## 4 Discussion
### Pupil Dialation in Response to Vocal Samples
Evidence exists for increased pupil dilation when listening to auditory stimuli with negative affective connotations [30; 31]. As such, emotional valence may be a contributing factor to our pupil data, especially for our naive listeners who are exposed to abnormal voice samples for the first time and perceived them to be aversive. The fact that the PPD, albeit pronounced, is reduced in magnitude on the second presentation of the Talker #1 stimulus, perhaps suggests that repeated exposure may reduce the negative emotional valence. We acknowledge that this explanation is speculative, but it is in line with previous studies that report habituation secondary to repetition and exposure [32; 33]. Furthermore, this explanation is consistent with findings from [PERSON] et al. [34] who reported that listening effort ratings from listeners who are familiar and exposed to abnormal voice samples (in their case, that of esophageal voices) are significantly lower when compared to similar ratings from naive listeners. Given the speculative nature, further research is warranted to understand the relative contribution of cognitive load and emotional valence to pupillary responses when listening to disordered voice and speech samples. To summarize, our data on AdSD samples support the notion that when confronted with stimuli characterized by an abnormal vocal quality, listeners, on average, demonstrate a physiologic response that corresponds to their auditory-perceptual assessments. These findings provide valuable insights  
Figure 6: (**a**) Pupil tracks from a participant when listening to Talker 1 stimulus during the test and retest sessions. The Talker 1 stimulus was the 7 th during the test session and 22 nd during the retest session in terms of the presentation order. (**b**) Pupil tracks from a different participant when listening to the same Talker 1 stimulus. For this listener, the presentation order for Talker 1 stimulus was 21 st and 11 th during the test and retest sessions, respectively. into the demands of effective verbal communication in general, and the challenges that may occur in the presence of disordered speech or an abnormal vocal quality specifically. While the present data offer valuable insights on various aspects of auditory-perceptual evaluation of voice quality, there are some limitations which deserve mention. It is pertinent to note that none of the talker samples used in the present study were characterized by reduced intelligibility, rather, the speech samples were different in the consistency and flow of speech production. Therefore, future research might seek to investigate the relationship between auditory-perceptual features and pupil dilation when listeners are asked to make auditory-perceptual judgments of unique sentence stimuli that simultaneously requires comprehension (i.e., intelligibility) of such sentences which are characterized by different degrees of AdSD severity. Furthermore, our study only assessed ratings of strain and listening effort in relation to pupillary responses from naive normal hearing listeners. Having experienced listeners and gathering their physiological responses along with subjective auditory-perceptual ratings can be complementary. In fact, it would be interesting to observe what the PPDs of experienced listeners who have ample exposure to disordered voices through their profession. Our listeners also rated talker stimuli based on their individual internal standards. While excellent reliability was documented in our study, it would be valuable to determine if adding perceptual anchors might influence the ratings and concurrent PPD values. In addition, no acoustic measures were performed on our AdSD audio samples. Future studies which are designed to evaluate potential correlations between acoustic measures of dysphonic speech, auditory-perceptual ratings and pupillometry would be a valuable area for future study. Finally, the temporal gap between test-retest was relatively short (10-15 min).