Robert E. Hillman

Hamzeh Ghasemzadeh, Robert E. Hillman, Daryush D. Mehta

This study's first purpose is to provide quantitative evidence that would incentivize researchers to instead use the more robust method of nested cross-validation. The second purpose is to present methods and MATLAB codes for doing power analysis for ML-based analysis during the design of a study. Monte Carlo simulations were used to quantify the interactions between the employed cross-validation method, the discriminative power of features, the dimensionality of the feature space, and the dimensionality of the model. Four different cross-validations (single holdout, 10-fold, train-validation-test, and nested 10-fold) were compared based on the statistical power and statistical confidence of the ML models. Distributions of the null and alternative hypotheses were used to determine the minimum required sample size for obtaining a statistically significant outcome (α=0.05, 1-\b{eta}=0.8). Statistical confidence of the model was defined as the probability of correct features being selected and hence being included in the final model. Our analysis showed that the model generated based on the single holdout method had very low statistical power and statistical confidence and that it significantly overestimated the accuracy. Conversely, the nested 10-fold cross-validation resulted in the highest statistical confidence and the highest statistical power, while providing an unbiased estimate of the accuracy. The required sample size with a single holdout could be 50% higher than what would be needed if nested cross-validation were used. Confidence in the model based on nested cross-validation was as much as four times higher than the confidence in the single holdout-based model. A computational model, MATLAB codes, and lookup tables are provided to assist researchers with estimating the sample size during the design of their future studies.

Katie Matton, Purvaja Balaji, Hamzeh Ghasemzadeh et al.

Phonotrauma refers to vocal fold tissue damage resulting from exposure to forces during voicing. It occurs on a continuum from mild to severe, and treatment options can vary based on severity. Assessment of severity involves a clinician's expert judgment, which is costly and can vary widely in reliability. In this work, we present the first method for automatically classifying phonotrauma severity from vocal fold images. To account for the ordinal nature of the labels, we adopt a widely used ordinal regression framework. To account for label uncertainty, we propose a novel modification to ordinal regression loss functions that enables them to operate on soft labels reflecting annotator rating distributions. Our proposed soft ordinal regression method achieves predictive performance approaching that of clinical experts, while producing well-calibrated uncertainty estimates. By providing an automated tool for phonotrauma severity assessment, our work can enable large-scale studies of phonotrauma, ultimately leading to improved clinical understanding and patient care.

Gabriel A. Alzamendi, Sean D. Peterson, Byron D. Erath et al.

Poor laryngeal muscle coordination that results in abnormal glottal posturing is believed to be a primary etiologic factor in common voice disorders such as non-phonotraumatic vocal hyperfunction. Abnormal activity of antagonistic laryngeal muscles is hypothesized to play a key role in the alteration of normal vocal fold biomechanics that results in the dysphonia associated with such disorders. Current low-order models of the vocal folds are unsatisfactory to test this hypothesis since they do not capture the co-contraction of antagonist laryngeal muscle pairs. To address this limitation, a self-sustained triangular body-cover model with full intrinsic muscle control is introduced. The proposed scheme shows good agreement with prior studies using finite element models, excised larynges, and clinical studies in sustained and time-varying vocal gestures. Simulations of vocal fold posturing obtained with distinct antagonistic muscle activation yield clear differences in kinematic, aerodynamic and acoustic measures. The proposed tool is deemed sufficiently accurate and flexible for future comprehensive investigations of non-phonotraumatic vocal hyperfunction and other laryngeal motor control disorders.

Marzyeh Ghassemi, Zeeshan Syed, Daryush D. Mehta et al.

Voice disorders affect an estimated 14 million working-aged Americans, and many more worldwide. We present the first large scale study of vocal misuse based on long-term ambulatory data collected by an accelerometer placed on the neck. We investigate an unsupervised data mining approach to uncovering latent information about voice misuse. We segment signals from over 253 days of data from 22 subjects into over a hundred million single glottal pulses (closures of the vocal folds), cluster segments into symbols, and use symbolic mismatch to uncover differences between patients and matched controls, and between patients pre- and post-treatment. Our results show significant behavioral differences between patients and controls, as well as between some pre- and post-treatment patients. Our proposed approach provides an objective basis for helping diagnose behavioral voice disorders, and is a first step towards a more data-driven understanding of the impact of voice therapy.