# Pareto-Optimized AVQI Assessment of Dysphonia: A Clinical Trial Using Various Smartphones
## 2 State of the Art Review
### Use of Voice Quality Index Instruments in the Medical Domain
AVQI has been shown to be a reliable multiparametric measure for assessing the severity of dysphonia, which is often a rare, persistent, and long-term neurological voice problem caused by excessive or incorrect contraction of the laryngeal muscles. Alternatively, the Ulosian technique [27] sought to identify irregularities in the voice affected by PD and build an automated screening tool capable of distinguishing between the voices of patients with PD and healthy volunteers while also generating a voice quality score. The classification accuracy was tested using two speech corpora (the Italian PVS and our own Lithuanian PD voice dataset), and the results were confirmed to be medically adequate. [PERSON] explored the impact of intensive speech therapy that targets the voice or focuses on articulation on the quality of the voice as judged by the AVQI in people with [PERSON]'s disease [28]. The results show that voice-focused therapy results in significant gains in voice quality in this population. The growing number of validity studies that evaluate the validity of the AVQI requires a complete synthesis of existing results [29]. AVQI is a contemporary multivariate acoustic measure of dysphonia that assesses overall voice quality. In [30], a comparison of the two groups revealed a considerable difference between them. Consequently, AVQI serves as an excellent diagnostic method for obtaining scores from the dysphonic population and should be investigated in other voice issues. According to [PERSON]'s results [31], while the characteristics detected in the evaluations were similar to those expected from individuals with dysarthria, it is difficult to establish a differential diagnosis of this disorder based solely on auditory and physiological criteria. Similarly, the team of [PERSON] et al. [32] analyzed two acoustic properties, the cepstral spectral index of dysphonia (CSID) and AVQI, which have gained popularity as valid and reliable multiparametric indicators in the objective evaluation of hoarseness due to their inclusion of continuous speech and sustained vowels. Another multiparametric assessment, ABI, analyzes and detects breathiness mixing during phonation without being unaffected by other features of dysphonia, such as roughness. They discovered that CSID, AVQI, and ABI objectively increase the identification of voice quality problems. Their use is straightforward and their usefulness for physicians is high, in contrast to their demonstrated validity. The authors also reached the same conclusion in a similar study on synthetic voice [33]. The purpose of [PERSON]'s [34] study was to assess the voice in patients with thyroid pathology using two objective indicators with high diagnostic precision. AVQI was used to assess general vocal quality, and ABI was used to assess breathiness, both of which were found to be relevant. Other researchers wanted to use cutting-edge deep learning research to objectively categorize, extract, and assess substitute voicing following laryngeal oncosurgery from audio signals [35]. Their technique had the highest true-positive rate of all of the cutting-edge approaches examined, reaching an acceptable overall accuracy and demonstrating the practical usage of voice quality devices. In a similar study, ASVI was found to be a quick and efficient option after laryngeal oncosurgery [36]. Individuals who have had maxillectomies may have changes in the stomatognathic functions involved in oral communication. Rehabilitative care should prioritize the restoration of these functions by surgical flaps, obturator prosthesis, or both. Improvements in intelligibility and resonance were found in the absence of trans-surgical palate obturators (TPO) in the vocal evaluation performed by [37], and minor hypernasality was discovered in only one instance in the presence of TPO. In a similar study [38], [PERSON] found no statistical significance in the VHI-10 scores over time compared to AVQI. AVQI and comparable instruments were also used in other related areas.