# 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  
Naturally, the medical domain is the primary field in which impairment and acoustic measures can be used to accurately assess overall voice quality in numerous medical pathologies [16] and therapies [17].To reduce the danger of voice problems in those who rely heavily on their voices, such as teachers, vocal screening is essential from the start of their professional studies. A dependable and precise screening instrument is required. AVQI has been shown to distinguish between normal and disordered voices and to be a therapy outcome measure. The purpose of the study of [18] was to see whether the AVQI could be used as a screening tool in conjunction with auditory and self-perception of the voice to differentiate between normal and somewhat inferior voices. [PERSON] et al. [19] sought to assess the accuracy of AVQI and its isolated acoustic measurements to distinguish voices with varying degrees of deviation in severity of disorder. The results showed that the AVQI is a reliable instrument for distinguishing between different degrees of vocal deviation, and that it is more accurate for voices with moderate and severe abnormalities. When identifying voices with a higher degree of variation, isolated acoustic measurements perform better. Their other investigation [20] discovered that AVQI had the highest accuracy at a length tailored. To improve the reliability of voice analysis, a systematic approach should be followed, along with a specific speech material control that allows comparability between clinics and voice centers. A combination of acoustic measures with the same weight is more accurate in distinguishing different degrees of departure but is inconsistent. In clinical voice practice, outcome measures measuring acoustic voice quality and self-perceived vocal impairment are often utilized. Earlier studies on the link between acoustic and self-perceived measures have indicated relatively minor correlations, but it is unclear whether acoustic measurements connected with voice quality and self-perceived voice handicap become altered in a comparable way throughout voice therapy. As a result, the [21] study looked at the association between the degree of change in AVQI and the Voice Handicap Index (VHI). Voice treatment provided in a community voice clinic to individuals with various diseases was also shown to be successful, as evaluated by improvements in VHI and AVQI [22]. During the COVID-19 pandemic, the use of nose-and-mouth cover respiratory protection masks (RPMs) has become widespread. The effects of wearing RPMs, particularly on the perception and production of spoken communication, are increasingly emerging and their impact on medical voice analysis devices is significant [23]. The effects of face masks on spectral speech acoustics were evaluated in the [PERSON] investigation [24]. Speech intensity, spectral moments, spectral tilt, and energy in mid-range frequencies were among the outcome metrics examined at the utterance level. Although the impact magnitude varied, masks were associated with changes in spectral density characteristics consistent with a low-pass filtering effect. The center of gravity, spectral diversity (in habitual speech), and spectral tilt had greater impacts (in all speech styles). KN95 masks outperformed the surgical masks in terms of speech acoustics. The general pattern of acoustic speech alterations was consistent between the three speaking styles. Compared to habitual speech, loud speech followed by clear speech was successful in removing the filtering effects of masks. In a similar study, [PERSON] discovered that wearing COVID-19 protective masks did not significantly degrade the findings of AVQI or ABI based on a selected sample of healthy or minimally impaired voices [25]. According to [PERSON] voice research [26], AVQI incorporates acoustics from both vowel and sentence settings and therefore may be preferred to CPPS (vowel) or CPPS (sentence).