# Pareto-Optimized AVQI Assessment of Dysphonia: A Clinical Trial Using Various Smartphones
## 2 State of the Art Review
### Language Factors in Voice Quality Analysis  
Voice quality metrics have been found to be useful and efficient in the analysis of a variety of very different spoken languages. The purpose of the [54] study was to confirm the impact of different cultural origins and languages (Brazil Portuguese and European Portuguese) on the perception of voice quality. Another goal was to evaluate the relationship between clinical auditory perception assessments and acoustic measures such as AVQI and ABI, as well as their influence on concurrent validity. They discovered that Brazilian raters evaluated voice quality as more deviant and that Brazilian voice samples were less severe (a possible language characteristic). More research is needed to determine whether there was a task or a sample consequence, as well as whether revisions to the AVQI and ABI formulations are needed for Brazilian Portuguese. A similar assessment was made for the Italian speaking population [55]. The auditory perceptual RBH scale (roughness, breathiness, and hoarseness) and acoustical analysis using AVQI validated dysphonia in a study of the Polish population using recorded voice [56]. [PERSON] [57] explored the verification of AVQI in the South Indian population and found it to be superior in terms of diagnostic precision and internal consistency. [PERSON] et al. sought to validate the AVQI version 3.01 and ABI as acoustic analysis tools in Korean [58]. They discovered that AVQI and ABI had good concurrent validity in quantifying the severity of dysphonia with respect to OS and B in a sample of Korean speakers. A further investigation of the Korean population found that each measure had a strong discriminative ability to distinguish the presence or absence of voice difficulties [59]. The findings of this study might be used as an objective criterion to detect voice disorders. According to [60], the AVQI is a robust multiparametric measure that can reliably differentiate between subcategories of severity of perceptual dysphonia with good accuracy in Kannada. Moreover, AVQI has been shown to be useful in analyzing signals with greater degrees of aperiodicity, such as extreme hoarse voice quality [7]. The AVQI was lower (better) in samples with a high degree of strain for Finnish speakers, but the variation was not substantial [61]. Only CPPS distinguished between modest and large degrees of crack. With normophonic speakers, the AVQI does not appear to distinguish between low and high levels of crack and strain. [PERSON] [62] investigated the validity (both concurrent and diagnostic) and the test-retest reliability of AVQI in a Turkish speaking community. The link between AVQI scores and auditory perception rating of total voice quality was statistically significant. The dysphonic voice was assigned a necessary threshold by AVQI. Intraclass correlation coefficient values using a two-way mixed effects model, single-measures type, and absolute agreement definition demonstrated high test-retest reliability for the AVQI in Turkish. Furthermore, the considerable values of concurrent validity and diagnostic accuracy of both versions of AVQI-Persian were verified, demonstrating that it can distinguish between normal and diseased voices in Persian speakers [63]. As a conclusion, it is clear that AVQI and similar metrics can be utilized for language-independent screening or diagnosis.