OBJECTIVE: In this prospective study, we aimed to investigate the difference in voice acoustic parameters between girls with idiopathic central precocious puberty (ICPP) and those who developed normally during prepuberty.
METHODS: Our study recruited 54 girls diagnosed with ICPP and randomly sampled 51 healthy prepubertal girls as the control. Tanner stages, circulating hormone levels and bone ages of the girls with ICPP and the age and body mass index (BMI) of all participants were recorded. Acoustic analyses were performed using PRAAT computer-based voice analysis software and the mean pitch (F0), jitter, shimmer, noise-to harmonic-ratio (NHR) and harmonic-to-noise ratio (HNR) values were compared in the patient and control groups.
RESULTS: The two groups did not significantly differ in age or BMI. In the evaluation of the F0 and jitter values, we were found to be lower in the control group than in the patient group. However, we did not find a statistical significance. The mean shimmer values of the patient group were significantly higher than those of the control group. In addition, a statistically significant difference was noted for the mean HNR and NHR values (P < 0.001). A moderate negative correlation was found between shimmer and hormone levels in the patient group.
CONCLUSIONS: Voice acoustic parameters one of the defining features of girls with ICPP. Voice changes in acoustic parameters could reflect hormonal changes during puberty. Clinicians should suspect ICPP when there is a change in the voice.

Quantifying pain in patients admitted to intensive care units (ICUs) is challenging due to the increased prevalence of communication barriers in this patient population. Previous research has posited a positive correlation between pain and physical activity in critically ill patients. In this study, we advance this hypothesis by building machine learning classifiers to examine the ability of accelerometer data collected from daily wearables to predict self-reported pain levels experienced by patients in the ICU. We trained multiple Machine Learning (ML) models, including Logistic Regression, CatBoost, and XG-Boost, on statistical features extracted from the accelerometer data combined with previous pain measurements and patient demographics. Following previous studies that showed a change in pain sensitivity in ICU patients at night, we performed the task of pain classification separately for daytime and nighttime pain reports. In the pain versus no-pain classification setting, logistic regression gave the best classifier in daytime (AUC: 0.72, F1-score: 0.72), and CatBoost gave the best classifier at nighttime (AUC: 0.82, F1-score: 0.82). Performance of logistic regression dropped to 0.61 AUC, 0.62 F1-score (mild vs. moderate pain, nighttime), and CatBoost\'s performance was similarly affected with 0.61 AUC, 0.60 F1-score (moderate vs. severe pain, daytime). The inclusion of analgesic information benefited the classification between moderate and severe pain. SHAP analysis was conducted to find the most significant features in each setting. It assigned the highest importance to accelerometer-related features on all evaluated settings but also showed the contribution of the other features such as age and medications in specific contexts. In conclusion, accelerometer data combined with patient demographics and previous pain measurements can be used to screen painful from painless episodes in the ICU and can be combined with analgesic information to provide moderate classification between painful episodes of different severities.

OBJECTIVE: To evaluate the efficacy of platelet-rich plasma (PRP) in benign vocal fold lesions.
METHODS: MEDLINE, Cochrane Central, Web of Science, and Scopus databases were searched in April 2023 for relevant clinical trials. Inclusion criteria were clinical trials evaluating the efficacy of PRP in benign vocal fold lesions. We conducted a comparative double-arm analysis using the pooled mean difference (MD) and 95% confidence interval (CI). Outcomes of interest included the vocal handicap index (VHI), the Jitter and Shimmer percentages, and the noise-to-harmonic ratio (NHR).
RESULTS: Six studies matched the inclusion criteria. The pooled analysis shows that PRP was associated with significantly lower VHI scores compared with the control (MD = - 5.06, p < 0.01). Regarding the Jitter percentage, the PRP group was not superior to the control group at 2 and 4 weeks. However, the results revealed that PRP significantly reduced the Jitter percentage at 3 months (MD = - 0.61, p = 0.0008). The overall analysis favored the PRP arm significantly (p < 0.001). As for the Shimmer percentage, the combined effect estimate favored the PRP group (MD = - 1.22, p = 0.002). Subgroup analysis according to the time did not reveal any significant differences between studies at 2 weeks, 4 weeks, and 3 months. The analysis of the NHR outcome revealed a significant difference between both groups (MD = -1.09, p = 0.01). However, at 4 weeks, the treatment group had a significantly lower NHR % compared to the control group (MD = - 0.61, p = 0.02). There was no significant difference at 3 months (MD = - 2.14, p = 0.14).
CONCLUSIONS: Platelet-rich plasma is effective in reducing VHI scores, Jitter and Shimmer percentages, and NHR values. This effect is more evident after follow-up, especially 3 months.

BACKGROUND: Vocal fold polyps (VFP) are a common cause of voice disorders and laryngeal discomfort. They are usually treated by behavioral voice therapy (VT) or phonosurgery, or a combination (CT) of both. However, the superiority of either of these treatments has not been clearly established.
METHODS: Three databases were searched from inception to October 2022 and a manual search was performed. All clinical trials of VFP treatment were included that reported at least auditory-perceptual judgment, aerodynamics, acoustics, and the patient-perceived handicap.
RESULTS: We identified 31 eligible studies (VT: n = 47-194; phonosurgery: n = 404-1039; CT: n = 237-350). All treatment approaches were highly effective, with large effect sizes (d > 0.8) and significant improvements in almost all voice parameters (p-values < 0.05). Phonosurgery reduced roughness and NHR, and the emotional and functional subscales of the VHI-30 were the most compared to behavioral voice therapy and combined treatment (p-values < 0.001). Combined treatment improved hoarseness, jitter, shimmer, MPT, and the physical subscale of the VHI-30 more than phonosurgery and behavioral voice therapy (p-values < 0.001).
CONCLUSIONS: All three treatment approaches were effective in eliminating vocal fold polyps or their negative sequelae, with phonosurgery and combined treatment providing the greatest improvement. These results may inform future treatment decisions for patients with vocal fold polyps.

BACKGROUND: An intact auditory system is essential for the development and maintenance of voice quality and speech prosody. On the contrary hearing loss affects the adjustments and appropriate use of organs involved in speech and voice production. Spectro-acoustic voice parameters have been evaluated in Cochlear Implant (CI) users, and the authors of previous systematic reviews on the topic concluded that fundamental frequency (F0) seemed preliminarily the most reliable parameter to evaluate voice alterations in adult CI users. The main aim of this systematic review and meta-analysis was to clarify the vocal parameters and prosodic alterations of speech in pediatric CI users.
METHODS: The protocol of the systematic review was registered on the PROSPERO database, International prospective register of systematic reviews. We conducted a search of the English literature published in the period between January 1, 2005 and April 1, 2022 on the Pubmed and Scopus databases. A meta-analysis was conducted to compare the values of voice acoustic parameters in CI users and non-hearing-impaired controls. The analysis was conducted using the standardized mean difference as the outcome measure. A random-effects model was fitted to the data.
RESULTS: A total of 1334 articles were initially evaluated using title and abstract screening. After applying inclusion/exclusion criteria, 20 articles were considered suitable for this review. The age of the cases ranged between 25 and 132 months at examination. The most studied parameters were F0, Jitter, Shimmer and Harmonics-to-Noise Ratio (HNR); other parameters were seldom reported. A total of 11 studies were included in the meta-analysis of F0, with the majority of estimates being positive (75%); the estimated average standardized mean difference based on the random-effects model was 0.3033 (95% CI: 0.0605 to 0.5462; P = 0.0144). For Jitter (0.2229; 95% CI: -0.1862 to 0.7986; P = 0.2229) and shimmer (0.2540; 95% CI: -0.1404 to 0.6485; P = 0.2068) there was a trend toward positive values without reaching statistical significance.
CONCLUSIONS: This meta-analysis confirmed that higher F0 values have been observed in the pediatric population of CI users compared to age-matched normal hearing volunteers, whereas the parameters of voice noise were not significantly different between cases and controls. Prosodic aspects of language need further investigations. In longitudinal contexts, prolonged auditory experience with CI has brought voice parameters closer to the norm. Following the available evidence, we stress the utility of inclusion of vocal acoustic analysis in the clinical evaluation and follow-up of CI patients to optimize the rehabilitation process of pediatric patients with hearing loss.

Acoustic voice analysis is still a valuable technique which enables voice clinicians to compare voices to differentiate them into normal and abnormal. The present study was undertaken to standardize acoustic voice parameters in normal healthy adult individuals and gender comparison among them and also acoustic voice analysis of pathological voices and it\'s comparison with normal healthy voices. Voice samples of vowels /a/, /i/ and /u/ of 80 normal healthy adults (males = 40, females = 40) of control group and 40 patients with dysphonic voice of case group collected and acoustic voice parameters were extracted by using Praat software. There were statistically significant higher values of fundamental frequency (F0) in females, while jitter local (%), shimmer local (%) and harmonic to noise ratio (HNR) had no gender differences in normal healthy voices. Pathological voices of case group subjects with laryngeal pathologies had statistically significant higher values of jitter local (%), shimmer local (%) and lower values of HNR as compare to normal healthy voices of control group. Objective voice analysis by using Praat software is convenient, reliable and cost effective method. This study establishes normative acoustic voice parameters in normal healthy adults. There are no gender differences in adult healthy voices except fundamental frequency (F0), which is higher in females. Patients who are with dysphonic voices due to laryngeal pathologies had altered values of acoustic parameters compared to normophonic adults and clinicians can precisely differentiate pathological voices from normophonics.

UNASSIGNED: Speech production is the most unique task performed by a human. The speech signals consist of strings of vowels and consonants. Vowels are differentiated based on acoustic characteristics.
UNASSIGNED: A total of 50 Nepali students, 25 males and 25 females of the age range 18 to 25 years with no history of voice disorders, flu, neurological disorders, speech, language impairment, and respiratory dysfunction were included in the study. Sustained phonation of five short vowels /a/, /i/, /o/, /u/ and /e/ were used in order to measure the acoustic variables. PRAAT software was used to extract the acoustic parameter of voice; mean pitch, Jitter, RAP, PPQ 5, Shimmer, and APQ 11.
UNASSIGNED: Mean and SD was calculated using SPSS. Mann-Whitney test revealed there was a highly significant difference in all the parameters taken for the study among males and females. However, the females had greater F0, jitter, RAP, PPQ5, shimmer, APQ11 than the males.
UNASSIGNED: Before implementing these norms in clinical set up we must consider that these values are developed for the adults whose L1 is Nepali language and the software used for the establishment of norms was Praat.

Laryngopharyngeal cancers are one of the most commonly diagnosed head and neck malignancies frequently presenting primarily with change in voice. Radiotherapy being the main modality of treatment for early cancers continues to affect voice. Hence, acoustic analysis of the voice offers quantifiable values of several parameters delineating the obvious effect of the therapy. A total number of 60 patients, diagnosed with laryngopharyngeal cancers undergoing radiotherapy underwent acoustic voice assessment using Dr. speech software pre-treatment and at 1 and 3 months post radiotherapy. Data analysis was done using Mann-Whitney test and Wilcoxon signed rank test and a significant p value was obtained. The results of the study showed fundamental frequency (F0) and noise to harmonic ratio (NHR) to be the most affected in comparison to Jitter and Shimmer. The F0 and NHR values across baseline evaluation, first month and third month follow up showed a steady deterioration which was significant. The deterioration noted from the first to third month was not statistically significant. Across genders both F0 and NHR deterioration is more in males than in females. Radiotherapy causes definitive alterations in some acoustic measures of voice, which make the voice disharmonic and hoarse with contribution of harshness and breathiness. The effect is more pronounced on vocal parameters that are structure and projection based as evidenced by deterioration in values noted in F0 and NHR. Persistent deteriorated acoustic parameters for a longer duration of time are more likely which emphasizes the need for early voice rehabilitation.

BACKGROUND: There are currently no objective biomarkers that allow the quantification of negative symptoms of schizophrenia. This study therefore explored the use of acoustic features in identifying the severity of negative symptoms in patients with schizophrenia.
METHODS: We recruited 79 inpatients who were diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (the schizophrenia group) at the Huilongguan Hospital in Beijing, China, and 79 healthy controls from the surrounding community (the control group). We assessed the clinical symptoms of the patients with schizophrenia using the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS) and recorded the voice of each participant as they read emotionally positive, neutral, and negative texts. The Praat software was used to analyse and extract acoustic characteristics from the recordings, such as jitter, shimmer, and pitch. The acoustic differences between the two groups of participants and the relationship between acoustic characteristics and clinical symptoms in the patient group were analysed.
RESULTS: There were significant differences between the schizophrenia and control groups in pitch, voice breaks, jitter, shimmer, and the mean harmonics-to-noise ratio (p < 0.05). Jitter was negatively correlated with the blunted affect and alogia subscale scores of the BNSS, both in the positive and neutral emotion conditions, but the correlation disappeared in the negative emotion condition. However, shimmer exhibited a stable negative correlation with the blunted affect and alogia subscale scores of the BNSS in all three emotion conditions. A linear regression analysis showed that pitch, jitter, shimmer, and age were statistically significant predictors of BNSS subscale scores.
CONCLUSIONS: Acoustic emotional expression differs between patients with schizophrenia and healthy controls. Some acoustic characteristics are related to the severity of negative symptoms, regardless of semantic emotions, and may therefore be objective biomarkers of negative symptoms. A systematic method for assessing vocal acoustic characteristics could provide an accurate and feasible means of assessing negative symptoms in schizophrenia.
UNASSIGNED: Acoustic emotional expression differs between patients with schizophrenia and healthy controls. A systematic method for assessing vocal acoustics could provide an accurate and feasible means of assessing negative symptoms in schizophrenia.

OBJECTIVE: Research involving acoustic analysis does not always consider the level of background noise in the room where the recording process is going to be carried out, or if they do, the maximum value of background noise used varies from author to author. The objective of this research is to establish if the parameters: f0, Jitter, Shimmer and Alpha ratio vary in relation to different levels of background noise in the room where the recording process is carried out and to establish a maximum value of this.
METHODS: The Praat program was used to get the average value of the parameters: f0, Jitter, Shimmer and Alpha ratio from a voice sample of 33 subjects inside an Audiometric booth whose background noise level was 28,1 dB(A). A statistical comparison was made between the average value of each parameter as the background noise increased in relation to the average values ​​obtained with the baseline background noise of the cabin for each parameter.
RESULTS: The f0 and Alpha ratio parameters show reliable values ​​up to a background noise level of 47,7 dB(A), while the Jitter and Shimmer parameters do so up to a background noise level of 43,8 dB(A).
CONCLUSIONS: Considering that the acoustic parameters are all obtained from the same recording, we can point out that the recommended maximum background noise level in the room where the recordings are made should not exceed 43,8 dB(A).