for Muscle Tension Dysphonia: A Systematic Review and Meta‐analysis

Latoszek

Hetjens

2023

The Laryngoscope

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ObjectiveMuscle tension dysphonia (MTD) is the most common functional voice disorder. Behavioral voice therapy is the front‐line treatment for MTD, and laryngeal manual therapy may be a part of this treatment. The objective of this study was to investigate the effect of manual circumlaryngeal therapy (MCT) on acoustic markers of voice quality (jitter, shimmer, and harmonics‐to‐noise ratio) and vocal function (fundamental frequency) through a systematic review with meta‐analysis.Data SourcesFour databases were searched from inception to December 2022, and a manual search was performed.Review MethodsThe PRISMA extension statement for reporting systematic reviews incorporating a meta‐analysis of health care interventions was applied, and a random effects model was used for the meta‐analyses.ResultsWe identified 6 eligible studies from 30 studies (without duplicates). The MCT approach was highly effective on acoustics with large effect sizes (Cohen's d > 0.8). Significant improvements were obtained in jitter in percent (mean difference of −.58; 95% CI −1.00 to 0.16), shimmer in percent (mean difference of −5.66; 95% CI −8.16 to 3.17), and harmonics‐to‐noise ratio in dB (mean difference of 4.65; 95% CI 1.90–7.41), with the latter two measurements continuing to be significantly improved by MCT when measurement variability is considered.ConclusionThe efficacy of MCT for MTD was confirmed in most clinical studies by assessing jitter, shimmer, and harmonics‐to‐noise ratio related to voice quality. The effects of MCT on the fundamental frequency changes could not be verified. Further contributions of high‐quality randomized control trials are needed to support evidence‐based practice in laryngology. Laryngoscope, 2023

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Reliable Jitter and Shimmer Measurements in Voice Clinics: The Relevance of Vowel, Gender, Vocal Intensity, and Fundamental Frequency Effects in a Typical Clinical Task

Cited by 186 publications

References 47 publications

Acoustic Perturbation Measures Improve with Increasing Vocal Intensity in Individuals With and Without Voice Disorders

Acoustic Perturbation Measures Improve with Increasing Vocal Intensity in Individuals With and Without Voice Disorders

What do these sounds tell us about the therapeutic alliance: Acoustic markers as predictors of alliance

The Efficacy of the Manual Circumlaryngeal Therapy for Muscle Tension Dysphonia: A Systematic Review and Meta‐analysis

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