ARTICLE IN PRESS

Acoustic and Aerodynamic Comparisons of Voice Qualities

Produced After Voice Training
*,†Nicholas A. Barone, *Christy L. Ludlow, and †Cari M. Tellis, *Harrisonburg, Virginia, and yDallas, Pennsylvania

Summary: Characteristics of true vocal fold vibration such as the proportion of closed phase of vibration to
open phase, longitudinal tension, and the amount of medial compression are used to define four conditions during
Estill Voice Training. However, it is unknown whether trainees achieve these phonatory differences after training.
Acoustic and aerodynamic measures were used to determine differences in Slack, Thick, Thin, and Stiff condi-
tions. Twenty-four female speech-language pathology graduate students received training perceiving and produc-
ing these four conditions and volunteered to participate 3−5 months later. After a 20-minute refresher training,
participants were recorded using the Phonatory Aerodynamic System with electroglottography and Computer-
ized Speech Lab. Four Estill Voice Training experts independently categorized the voice quality productions.
Aerodynamic and acoustic measures of productions classified by at least three of four experts as having the
intended quality determined if measures differentiated among voice qualities and supported the hypothesized
physiological concepts used in training at Bonferroni corrected P ≤ 0.0063. Results showed that Slack had low
fundamental frequency (fo), low sound pressure level (SPL), and high vibratory instability; Thick had high sub-
glottal pressure (Psg), high SPL, and high vibratory stability; Stiff had high airflow while Thin had lower Psg
than Thick. Seven measures differentiated the four qualities with 88.1% accuracy while only Psg, airflow, and jit-
ter were required to differentiate Thick, Stiff, and Thin with 88.7% accuracy. As acoustic and aerodynamic meas-
ures differentiated among voice qualities and supported the theoretical physiological characteristics used in
training, they could be used to track accuracy during training.
Key Words: Voice qualities−Voice training−Acoustic measures−Aerodynamic measures−Discriminant func-
tion analysis−Classification accuracy.
Abbreviations: fo, fundamental frequency−Hz, Hertz−dB, decibels−Psg, subglottal pressure−SPL, sound
pressure level−NHR, noise-to-harmonic ratio−PAS, Phonatory Aerodynamic System−EGG, electroglotto-
graph−CSL, Computerized Speech Lab−MDVP, Multidimensional Voice Program.

INTRODUCTION a common terminology is to refer to possible physiological

The ability to perceive and produce different voice quali-
ties is important for the understanding and treatment of
people with voice disorders. Graduate students in speech-
language pathology are required to learn to perceptually
differentiate between voice qualities and to control their
voice production system to produce voice qualities accu-
rately and reliably. Voice qualities are auditory-percep-
tual phenomena.1−5 Different categories of voice qualities
may be used for voice training from those used to
describe voice disorders. Further, varying types of experi-
ence and training can contribute to the reliable classifica-
tion of various voice qualities.6,7
A common terminology for describing different catego-
ries of voice quality is needed. One approach to developing
Accepted for publication July 15, 2019.
Funding: Support in part for the first author’s research was provided by the home
institution during his research training program as a PhD student at James Madison
University. These funding sources had no involvement in the study or the develop-
ment of the article for submission reporting the research.
Conflicts of Interest: The authors declare that there is no conflict of interest.
From the *Department of Communication Sciences and Disorders, James Madison
University, Harrisonburg, Virginia; and the yDepartment of Speech Language Pathol-
ogy, Misericordia University, Dallas, Pennsylvania.
Address correspondence and reprint requests to Nicholas A. Barone, Communica-
tion Science and Disorders Program, Department of Human Services, Curry School
of Education and Human Development, University of Virginia, PO Box 400267,
Charlottesville, VA 22904. E-mail: Nab5d@virginia.edu
Journal of Voice, Vol. &&, No. &&, pp. &&−&&
0892-1997
© 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.jvoice.2019.07.011
and anatomical mechanisms that might be used during the
production of different voice qualities.2,8−18 By referring
to hypothesized mechanisms for producing different voice
qualities, both perceptual and production accuracy could
possibly be reinforced during training. The Estill Voice
Training system postulates that different physiological
mechanisms are used to produce different voice qualities
(37−39). Although such an approach may benefit student
training when learning to perceive and produce different
voice qualities, it is unknown whether the different voice
qualities differ on acoustic and aerodynamic attributes
that might support the hypothesized physiological differen-
ces among the voice qualities.
The Estill Voice Training system19,20 postulates a frame-
work for defining voices by the component systems used to
create different voice qualities at the level of the true vocal
folds, and the vocal tract including, but not limited to the
true vocal folds: body and cover, false vocal folds, aryepi-
glottic sphincter, larynx position, and velopharyngeal clo-
sure. For this study, the focus was on the expected
manipulations of the true vocal folds that participants were
expected to use to produce the different voice qualities.
These manipulations refer to vocal fold mass distribution
using changes in length and tension properties, that is, con-
ditions of the body and cover, for the production of different
perceptual voice qualities.21−23 Imaging studies using mag-
netic resonance imaging and x-ray computed tomography
 ARTICLE IN PRESS
2 Journal of Voice, Vol. &&, No. &&, 2019
during the production of voice qualities have indicated pos-
sible differences in vocal fold shapes.24−27 Also, the vertical
depth of contact between the vocal folds during vibration
has been examined using high-speed stereo-endoscopy28
and high-speed endoscopy with laser measurement sys-
tems,29−31 to indicate differences between voice qualities.
Four conditions of the true vocal folds body and cover have
been described based on concepts of the depth of contact of
the folds and longitudinal tension.19,21,23,28,30,32 The four
different conditions are Slack (glottal fry), Thick (modal or
chest voice), Thin (soft clear voice), and Stiff (breathy
voice). For clarity for readers unfamiliar with the Estill
model, in this manuscript, the four conditions (Thick, Thin,
Stiff, and Slack) will be referred to as voice qualities. This
study will examine acoustic and aerodynamic measures of
these four voice qualities to determine if there was acoustic
and aerodynamic evidence of different vocal fold body and
cover conditions for each.
The following explanations are used when teaching per-
ception and production of the four qualities. Thick voice
quality or modal (chest) voice is theorized to involve a pliant
body and cover with a thick, deep contact of the folds along
the full medial edge from the lower to the upper border.19
This deep margin of contact is hypothesized to be due to a
lax vocal ligament with thyroarytenoid muscle activa-
tion.21,32 Complete closure of the folds with full anterior to
posterior vibration is also proposed to occur. Thin voice
quality is theorized to involve a less-flexible body and cover
with a shallow depth of contact of the folds that does not
span the full lower to upper border of the medial edge,
resulting in a rounding and thinning of the edge.19 Complete
closure of the glottal space is hypothesized with full anterior
to posterior vibration. Longitudinal tension is thought to be
applied to the vocal fold due to a tight vocal ligament pre-
venting the lower margin of the vocal folds from coming
into contact.32
Stiff voice quality condition (falsetto and/or breathy
voice) is thought to involve elongated vocal folds with less
contact of the vocal folds without full glottal closure result-
ing in a breathy voice quality.19 Longitudinal tension is
hypothesized creating a thinner margin of vibration21,32 and
the arytenoids may be slightly abducted resulting in a poste-
rior glottal gap. In the Slack condition (glottal fry), the
vocal fold body and cover are hypothesized to be loose
resulting in an inconsistent vibratory pattern due to
increased vibratory mass at points along the vibratory mar-
gin with audible gaps.32 The vocal folds are hypothesized to
be short and flaccid with decreased longitudinal tension cre-
ating a thicker, more compact vocal fold vibratory margin.
Currently, it is not feasible to verify the hypotheses con-
cerning physiological mechanisms of the vocal folds and
cover without invasive high-speed three-dimensional high-
resolution imaging of vocal fold vibration during human
voice production. Based on the hypothesized physiological
differences, however, some acoustic and aerodynamic differ-
ences between these four voice qualities might be expected.
For example, voice intensity may be highest in Thick, lower
in Thin and Stiff, and lowest in Slack. Voice airflow might
be highest in Stiff, lower in Thin and Thick, and lowest in
Slack; and fo might be lowest in Slack, higher in Thick,
higher again in Thin, and highest in Stiff. Because of some
hypothesized differences, subglottal pressure may be highest
in Slack and Thick and reduced in Thin and Stiff. Because
of instability during vibration, the noise-to-harmonic ratio
(NHR) would be lowest in Thick and Thin and higher in
Slack and Stiff. Similarly, instability of the vibratory period
should be greatest in Slack and Stiff and less in Thick and
Thin.
This study examined the production of the four voice
qualities by graduate speech pathology students trained
using the physiological Estill Voice Training concepts
taught within their class on voice disorders. Productions of
these four qualities were recorded from students and then
each production was categorized as one of the four qualities
based on their perceptual judgments independently by exter-
nal reviewers who were experts in Estill Voice Training.
Those productions that were categorized by at least 75% of
the external reviewers as having the same quality as was
intended by the students during production, were then ana-
lyzed using acoustic and aerodynamic measures to examine
(1) whether productions of the four qualities differed on
acoustic and aerodynamic measures of voice production, (2)
whether the four qualities could be discriminated based on
their acoustic and aerodynamic measures, and (3) whether
the acoustic and aerodynamic differences were supportive
of the hypothesized physiological concepts used in training.
METHODS
The protocol and consent were approved by the Internal
Review Board of Misericordia University and James Madi-
son University.
Participants
Potential participants were female students who had com-
pleted a modified version of the Estill Voice Training vocal
quality perception and production training as part of a
Voice Disorders course in a speech-language pathology
master’s degree curriculum 3−5 months prior to the study.
During the voice training, the third author, a certified course
instructor in Estill Voice Training with 13-year experience
teaching these concepts, was the professor teaching the
course along with the student assistant, the first author in
this study. The voice training followed levels 1 and 2 Estill
Voice Training method modified over one semester and
involved approximately 8 hours of direct instruction in the
classroom, additional home practice, and graded (for credit)
assignments including one at the end of the semester when
students were required to produce the voice qualities and
conditions at the completion of the course.
Recruitment for the study took place 3−5 months after
the course was completed and grades had been assigned,
was independent of any coursework, and was entirely volun-
tary. Inclusion criteria were a satisfactory grade on the
 ARTICLE IN PRESS
Nicholas A. Barone, et al Differences in Acoustic and Aerodynamic Measures 3

Voice Disorders course that involved Estill voice quality
training. In addition, after informed consent, participants
were examined by the first author and criteria included that
the participants had a score of 10 or less out of 50 on the
Voice Handicap Index,33 and a score of 10 or less out of 100
on the Consensus Auditory-Perceptual Evaluation of Voice
(CAPE-V)34 on each of the six voice quality features (overall
severity, roughness, breathiness, strain, pitch, and loudness)
at time of admission to the study. Exclusion criteria were a
history of vocal pathology and previous training in voice
performance prior to the Voice Disorders course.
Procedures
Voice quality refresher training
A brief 20-minute refresher training on the target voice
qualities derived from level 1 Estill Voice Training19 was
presented by the first author. Following a review of the four
voice quality conditions (Thick, Thin, Stiff, and Slack), the
participants practiced each of them while receiving trainer
feedback. Participants were instructed to focus on changing
only their true vocal fold body and cover configurations
while maintaining a neutral or consistent vocal tract config-
uration. Spectrographic analysis on Voiceprint Plus 6.0 soft-
ware (Estill Voice International, Pittsburgh, Pennsylvania)
was also used as feedback during training comparing partic-
ipant production spectrographs to expert production spec-
trographic examples provided within the Voiceprint
software. When participants reported that they were able to
produce each target voice quality condition and were judged
by the trainer as accurate in their productions of each of the
conditions, recording was conducted. If a participant was
judged unable, or self-reported they were unable, to ade-
quately produce any of the four conditions, they were
excluded from further participation in the study.
adequacy of the EGG signal was examined on the computer
display. Participants were instructed on securing the mask
around the nose and mouth to provide a good seal and pre-
vent air leakage.
As Smitheran and Hixon35 noted that different fo values
could lead to differences in aerodynamic and acoustic meas-
ures, we chose to control the target fo to reduce these effects
among the three qualities: Thick, Thin, and Stiff. Estill
Training states that Thick, Thin, and Stiff can be produced
at any fo,19,20 so we chose to use the same fo target for these
productions. However, as Slack is characterized by a low
and unstable fo,36 we did not attempt to control the target
fo for this quality. As all potential participants were female,
for Thick, Thin, and Stiff, a pure tone at 262 Hz (C4) was
played as the target fo for a participant to produce on all
targets except Slack.35
During testing, the examiner checked that the pneumo-
tachometer mask was sealed on the participant’s face and
that the lips were sealed around the intraoral tubing during
production of the bilabial plosive /p/. When the participants
reported they were ready, they were instructed to repeat /pi/
five times for each of three trials at the target fo (except for
Slack) while the examiner visually cued the participant to
produce each syllable to ensure an appropriate rate at
approximately 88 beats/min.37 This was followed by pro-
duction of a single /pi/ with the vowel prolonged for 4 sec-
onds with the PAS facemask secured against the face. The
effects of the pneumotachometer on the participants’ per-
ception of their production was reduced as much as possible
by producing target voice quality conditions with the mask
off immediately prior to producing the same target with the
mask on through the pneumotachometer. Data were col-
lected in the following order across all subjects: Thick,
Thin, Stiff, and then Slack.

Preparation of samples for categorizing by external

Post-training recording
reviewers
After 20 minutes of refresher training, participants’ produc-
Following data collection, each of the participants’ produc-
tions were digitally recorded in a sound-treated, quiet room
tions was compiled into .WAV files from the CSL record-
with the Phonatory Aerodynamic System (PAS) with elec-
ings. To determine how accurately participants achieved the
troglottograph (EGG) and the Computerized Speech Lab
target qualities these were provided to external expert
(CSL) running the Multidimensional Voice Program
reviewers. The .WAV files consisted of five productions of
(MDVP; KayPENTAX, Lincoln Park, New Jersey). The
/pi/ for each voice quality recorded from each participant
PAS instrumentation included a facemask with a pneumo-
uploaded to an online survey (Qualtrics, Provo, Utah). The
tachometer (airflow head), an intraoral pressure transducer
survey consisted of 119 audio samples in random order, 96
with tubing placed in the mouth, and a condenser micro-
were participant productions (24 participants with four sam-
phone, inset within the PAS equipment at a fixed distance
ples each) and 23 were randomly repeated samples to be
(16 cm) from the pneumotachometer and previously cali-
used for determining intrarater reliability.
brated for measurement of sound pressure level (SPL) in
dB. The CSL MDVP was used to record the voice for acous-
tic analysis. External reviewers categorizing of voice qualities
Prior to testing, air volume was calibrated for the pneu- Potential reviewers credentialed with the highest level Estill
motachometer for each participant using a 1-L syringe. Voice Training certification were contacted using the Estill
Intraoral pressure in centimeters of water was also cali- International website database of Certified Course Instruc-
brated as part of the PAS system following manufacturer tors. If they agreed to participate, they were sent a link to a
instructions (KayPENTAX). The EGG transducers were Qualtrics survey and asked to review unlabeled WAV file
positioned on the skin over the thyroid cartilage, and the samples, played using Qualtrics. The reviewers were
 ARTICLE IN PRESS
4 Journal of Voice, Vol. &&, No. &&, 2019
instructed to listen to each sample and choose the voice
quality condition from the four categories that best matched
the sample. Reviewers were able to listen to the samples as
often as they wanted before selecting a category. The selec-
tions completed by the expert reviewers were downloaded
from the Qualtrics survey website and transferred to a
spreadsheet for analysis.
Acoustic and aerodynamic measures
Acoustic measures were made using the MDVP software.
Measures were made from 4-second recording of the pro-
longed /i/ vowel after /p/, and included mean fo in Hz, SPL
in dB, jitter percent (percent of cycle to cycle variation in
fo), shimmer percent (percent of cycle-to-cycle variation in
amplitude), and NHR. Using the EGG recordings, the
closed phase quotient (proportion of the cycle when the
vocal folds were closed) was obtained using the PAS soft-
ware. This provided a measure of the proportion of the
vibratory cycle that the vocal folds were in contact.
From the five repetitions of /pi/, the PAS software was
used to automatically derive measures of the estimated peak
subglottal pressure (Psg) in centimeters of water (cm H2O)
and mean airflow during voicing in liters per second (L/s)
from the five /pi/ productions. The PAS software contained
an autothreshold system that only included those produc-
tions meeting the software criteria before computing the
mean values for SPL, Psg, airflow, and EGG closed quo-
tient within an utterance of five /pi/ repetitions. Mean meas-
ures for each production were transferred into a spreadsheet
containing the four target voice quality productions of each
participant.
Statistical analysis
The data were transferred into SYSTAT version 13 and
SPSS version 25 (IBM, Armonk, NY) for statistical analy-
sis. Using the categories identified by each of the external
reviewers, inter-reviewer agreement and intra-reviewer
agreement was measured using Cohen’s Kappa coeffi-
cients.38 To determine which productions were accurate rep-
resentations of one of the four qualities, only the
productions that were categorized by 75% of the external
reviewers as having the same voice quality as was intended
by the participant were selected for analysis. These produc-
tions were used for voice quality comparisons on the acous-
tic and aerodynamic measures using General Linear Model
Analysis of Variance (GLM ANOVA) and discriminant
function analyses (DFA). The GLM ANOVAs compared
the four qualities on each of the acoustic and aerodynamic
measures. To correct for multiple comparisons using eight
measures, the required alpha for statistical significance was
corrected to 0.05/8 = 0.0063, for quality comparison
ANOVAs. If an ANOVA was statistically significant, post
hoc paired comparisons among voice qualities were also
Bonferroni corrected by using P< 0.0063.
As the examiner played a pure tone at 262 Hz (C4) before
the participant produced the vowel or /pi/ repetitions for all
voice qualities except Slack, differences in fo could be
expected based on methodological differences; therefore, fo
was not included as a possible predictor in the DFA examin-
ing whether the measures could predict voice quality. A sub-
sequent stepwise backwards DFA examined which
measures, including fo, could differentiate among Thin,
Thick, and Stiff voice qualities.
RESULTS
Participants
Of the 27 female participants recruited into the study, 24
met all inclusion criteria and were able to produce the four
voice qualities. One was excluded due to a history of voice
pathology (vocal nodules) and two scored above 10 on the
CAPE-V. The participants were between 21 and 35 years of
age (mean 24.2 years).
External reviewers
Six persons were identified with the highest level of certifica-
tion as trainers with Estill Voice Training expertise on the
website and were sent invitations to participate. Four out of
six expert trainers responded to the survey and agreed to
participate. The four external reviewers who completed the
survey had an average of 12.5 years of the highest level of
certification and professionally used the voice quality condi-
tions daily.
Data sets
For each of the 24 participants, four samples, one for each
of the four qualities, were recorded yielding a total of 96
samples. Of those, the PAS readings were inaccurate either
due to mask placement errors, performance errors, or dys-
function of the one of the transducers, on 6 of the 96 record-
ings resulting in 90 accurate items that were classified by the
four external reviewers.
Voice quality classifications by external reviewers
Inter-reviewer reliability
Agreement between the four external reviewers was exam-
ined to determine the inter-reviewer reliability. Cohen’s
Kappa values were computed between classifications by
each reviewer pair using all 90 productions. Table 1 shows
the Kappa values between reviewer pairs. A Kappa value
>0.6 would indicate a good relationship.39 Although all
TABLE 1.
Cohen’s Kappa Values on Inter-Reviewer Agreement on
the 90 Productions Classified by Each External Reviewer
Judge 1 Judge 2 Judge 3
Judge 2 0.808
Judge 3 0.823 0.881
Judge 4 0.821 0.808 0.793
 ARTICLE IN PRESS
Nicholas A. Barone, et al Differences in Acoustic and Aerodynamic Measures
pairs had good inter-reviewer agreement, reviewer 4 had
somewhat lower Kappa values in relation to the other three
reviewers.
Intrajudge reliability
The reviewers differed in their intrareviewer reliability. The
Cohen's Kappa values measuring agreement between
repeated classifications on 23 items were 0.762 for judge 1,
0.941 for judge 2, 0.942 for judge 3, and 0.752 for judge 4.
Agreement between external reviewer classifications
and intended voice quality of productions by
participants
The 90 productions that were used in the Qualtrics surveys
and completed by each of the four external reviewers
resulted in a total of 360 classifications (4 £ 90). As shown
in Table 2, of the 360 productions, 328 were classified by the
external reviewers as having the same voice quality as the
speaker intended that is 91.1%. Of the 92 Slack productions,
all but two were classified as Slack by the four reviewers
(97.8%), while one classification was Thick and one was
Thin. Of the 88 Stiff productions, 82 were classified as Stiff
(93.2%) while 6 classifications were Thin by the reviewers
(6.8%). Of the 92 Thick intended productions, 80 were clas-
sified as Thick (86.9%), 5 as Stiff (5.4%), and 7 as Thin
(7.6%). For the 88 productions intended to be Thin, 76 were
classified as Thin (86.4%), 9 as Stiff (10.2%), and 3 as Thick
(3.4 %). Overall of the 90 productions, 68 (75.6%) were cate-
gorized by all four reviewers as having the speaker intended
voice quality.
Because of the differences in accuracy of some of the pro-
ductions when classified by the four external reviewers, it
was decided to only use those productions where at least
three of the four external reviewers agreed with the voice
quality classification intended by the participant when com-
paring productions on their acoustic and aerodynamic
measures. There were 5 items out of 90 (5.6%) where three
out of the four reviewers did not agree on the same quality
and no quality could be compared with the speakers
intended category. Of the remaining 85 productions, three
reviewers agreed upon the same category as the participant’s
intended voice quality with only one exception; one
TABLE 2.
Classifications of the Productions by External Reviewers and Their Relationship With Intended Voice Quality of the
Participants
Participants Classifications by Judges
Intended Voice Quality Slack Stiff
Slack 90 0 1
Stiff 0 82
Thick 0 5
Thin 0 9
Total 90 96
5
participant’s intended Thin production was classified by
three of the four reviewers as Stiff; therefore, this production
was removed from the data base when using acoustic and
aerodynamic measures to differentiate between productions
of different voice qualities. Of the remaining 84 productions,
all participants had at least one production included for fur-
ther analysis and all were confirmed to have the intended
quality by at least three of the four reviewers.
Differentiation between four voice qualities on
acoustic and aerodynamic measures
GLM ANOVAs between voice qualities on acoustic
and aerodynamic measures
The remaining 84 productions were used in the comparisons
of the four voice qualities of the acoustic and aerodynamic
measures. Figure 1 contains boxplots of the distribution of
values for each acoustic and aerodynamic measure for the
four voice qualities when at least three of the four external
reviewers assigned the same voice quality as the quality
intended by the participant. Table 3 contains the GLM
ANOVAs results and the post hoc paired comparisons. Fol-
lowing Bonferroni correction, alpha was set at ≤0.0063
(0.05/8). The only measure that did not show significant dif-
ferences between qualities was the percent of the cycle that
was closed on the EGG; the others all showed significant
differences between voice qualities on the measures
(Table 3). On SPL, Slack had lower SPL than Stiff, Thick
and Thin, while Thick had a higher SPL than Thin. On Psg,
Thick had a higher pressure than Stiff, Slack, and Thin. On
airflow, Stiff had a higher flow than Slack, Thick, and Thin.
On fo, Slack had a lower fo than Stiff, Thick, and Thin. On
Jitter, Shimmer, and NHR, Slack had a higher level than
Stiff, Thick, and Thin.
Discriminant function analyses among qualities on
acoustic and aerodynamic measures
Before conducting the DFAs to determine if the acoustic
and aerodynamic measures were independent, we examined
the Pearson correlation coefficients among measures for the
data set as a whole of 84 productions and within each qual-
ity. This was particularly a concern as jitter and shimmer
were likely to be related and both could also be related to
Thick Thin Total (% Agreement)
1 92 (97.8)
0 6 88 (93.2)
80 7 92 (86.9)
3 76 88 (86.4)
84 90 360 (91.1)
 ARTICLE IN PRESS
6 Journal of Voice, Vol. &&, No. &&, 2019

FIGURE 1. Boxplots showing the median and the quartile distributions of each of the acoustic and aerodynamic measures in the four voice
qualities, Stiff (SF), Slack, (SK), Thick (TK), and Thin (TN). The measures shown are sound pressure level (SPL) measured in decibels (dB),
estimate of subglottal pressure (Psg) in centimeters of water (cm H2O), airflow in liters per second (L/s), EGG in percent closed phase, funda-
mental frequency (fo) in Hertz (Hz), jitter in percent variability of fo, shimmer in percent dB SPL variability, and noise-to-harmonic ratio
(NHR).

NHR. Although the relationship between jitter and shim-
mer was r = 0.876 (r2 = 0.767) for the data set as a whole the
relationship varied among the four qualities with r = 0.790
for Slack, r = 0.189 for Thick, r = 0.383 for Thin, and
r = 0.848 for Stiff, indicating that the relationships varied
within the different voice qualities. Similar findings occurred
between jitter and HNR with an r = 0.857 (r2 = 0.734) for
the data set as a whole but varied among voice qualities
from r = 0.764 for Slack, r = 0.309 for Thick, r = 0.105 for
Thin, and r = 0.741 for Stiff. Therefore, it was decided to
include all seven remaining measures in the DFAs except
for fo because of methodological differences between testing
for Slack from Thick, Thin, and Stiff when a target fo was
provided.
The DFA differentiating between the four voice qualities
on the 84 productions was able to account for 100% of the

TABLE 3.
Results of the General Linear Model Analysis of Variance for Each of the Acoustic and Aerodynamic Measures Using a ≤
0.0063 for the Quality Comparisons and the Bonferroni Corrected Post Hoc Paired Comparisons
GLM ANOVA Results Post Hoc Comparisons (P Values)
F Stiff Vs Stiff Vs Stiff Vs Slack Vs Slack Vs Thick Vs
Measure Ratio P Slack Thick Thin Thick Thin Thin
SPL 53.154 <0.0005 <0.0005 ns ns <0.0005 <0.0005 <0.0005
Psg 26.915 <0.0005 ns <0.0005 ns <0.0005 ns <0.0005
Airflow 55.361 <0.0005 <0.0005 <0.0005 <0.0005 ns ns Ns
EGG 2.596 ns - - - - - -
fo 228.736 <0.0005 <0.0005 ns ns < .0005 <0.0005 ns
Jitter 25.961 <0.0005 <0.0005 ns ns < .0005 <0.0005 ns
Shimmer 20.306 <0.0005 <0.0005 ns ns < .0005 <0.0005 ns
NHR 73.232 <0.0005 <0.0005 ns ns < .0005 <0.0005 ns
Notes: When comparisons had a probability >0.0063, then the result was designated as nonsignificant (ns). When the initial comparison was “ns” no post hoc
comparisons were conducted designated by “-.”
Abbreviations: SPL, sound pressure level; Psg, subglottal pressure; EGG, % closed phase on electroglottograph; fo, fundamental frequency; NHR, noise-to-
harmonic ratio.
 ARTICLE IN PRESS
Nicholas A. Barone, et al Differences in Acoustic and Aerodynamic Measures 7

TABLE 4.
Wilks’ Lambda, Canonical Correlations, and Eigenvalues for Canonical Discriminant Functions
Test of Wilks’ % of
Functions λ x2 df P rc rc 2 Variance Eigenvalues
1−3 0.037 255.918 21 <0.0005 0.901 0.812 61.5 4.332
2−3 0.196 126.199 12 <0.0005 0.818 0.669 28.8 2.028
3 0.594 40.325 5 <0.0005 0.637 0.406 9.7 0.683
Abbreviations: rc, canonical correlation; rc2, effect size.

variance and significantly differentiate between groups
using the full model test (functions 1 through 3), partial
model test (functions 2 and 3), and the test of function 3
(Table 4). All three functions combined accounted for 100%
of dispersion. A large canonical correlation and effect size
was found for functions 1 and 2; while function 3, although
significant, had only a moderate canonical correlation and
effect size.
The standardized discriminant function coefficients and
structure coefficients were examined to determine which
measurements contributed to group classification. Func-
tion 1 significantly discriminated Slack from all other con-
ditions (Figure 2) with NHR and SPL, and to some extent
jitter and shimmer, primarily contributing to group differ-
ences (Table 5). Function 2 significantly classified Thick
from Thin, Stiff and Slack, and Stiff from Thick, Thin
and Slack (Figure 2) with group differences primarily
dependent on airflow (Table 5). Although function 3 only
accounted for 9.7% of the variance, it still significantly
classified Thin (group centroid = 1.523) from other qual-
ities (Thick centroid = 0.622, Stiff centroid = 0.376, Slack
centroid = 0.264) with subglottal pressure and airflow pri-
marily responsible for group differences.
The classification accuracy using these three functions
was 95.2% for Thick, 94.4% for Thin, 87% for Slack, and
77.3% for Stiff. Slack was low on function 1 (Figure 2) with
high HNR, shimmer and jitter, and low SPL (Figure 1).
Three Slack productions were misclassified, two as Thin
and one as Stiff. Stiff was high on both functions 1 and 2
(Figure 2), and was characterized by high airflow. It had the
lowest classification accuracy, with three misclassified as
Thin, one as Slack, and one as Thick. Thick was high on
function 1 and low on function 2, with high SPL, high Psg
and low NHR, jitter and shimmer. Only one Thick produc-
tion was misclassified as Stiff. Thin was close to zero on
functions 1 and 2, but distinctively low on function 3. It was

FIGURE 2. A plot of the canonical scores of each of the 84 productions based on the discriminant function analysis using seven acoustic
measures to differentiate between Slack, Thick, Thin, and Stiff. Although the model employed three factors only factors 1 and 2 are used to
display the canonical scores for each production.
 ARTICLE IN PRESS
8 Journal of Voice, Vol. &&, No. &&, 2019

TABLE 5.
Standardized Discriminant Function Coefficients (r) and Structure Canonical Coefficients (rs) With Effect Sizes (rs2) for
Seven Acoustic and Aerodynamic Measures for Differentiating Among the Four Voice Qualities: Stiff, Slack, Thick, and
Thin
Function 1 Function 2 Function 3
Variables r rs rs2 r rs rs2 r rs rs2
SPL 0.515 0.652 0.425 0.293 0.204 0.042 0.181 0.316 0.100
Psg 0.044 0.279 0.078 0.502 0.387 0.150 0.708 0.734 0.539
Airflow 0.207 0.401 0.161 0.911 0.778 0.605 0.393 0.474 0.225
EGG 0.053 0.103 0.011 0.014 0.157 0.025 0.031 0.039 0.002
Jitter 0.139 0.440 0.194 0.224 0.201 0.040 0.228 0.284 0.081
Shimmer 0.199 0.408 0.166 0.105 0.068 0.005 0.058 0.218 0.048
NHR 0.921 0.778 0.605 0.026 0.078 0.006 0.764 0.409 0.167
Note: The rs2 provides the percentage of variance accounted for in the composite score for each function.
Abbreviations: SPL, sound pressure level; Psg, subglottal pressure; EGG, % closed phase electroglottograph; NHR, noise-to-harmonic ratio.

low on jitter, shimmer, NHR, SPL, Psg, and airflow with
high classification accuracy and only one misclassification
as Thick.
A pure tone of 262 Hz (C4) was played as a target pitch
immediately prior to the production of three qualities:
Thick, Thin, and Stiff; therefore, with no difference in pro-
cedures between these three qualities, the measure of fo
could be included when acoustic and aerodynamic measures
were examined for differentiation among these three quali-
ties on 62 productions (with Slack removed). A stepwise
backwards DFA was calculated to identify the optimal mea-
sure combination for differentiating between Thick, Thin,
and Stiff. The optimal combination was just three measures:
Psg, airflow, and jitter for the full model test of function 1
and the test of function 2, both of which were significant at
P< 0.0005 (Table 6). A large canonical correlation and
effect size was found for function 1 and a moderate canoni-
cal correlation and effect size was found for function 2. The
two functions accounted for 100% of the dispersion.
For function 1 Stiff was high and Thick was low, and on
function 2 Thin was low (Figure 3). Airflow and Jitter pri-
marily contributed to group differences on function 1 differ-
entiating Stiff from Thick and Thin (Figure 3 and Table 7).
For function 2, Thin was discriminated from Thick and Stiff
based on Psg and airflow. The overall classification accu-
racy was 88.7% correct. Three Stiff productions were mis-
classified as Thin, while one Thick was misclassified as Thin
and two Thin items were misclassified as Thick. The
classification accuracy was 86.4% for Stiff, 95.2% for Thick,
and 88.9% for Thin. Stiff was distinguished by high airflow
and jitter, while Thick had greater subglottal pressure
(Figure 1). Thin had low subglottal pressure compared to
Thick.
DISCUSSION
The purpose of this study was to determine if the concepts
that are used to guide training for the perception and pro-
duction of four voice qualities in Estill Voice Training are
supported by differences in acoustic and aerodynamic meas-
ures among productions of these voice qualities. To assure
that the voice qualities were accurate, four external
reviewers with expert experience in Estill training were
asked to review the productions and independently catego-
rize them as one of the four voice qualities. Overall there
was high agreement between the intended voice qualities
and the categories assigned by the external reviewers. This
agreement was greatest for Slack and high for Stiff, with
both well over 90% accuracy. Thick and Thin were less
accurate with percent correct in the mid 80%, with some dis-
agreement between these two categories and with Stiff.
The DFA examined the acoustic and aerodynamic meas-
ures that characterized each of the four qualities. Seven
measures were included; as a target fo was not included dur-
ing the procedure for Slack while the other three required
the participant to match a 262-Hz (C4) tone, fo was

TABLE 6.
Wilks’ Lambda, Canonical Correlations, and Eigenvalues for Canonical Discriminant Functions for Backwards Stepwise
Discriminant Functions Between Stiff, Thick and Thin
Test of Wilks’ % of
Functions λ x2 df P rc rc2 Variance Eigenvalues
1 and 2 0.117 122.525 6 <0.0005 0.887 0.787 81.6 3.689
2 0.546 34.443 2 <0.0005 0.673 0.453 18.4 0.830
Abbreviations: rc, canonical correlation; rc2, effect size.
 ARTICLE IN PRESS
Nicholas A. Barone, et al Differences in Acoustic and Aerodynamic Measures 9

FIGURE 3. Canonical score plot shows the functions 1 and 2 canonical scores for Stiff, Thick, and Thin from a stepwise discriminant func-
tion analysis that employed three measures: estimate of subglottal pressure (Psg) in centimeters of water (cm H2O), airflow in liters per sec-
ond (L/s), and Jitter in percent variability of fo.

excluded. Two qualities were accurately categorized, 95%
for Thick and 94% for Thin by the measures on the initial
DFA. Thus, although external reviewers judged participants
as less able to produce Thick and Thin, these qualities had
few classification errors based on the DFA. The only error
for Thick was one misclassification as Stiff, and Thin had
only one erroneously classified as Thick.
Thick voice quality, or modal (chest) voice, is theorized to
involve a pliant body and cover with a deep contact of the
folds along the full medial edge from the lower to the upper
border and complete closure of the folds with full anterior
to posterior vibration.19 The Thick deep margin of contact
is hypothesized to be due to a lax vocal ligament with thyro-
arytenoid muscle activation.21,32 These characteristics
would predict no loss of air between pulses, thus low
TABLE 7.
Standardized Discriminant Function Coefficients (r) and
Structure Canonical Coefficients (rs) With Effect Sizes
(rs2) of Stepwise (Backward) Discriminant Function
Analysis Selecting the Best Combination of Measures
for Differentiating Among Stiff, Thick, and Thin From
Seven Acoustic and Aerodynamic Measures
Function 1 Function 2
2 would predict high airflow, which was the main distinguish-
Variables r rs rs r rs
Psg 0.505 0.303 0.092 0.857 0.945 0.893
Airflow 0.691 0.636 0.404 0.314 0.564 0.318
Jitter 0.595 0.685 0.469 0.088 0.147 0.022
airflow, a high subglottal pressure, and low HNR, jitter,
and shimmer. The results showed that Thick was character-
ized by high SPL, high subglottal pressure, and low HNR,
jitter, and shimmer, which is in agreement with the concepts
used in training Thick.
The Thin voice quality is theorized to have a less-flexible
body and cover with a shallow depth of contact of the folds
that does not span the full lower to upper border of the
medial edge.19 Complete closure of the glottal space is
hypothesized with full anterior to posterior vibration. Lon-
gitudinal tension is thought to be applied to the vocal fold
due to a tight vocal ligament preventing the lower margin of
the vocal folds from coming into contact.32 These character-
istics would predict less SPL and less subglottal pressure
than Thick, with similar airflow, all of which were found.
The one misclassification for Thin was as Thick. The only
distinguishing differences for Thin were the lower SPL and
lower Psg than Thick.
Stiff voice quality condition (falsetto and breathy voice) is
thought to be due to the elongated vocal folds being Stiff,
with less contact of the vocal folds without full glottal clo-
sure resulting in a breathy voice quality.19 Longitudinal ten-
sion is hypothesized creating a thinner margin of
vibration.21,32 In Stiff, the arytenoids may slightly abducted
resulting in a posterior glottal gap. These characteristics
rs 2
ing measure for Stiff. Stiff, however, had the highest number
of misclassifications with only 77% classified correctly, with
three misclassified as Thin, one misclassified as Slack, and
one as Thick. This suggests that Stiff was slightly more diffi-
cult to characterize using the acoustic and aerodynamic
 ARTICLE IN PRESS
10
measures. Stiff productions, however, were accurately clas-
sified by the external reviewers when compared with the
intended production classification at 93.2%. Thus, Stiff
proved to be easily learned by the participants.
In the Slack condition (glottal fry), it is hypothesized that
the vocal fold body and cover are loose resulting in a very
slow vibratory pattern due to increased vibratory mass with
audible gaps.32 The vocal folds are hypothesized to be short
and flaccid with decreased longitudinal tension creating a
thicker, more compact vocal fold vibratory margin. This
would predict a low fo, a high proportion of closed phase
on the EGG, and high instability of vibration increasing
NHR, jitter, and shimmer. The results found high NHR
and high shimmer, low airflow, and low SPL. In addition,
Slack was characterized by a low fo.
To improve classification accuracy between Thick, Thin,
and Stiff, Slack was removed and fo was included and a
stepwise backwards DFA conducted. The percent correct
classification increased in the stepwise DFA, from 77% to
86.4% for Stiff, while Thick and Thin continued to have
95% and 89% classification accuracy while using Psg, air-
flow, and jitter. Therefore, fo did not differentiate between
Stiff, Thick, and Thin, perhaps because a 262-Hz tone was
played before each production of these three voice qualities.
Accordingly, voice training enabled the participants to
achieve relatively good accuracy in producing the types of
voice qualities and these in turn could be differentiated
using acoustic and aerodynamic measures that would be
expected based on the theoretical concepts used in the Estill
Voice Training System. Ideally, direct measures of vocal
fold lengthening, depth of contact from the superior to infe-
rior surface of the medial edge of the vibrating folds, and
muscle contraction would provide the most accurate feed-
back to trainees on their achievement of the physiological
parameters intended for each production. Such measures,
however, are not feasible during voice production without
significant interference using invasive methods such as rigid
endoscopy with lasers for measuring vocal fold length accu-
rately, three-dimensional high-speed high-resolution imag-
ing (not yet available), and laryngeal electromyography.
Besides the theoretical concepts being provided to guide
trainees, facilitation during training is dependent upon
feedback by experts. In addition, with training, trainees
may be gaining perceptual accuracy in distinguishing their
voice productions of the four qualities. Given that the
acoustic and aerodynamic measures used here were found
to distinguish between the four voice qualities, perhaps the
measures of SPL, Psg, airflow, fo, and NHR could be used
along with spectroscopy for monitoring trainees’ produc-
tion accuracy in addition to perceptual judgments by
experts during training.
This study had several limitations. First, only female par-
ticipants were studied; it is unknown whether male trainees
would have similar results after participating in Estill Voice
Training. Second, no systematic information was gathered
on the amount of training that is needed for trainees to gain
accuracy in producing each of the voice qualities. It can be
Journal of Voice, Vol. &&, No. &&, 2019
stated, however, that overall participants had good carry-
over from their initial training (3−5 months prior to testing)
as shown by the high accuracy at producing the target
sounds as judged by three out of four expert judges.
Third, the trainees were not assessed on their perceptual
accuracy in classifying voice quality productions; only the
accuracy of their productions was assessed by experts in the
Estill Voice Training methods.
Fourth, by using the Phonatory Aerodynamic System
with the Smitheran and Hixon35 technique for estimating
subglottal pressure Psg, we were able to examine whether
changes in subglottal pressure occurred between the differ-
ent voice qualities. The results demonstrated that Psg was
among the best combination of measures for differentiating
among Stiff, Thick, and Thin as Thick had higher estimated
levels of subglottal pressure. However, the use of the /pi/
repetition task with the Phonatory Aerodynamic System
was not a usual voicing task and eliminated the ability to
image the vocal folds during recording. The need for the
pneumotachometer mask and to seal the lips during the /p/
closure to measure intraoral pressure placed some con-
straints on the participants. In spite of this, however, they
were able to produce samples that were judged by the exter-
nal reviewers as being representative of the four different
voice qualities. Thus, we were unable to measure vocal fold
length, configuration, or opening during vibration to con-
firm that the intended vocal fold configuration was
achieved.
A separate study using rigid stroboscopy for high-speed
video recording with parallel lasers for distance calibration
into millimeters would be required. However, as rigid stro-
boscopy requires that the mouth is held open and the tongue
protruded, this can alter vocal fold configuration. Other
vocal fold imaging techniques such as magnetic resonance
imaging and computed tomography require that the subject
maintain the same position for many seconds to complete a
scan, which is not possible during syllable repetition. Thus,
imaging to confirm the vocal fold configuration used for
each production presents challenges and would need to be
conducted in a separate study.
We did not ask the participants to report the amount of
effort they required to produce the different intended voice
qualities. This would have been of interest particularly as it
was 3−5 months after they had completed their Estill Voice
Training.
This study involved four expert listeners for categorizing
the productions as representing qualities based on Estill
Voice Training and might therefore be considered a first test
of this approach. Although a large number of expert listen-
ers might be optimal, this might increase the interexaminer
differences if experts were included with a wide range of
experience and skill in Estill Voice Training.
In conclusion, although indirect, the acoustic and aerody-
namic measures of the four voice qualities did show support
for the physiological concepts used in the Estill Voice Train-
ing method. Overall, Slack had a low fo, low SPL, and high
vibratory instability. Thick was characterized by high
 ARTICLE IN PRESS
Nicholas A. Barone, et al Differences in Acoustic and Aerodynamic Measures
subglottal pressure, high SPL, and good vibratory stability.
Stiff was characterized by high airflow and Thin had lower
subglottal pressure than Thick. These measures were able to
differentiate among the four voice qualities and might be
used for assessing production accuracy during training.
SUPPLEMENTARY DATA
Supplementary data related to this article can be found
online at https://doi.org/10.1016/j.jvoice.2019.07.011.
REFERENCES
1. Zraick RI, Kempster GB, Connor NP, et al. Establishing validity of
the consensus auditory-perceptual evaluation of voice (CAPE-V). Am
J Speech Lang Pathol. 2011;20:14–22.
2. Kreiman J, Gerratt BR. Perceptual assessment of voice quality: past,
present, and future. SIG 3 Persp Voice Voice Disord. 2010;20:62–67.
3. Eadie TL, Baylor CR. The effect of perceptual training on inexperienced
listeners' judgments of dysphonic voice. J Voice. 2006;20:527–544.
4. Shrivastav R, Sapienza CM, Nandur V. Application of psychometric
theory to the measurement of voice quality using rating scales.
J Speech Lang Hear Res. 2005;48:323–335.
5. Shrivastav R. Multidimensional scaling of breathy voice quality: indi-
vidual differences in perception. J Voice. 2006;20:211–222.
6. Kreiman J, Gerratt BR, Precoda K, et al. Individual differences in
voice quality perception. J Speech Lang Hear Res. 1992;35:512–520.
7. Kreiman J, Gerratt BR, Precoda K. Listener experience and percep-
tion of voice quality. J Speech Lang Hear Res. 1990;33:103–115.
8. Bassich CJ, Ludlow CL. The use of perceptual methods by new
clinicians for assessing voice quality. J Speech Hear Disord. 1986;51:
125–133.
9. De Bodt MS, Wuyts FL, Van de Heyning PH, et al. Test-retest study
of the GRBAS scale: influence of experience and professional back-
ground on perceptual rating of voice quality. J Voice. 1997;11:74–80.
10. de Krom G. Some spectral correlates of pathological breathy and
rough voice quality for different types of vowel fragments. J Speech
Lang Hear Res. 1995;38:794–811.
11. Fex S. Perceptual evaluation. J Voice. 1992;6:155–158.
12. Gelfer MP. Perceptual attributes of voice: development and use of rat-
ing scales. J Voice. 1988;2:320–326.
13. Kempster GB, Kistler DJ, Hillenbrand J. Multidimensional scaling
analysis of dysphonia in two speaker groups. J Speech Lang Hear Res.
1991;34:534–543.
14. Kent RD. Hearing and believing: some limits to the auditory-percep-
tual assessment of speech and voice disorders. Am J Speech Lang
Pathol. 1996;5:7–23.
15. Laver JD. Voice quality and indexical information. Int J Lang Com-
mun Disord. 1968;3:43–54.
16. Sonninen A, Hurme P. On the terminology of voice research. J Voice.
1992;6:188–193.
17. Sonninen A. Phoniatric viewpoints on hoarseness. Acta Otolaryngol.
1970;69:68–81.
18. Yumoto E, Sasaki Y, Okamura H. Harmonics-to-noise ratio and psy-
chophysical measurement of the degree of hoarseness. J Speech Lang
Hear Res. 1984;27:2–6.
11
19. Klimek MM, Obert K, Steinhauer K. The Estill Voice Training Sys-
tem, Level One: Compulsory Figures for Voice Control. Estill Voice
Training Systems International, LLC; 2005.
20. De Bot K, Lowie W, Verspoor M. A dynamic systems theory approach
to second language acquisition. Bilingualism Lang Cognit. 2007;10:
7–21.
21. Van den Berg J. Myoelastic-aerodynamic theory of voice production.
J Speech Lang Hear Res. 1958;1:227–244.
22. Hirano M. Morphological structure of the vocal cord as a vibrator and
its variations. Folia Phoniatr Logop. 1974;26:89–94.
23. Titze IR. On the mechanics of vocalfold vibration. J Acoust Soc Am.
1976;60:1366–1380.
24. Story BH. An overview of the physiology, physics and modeling of the
sound source for vowels. Acoust Sci Technol. 2002;23:195–206.
25. Story BH, Titze IR, Hoffman EA. The relationship of vocal
tract shape to three voice qualities. J Acoust Soc Am. 2001;109:
1651–1667.
26. Bergan CC, Titze IR, Story B. The perception of two vocal qualities in
a synthesized vocal utterance: ring and pressed voice. J Voice.
2004;18:305–317.
27. Samlan RA, Story BH. Relation of structural and vibratory kinematics
of the vocal folds to two acoustic measures of breathy voice
based on computational modeling. J Speech Lang Hear Res. 2011;54:
1267–1283.
28. Sommer DE, Tokuda IT, Peterson SD, et al. Estimation of inferior-
superior vocal fold kinematics from high-speed stereo endoscopic data
in vivo. J Acoust Soc Am. 2014;136:3290–3300.
29. Semmler M, Kniesburges S, Birk V, et al. 3D reconstruction of human
laryngeal dynamics based on endoscopic high-speed recordings. IEEE
Trans Med Imaging. 2016;35:1615–1624.
30. Semmler M, D€ ollinger M, Patel RR, et al. Clinical relevance of endo-
scopic threedimensional imaging for quantitative assessment of pho-
nation. Laryngoscope. 2018;128:2367–2374.
31. de Mul FF, George NA, Qiu Q, et al. Depth-kymography of vocal fold
vibrations: part II. Simulations and direct comparisons with 3D profile
measurements. Phys Med Biol. 2009;54:3955.
32. Titze IR. Principles of Voice Production. Iowa City, IA: National Cen-
ter for Voice and Speech; 2000.
33. Jacobson BH, Johnson A, Grywalski C, et al. The voice handicap
index (VHI): development and validation. Am J Speech Lang Pathol.
1997;6:66–70.
34. Kempster GB, Gerratt BR, Abbott KV, et al. Consensus auditory-per-
ceptual evaluation of voice: development of a standardized clinical
protocol. Am J Speech Lang Pathol. 2009;18:124–132.
35. Smitheran JR, Hixon TJ. A clinical method for estimating laryngeal
airway resistance during vowel production. J Speech Hear Disord.
1981;46:138–146.
36. Gottliebson RO, Lee L, Weinrich B, et al. Voice problems of future
speech-language pathologists. J Voice. 2007;21:699–704.
37. Grillo EU, Verdolini K. Evidence for distinguishing pressed, nor-
mal, resonant, and breathy voice qualities by laryngeal resistance
and vocal efficiency in vocally trained subjects. J Voice.
2008;22:546–552.
38. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med.
2012;22:276–282.
39. Fleiss JL. Design and Analysis of Clinical Experiments. John Wiley &
Sons; 2011.