On Acoustic Voice Quality Index measurement reliability in digital health applications: A narrative review and empirical evaluation of speech sample length requirements

Fredrik Nylén^*

• Umeå University, Umeå, Sweden

The Acoustic Voice Quality Index (AVQI) is a widely adopted tool for assessing dysphonia, incorporating sustained vowel and continuous speech samples to enhance ecological validity. Despite its broad use, the reliability of AVQI measurements, particularly in digital health applications, remains underexplored. This study aims to review the literature on AVQI's development and validation from the perspective of internal consistency of acoustic measurements, and to assess the amount of speech required to reliably determine the AVQI of a voice recording. Two sub-studies are described. Study 1: A narrative review was conducted using Google Scholar and Scopus to identify studies mentioning "AVQI" and "reliability". Key methodological details were extracted from studies reporting AVQI measurements, summarized, and discussed in terms of how the internal consistency of acoustic measurements was ensured across studies where AVQI had been validated or applied. Study 2: Recordings of sustained vowels, as well as read and spontaneous speech, from 54 native Swedish speakers (22 female, 32 male; age range: 46-78 years) were assessed in terms of the amount of speech required to obtain a reliable acoustic measurement of the speakers' voices. Simulations were performed using read and spontaneous speech materials of varying lengths. The variability in AVQI and its sub-measures was analyzed relative to the length (in words or in seconds) of continuous speech included. The result of study 1 shows that out of 129 identified studies, 85 reported on AVQI measurements that had been performed. The review highlighted substantial variability in continuous speech lengths used across studies, ranging from 4 to 200 words. A recommendation of 3 seconds of voiced segments was often adhered to, but was found to lack sufficiently robust grounding. The simulations indicated that AVQI achieves internal consistency at speech lengths of approximately 50 words (or 20 seconds), which is longer than the current recommendation. Both read and spontaneous speech provided stable AVQI measurements at these speech lengths. AVQI thresholds obtained using speech lengths shorter than 50 words (20 seconds) may require re-evaluation. Robust standardization of continuous speech lengths is essential for the successful adoption of AVQI in digital health applications.