# Pareto-Optimized AVQI Assessment of Dysphonia: A Clinical Trial Using Various Smartphones
## 2 State of the Art Review
### Measurement of the Effects of Vocal Fatigue and Related Impairments  
Measurement of the effects of vocal fatigue and related impairments is another well-established approach. Vocal loading tasks (VLTs) allow researchers to collect acoustic data and study how a healthy speaker alters their voice in response to obstacles. Such instruments can provide detailed voice information and aid speech pathologists in determining whether the vocal activity of instructors at work should be regulated or not [43]. There is a paucity of research on the effect of the talking rate in VLT on acoustic voice characteristics and vocal fatigue [44]. Vocal effort is widespread and frequently leads to decreased respiratory and laryngeal efficiency. However, it is not known whether the respiratory kinematic and acoustic adaptations used during vocal exertion differ between speakers who express vocal fatigue and those who do not. Ref. [45] evaluated respiratory kinematics and acoustic measurements in people with low and high degrees of vocal fatigue while performing a vocal exertion task. Ref. [46] looked at clinically normal voices with no history of vocal problems and assessed weariness. The Vocal Fatigue Index (VFI) was used for the subjective study of vocal loading, while the acoustic and cepstral analysis of voice recordings was used in both circumstances for objective analysis. The results demonstrated that there was a substantial difference in VFI scores between the two circumstances. The acoustic and cepstral properties of the voice also differed significantly between the two circumstances, a result also confirmed in the study [47]. A similar study [48] was conducted with VFI and the Borg vocal effort scale. Before, during and after periods of speaking, they objectively examined fluctuations in relative sound pressure level, frequency response, pitch intensity, averaged cepstral peak amplitude, and AVQI. AVQI was also used to evaluate the characteristics, vocal complaints, and habits of musicians and students of musical theater. Given the mismatch of high vocal requirements vs. poor vocal education, and hence greater risk for voice issues, choir singers' voice usage remains understudied. With mean scores on the Dysphonia Severity Index and AVQI, choir members demonstrated exceptional voice quality and capabilities [49]. The mean grade score corresponded to a normal to somewhat aberrant voice quality in terms of auditory perception. Patient-reported outcome measures revealed significant deviation scores, indicating significant singing voice impairment. Choir singers appear to be particularly prone to stress, with a high incidence rate. After 15 min of choir singing, the severity index of dysphonia improved considerably compared to the control group, although the self-perceived presence of fatigue and voice complaints increased. In both groups, the fundamental frequency rose. [PERSON] et al. [50] conducted a study on musical theater actors who had comparably good objective voice measurements (DSI, AVQI). There has been an upsurge in the number of VTDs and complaints about the singing voice. The AVQI was used to identify people who were susceptible to stress, vocal misuse, VTD, and pain symptoms. The purpose of [51] was to see if the voices of actors and actresses could be cognitively identified as being more resonant after an intensive Lessac Kinesnsic training workshop and to see if AVQI, ABI, and their acoustic measures could indicate classified voices as being more resonant. Unfortunately, statistical analysis that compared perceptual and auditory data for the final samples was not possible. [PERSON] conducted a similar study and discovered that professional actors had stronger vocal abilities than non-professionals [52]. The voice quality of the dancers is inferior to that of the actors. The findings reveal that one performance has little effect on vocal quality among theater performers and dancers. Nonetheless, the long-term consequences of performance are still being studied.