title: Towards Objective Voice Assessment: The Diplophonia Diagram.
abstract: OBJECTIVE
  Diplophonia is an often misinterpreted symptom of disordered voice, and needs objectification. An audio signal processing algorithm for the detection of diplophonia is proposed. Diplophonia is produced by two distinct oscillators, which yield a profound physiological interpretation. The algorithm's performance is compared with the clinical standard parameter degree of subharmonics (DSH).
  
  
  METHODS
  This is a prospective study.
  
  
  METHODS
  A total of 50 dysphonic subjects with (28 with diplophonia and 22 without diplophonia) and 30 subjects with euphonia were included in the study. From each subject, up to five sustained phonations were recorded during rigid telescopic high-speed video laryngoscopy. A total of 185 phonations were split up into 285 analysis segments of homogeneous voice qualities. In accordance to the clinical group allocation, the considered segmental voice qualities were (1) diplophonic, (2) dysphonic without diplophonia, and (3) euphonic. The Diplophonia Diagram is a scatter plot that relates the one-oscillator synthesis quality (SQ1) to the two-oscillator synthesis quality (SQ2). Multinomial logistic regression is used to distinguish between diplophonic and nondiplophonic segments.
  
  
  RESULTS
  Diplophonic segments can be well distinguished from nondiplophonic segments in the Diplophonia Diagram because two-oscillator synthesis is more appropriate for imitating diplophonic signals than one-oscillator synthesis. The detection of diplophonia using the Diplophonia Diagram clearly outperforms the DSH by means of positive likelihood ratios (56.8 versus 3.6).
  
  
  CONCLUSIONS
  The diagnostic accuracy of the newly proposed method for detecting diplophonia is superior to the DSH approach, which should be taken into account for future clinical and scientific work.
authors.affiliation: Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Vienna, Medical University of Vienna; Signal Processing and Speech Communication Lab, Graz University of Technology, Graz, Austria. Electronic address: philipp.aichinger@meduniwien.ac.at.
authors.forename: Philipp
authors.initials: P
authors.lastname: Aichinger
authors.affiliation: Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Vienna, Medical University of Vienna.
authors.forename: Imme
authors.initials: I
authors.lastname: Roesner
authors.affiliation: Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Vienna, Medical University of Vienna.
authors.forename: Berit
authors.initials: B
authors.lastname: Schneider-Stickler
authors.affiliation: Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Vienna, Medical University of Vienna.
authors.forename: Matthias
authors.initials: M
authors.lastname: Leonhard
authors.affiliation: Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Vienna, Medical University of Vienna.
authors.forename: Doris-Maria
authors.initials: DM
authors.lastname: Denk-Linnert
authors.affiliation: Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Vienna, Medical University of Vienna.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bigenzahn
authors.affiliation: Signal Processing and Speech Communication Lab, Graz University of Technology, Graz, Austria.
authors.forename: Anna Katharina
authors.initials: AK
authors.lastname: Fuchs
authors.affiliation: Signal Processing and Speech Communication Lab, Graz University of Technology, Graz, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Hagmüller
authors.affiliation: Signal Processing and Speech Communication Lab, Graz University of Technology, Graz, Austria.
authors.forename: Gernot
authors.initials: G
authors.lastname: Kubin
mesh_terms: D000162:Acoustics; D000465:Algorithms; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D016015:Logistic Models; D015999:Multivariate Analysis; D010363:Pattern Recognition, Automated; D010699:Phonation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted; D013018:Sound Spectrography; D013997:Time Factors; D014741:Video Recording; D014832:Voice Disorders / Q000175:diagnosis* / Q000503:physiopathology; D014833:Voice Quality
keywords: Acoustic analysis; Detection; Diplophonia; Dysphonia; Signal processing