Indian J Otolaryngol Head Neck Surg
https://doi.org/10.1007/s12070-021-02757-9
ORIGINAL ARTICLE
Acoustic Voice Analysis of Normal and Pathological Voices
in Indian Population Using Praat Software
Prashant Hippargekar1 • Sudhir Bhise1 • Shankar Kothule1 • Sharad Shelke1
Received: 26 April 2021 / Accepted: 4 July 2021
Ó Association of Otolaryngologists of India 2021
Abstract Acoustic voice analysis is still a valuable tech-
nique which enables voice clinicians to compare voices to
differentiate them into normal and abnormal. The present
study was undertaken to standardize acoustic voice
parameters in normal healthy adult individuals and gender
comparison among them and also acoustic voice analysis
of pathological voices and it’s comparison with normal
healthy voices. Voice samples of vowels /a/, /i/ and /u/ of
80 normal healthy adults (males = 40, females = 40) of
control group and 40 patients with dysphonic voice of case
group collected and acoustic voice parameters were
extracted by using Praat software. There were statistically
significant higher values of fundamental frequency (F0) in
females, while jitter local (%), shimmer local (%) and
harmonic to noise ratio (HNR) had no gender differences in
normal healthy voices. Pathological voices of case group
subjects with laryngeal pathologies had statistically sig-
nificant higher values of jitter local (%), shimmer local (%)
and lower values of HNR as compare to normal healthy
voices of control group. Objective voice analysis by using
Praat software is convenient, reliable and cost effective
method. This study establishes normative acoustic voice
parameters in normal healthy adults. There are no gender
differences in adult healthy voices except fundamental
frequency (F0), which is higher in females. Patients who
are with dysphonic voices due to laryngeal pathologies had
altered values of acoustic parameters compared to normo-
phonic adults and clinicians can precisely differentiate
pathological voices from normophonics.
& Sharad Shelke
sbshelke996@gmail.com
1
Swami Ramanand Teerth Rural Govt. Medical College,
Ambajogai, state Maharashtra, India
Keywords Acoustic voice analysis

Fundamental frequency (F0)
Jitter
Shimmer

Harmonics-to-noise ratio (HNR)
Praat software
Introduction
Voice can be defined as the laryngeal modulation of the
pulmonary air stream, which is then further modified by the
configuration of the vocal tract. [1] Since, speech is the
most important means of communication and expression,
any voice disorder can bring about deep implications to
social life. [2] Assessment of voice can be done with
qualitative and quantitative measures. Qualitative assess-
ment is done subjectively either by patient himself or by
professionals. Voice Handicap Index (VHI) and other such
grading systems are subjective measures of voice analysis
by patient himself. American Speech Language and
Hearing Association (ASHA) has developed Consensus
Auditory Perceptual Evaluation of Voice (CAPE-V) for
perceptual assessment of voice by professionals. [1]
Objective voice assessment methods analyze voices by
devices which are capable of measuring several acoustic
parameters, as stated by Almeida. [3] Many software has
been developed for this purpose, namely, Praat, [4] Dr.
Speech [5] and Multidimensional Voice Program etc. [6]
Praat (Boersma & Weenink 1992–2013), a general set of
tools for analysing, synthesizing and manipulating speech
and other sounds bundled into a single integrated computer
program. Many published studies on voice conditions in
the international literature have demonstrated the func-
tionality of the Praat software for differentiating patho-
logical from normal voice. Since it is free and easily used
software for all current major computer platforms
123

(nowadays MacOS, Windows, Linux) and continually
updated to accommodate new operating system develop-
ments and new analysis methods. It has been applied in
voice research worldwide. There is an online discussion
group on its website to foster debates and clearing of
doubts among users and software creators. [7]
Currently, acoustic voice parameters, commonly used in
applications of acoustic analysis as well as the most ref-
erenced in the literature, are the fundamental frequency
(F0), jitter, shimmer and harmonic to noise ratio (HNR).
[8, 9] However, acoustic voice analysis is an objective,
non-invasive, easy-to-use assessment method, that offers
indirect data of the vocal function through specific mea-
sures, in normal and pathological conditions, assisting in
the diagnostic process and in the monitoring of the treat-
ment of vocal alterations. [10] Standardization of the
acoustic data has significant implications for voice clini-
cians, students of speech and language pathology and
manufacturers of the instrumentations, regarding one’s
vocal health. Research in this field is still in its early stages
in India, and no study had been found to standardize the
acoustic parameters by using Praat software. The current
study was designed to standardize the acoustic voice
parameters in healthy adult individuals in India and to find
out differences in pathological voice acoustic parameters
and its characteristics.
Materials and Methods
Study Design and Ethical Aspects
This study was observational, cross-sectional study and
approved by the Research Ethics Committee on Human
Beings of the home institution, performed after all the
participants signed the Informed Consent Form.
Research Subjects
Voice differs between the genders and undergoes changes
throughout the lifetime, with greater vocal stability
observed in the adulthood. [10] The target population for
this study comprised both men and women, with a mini-
mum age of 21 years as voice alterations are commonly
occur during puberty. The maximum age was 50 years
because the voice is also modified because of aging of the
vocal mechanism. The present study comprises of mainly 2
groups- Control group having healthy voices (40 males and
40 females) and Case group having pathological voices (23
males and 17 females). The study participants were inter-
viewed at the time of voice recordings by a speech-lan-
guage therapist and answered a questionnaire, containing
questions related to the general health conditions,
123
Indian J Otolaryngol Head Neck Surg
menopause (in the case of women), vocal habits, as well as
complaints related to speech, voice and hearing disorders.
Inclusion Criteria for Control Group
Participants of both genders, within the established age
range (21–50 years), without any voice related complaints.
All the participants undergo auditory perceptual evaluation
by one speech language therapist. Speech language thera-
pist also simultaneously scales each subjects’ voice
according to GRBAS scale, [11] for sustained vowel /a/
and those subjects having score zero, were included. The
GRBAS (Grade, Roughness, Breathiness, Asthenia and
Strain) scheme is probably the most widely used, partly
due to its relative simplicity. Each dimension (overall
Grade of voice, Roughness, Breathiness, Ashtenia and
Strain of voice) is rated on a four-point scale by a speech
and language therapist, where 0 = no perceived abnor-
mality, 1 = mild, 2 = moderate and 3 = severe abnormal-
ity and finally total GRBAS score calculated by averaging
all scores. In addition to this, subjects having normal
laryngeal examination on video directed laryngoscopy
(VDL) done by ENT surgeon were included in the study.
Exclusion Criteria for Control Group
Participants had past history of neurological or pulmonary
diseases, head and neck surgery, smoking, speech or
hearing complaints, according to questionnaires or who
reported cold or allergic respiratory conditions on the day
of collection of voice sample or who were unable to per-
form the emission required to the recording of their voices
were also excluded from the study.
Inclusion Criteria for Case Group
Participant of both genders, within the established age
range (21–50 years), who is having dysphonia for more
than 3 months. All the participants undergo auditory per-
ceptual evaluation by one speech language therapist. Par-
ticipants, having score more than or equal to 1 on GRBAS
scale for sustained vowel /a/, were included. In addition to
this, each participant had undergone VDL examination by
ENT surgeon and those having benign lesions of Vocal
cord (Vocal cord nodule, polyps, cysts, Reinke’s edema) or
larynx (chronic laryngitis) were included in the study.
Exclusion Criteria for Case Group
Participants were having history of head and neck surg-
eries, neurological or pulmonary diseases in past. Those,
who had malignant diseases of larynx or vocal cord
paralysis due to any cause, on the day of sample collection,
Indian J Otolaryngol Head Neck Surg
if participant was suffered from allergic respiratory con-
dition or common cold, were excluded.
Sample Collection
In a period of one year from 1st June 2019 to 31st May
2020, a single speech language therapist recorded voice
samples of all participants (n = 120) in a sound treated
room at tertiary care hospital. Each participant was
explained the task, till he/she understands it very well.
Participant was asked to perform test trial before final
recording. The microphone (dynamic cardioid) was posi-
tioned at 45 degrees laterally to mouth to avoid disturbing
speech sample by nasal breaths and 10 cm away from
mouth, fixed with the help of specialized head band to keep
constant distance. Microphone was connected to Lenovo
laptop (windows 10) where the voice samples were
recorded directly in Praat software (version 6.0.43) at fre-
quency of 44,000 Hz by keeping in view the specifications
of the microphone. Each participant was sitting on chair
comfortably and requested to produce sustained vowel /a/
for minimum 6 s in a comfortable and using pitch and
loudness in a habitual way, after deep inhalation. Objective
measures such as jitter, shimmer and harmonic to noise
ratio (HNR) are typically analyzed on long-sustained
vowels [6]. At least three final trials were recorded for each
participant. If a sample was not recorded appropriately,
more trials were carried out. The recording audio of the
sustained emission of the vowel /a/ were imported and
edited in the Praat software, discarding the beginning 0.5 s
and end of the recording, selecting the most stable portion
of the emission with mean duration of 3 s, as to avoid
irregular patterns observed at starting and ending of voice
signals. In a similar way, voice samples for vowels /i/ and /
u/ were recorded. By using Praat software, average
acoustic voice parameters, fundamental frequency (F0),
local jitter (%), local shimmer (%) and harmonic to noise
ratio (HNR), from final three trials, were calculated for
each vowel of each participant.
Acoustic Voice Parameters
Fundamental Frequency (F0)
F0 is defined as the number of times a sound wave pro-
duced by the vocal cords repeats during a given time per-
iod. It is also the number of cycles of opening/closure of
the glottis. Unit of F0 is Hertz (Hz).
Jitter
Jitter is the measure of cycle-to-cycle variations of the
fundamental glottal period. Jitter perturbation can be given
by four related parameters: absolute jitter (jitta), the local
or relative jitter (jitt), relative average perturbation (rap)
and five points period perturbation (ppq5). In present study,
Local / relative jitter (jitt) used for analysis. Jitter (local/
jitt): Average absolute difference between the consecutive
periods, divided by the average period, in percentage [12].
Shimmer
Shimmer is a variation of amplitudes of consecutive peri-
ods. For shimmer, there are four related measures: the
absolute or local shimmer that is the absolute difference in
a logarithmic domain (ShdB) given in dB, the local
shimmer (Shim) in percentage of the average amplitude,
the three-point Amplitude Perturbation Quotient (apq3)
also in percentage and the five-point Amplitude Perturba-
tion Quotient (apq5) also in percentage. In current study,
Local shimmer (shim) used for vocal analysis. Shimmer
(local/shim): Average absolute difference between the
amplitudes of consecutive periods, divided by the average
amplitude. This is expressed in percentage (%).
Hormonic to Noise Ratio (HNR)
HNR provides an indication of the overall periodicity of
the voice signal by quantifying the ratio between the
periodic (harmonic part) and aperiodic (noise) components.
Analysis of Result
Two level analyses were done in this study. In first part,
acoustic voice parameters of normal healthy adult males
and females of control group for vowels /a/, /i/ and /u/ were
calculated and compared with each other to find out gender
differences in voice. Average acoustic parameters (jitter
local (%), shimmer local (%) and HNR) for normal healthy
voice of participants of control group for vowels /a/, /i/ and
/u/ calculated and were compared with pathological voice
parameters of case group.
Acoustic Parameters of Normal Healthy Voices
and Gender Comparison
Mean values of acoustic voice parameters for vowels /a/, /i/
and /u/ of both genders of control group with its standard
deviation (SD) and p-value described in Table 1.
123
 Indian J Otolaryngol Head Neck Surg

Table 1 Acoustic Voice Parameters of normal healthy adults of control group

Vowel Parameters Male (n = 40) Female (n = 40) P value

/a/ F0 131 ± 9.58 226 ± 17 \ 0.0001

Jitter local (%) 0.30 ± 0.12 0.37 ± 0.15 0.350
Shimmer local (%) 3.15 ± 0.76 3.31 ± 1.56 0.773
HNR 21.60 ± 1.71 22.18 ± 2.01 0.499
/i/ F0 130 ± 5.83 238 ± 16.19 \ 0.0006
Jitter local (%) 0.29 ± 0.11 0.21 ± 0.09 0.083
Shimmer local (%) 2.45 ± 0.58 2.59 ± 0.65 0.619
HNR 22.82 ± 2.66 23.62 ± 2.19 0.469
/u/ F0 131.70 ± 7.10 251.70 ± 16.34 \ 0.0003
Jitter local (%) 0.31 ± 0.12 0.24 ± 0.11 0.196
Shimmer local (%) 2.80 ± 0.47 2.78 ± 0.88 0.935
HNR 25.33 ± 3.56 26.05 ± 4.15 0.679

Observations and Results Fundamental Frequency (F0) control GROUP Male

Fundamental Frequency (F0) control GROUP Female
Gender Wise Distribution of Acoustic Voice
Parameters of Normal Healthy Adults 251
226 238

There were statistically significant higher values of fun-

damental frequency (F0) in females, while jitter local (%),
shimmer local (%) and harmonic to noise ratio (HNR) had
no gender differences in normal healthy voices as shown in
Table 1.
Fundamental Frequency (F0) range for both genders is
mentioned in Table 2.
Unpaired student t-test was applied as test of signifi-
cance with 95% confidence limit. There was significant
statistical gender difference in fundamental frequency (F0)
for all three vowels /a/, /i/ and /u/, with females had higher
values than males as shown in Fig. 1.
Pathological Voice Acoustic Parameters
Comparison with Normal Healthy Voices
It was already observed, there was significant gender dif-
ference in F0, so F0 was not used for comparison of
pathological voice. Average acoustic parameters (jitter
local (%), shimmer local (%) and HNR) for control group
(n = 80) calculated by averaging parameter values of males
131 130 131
/a/ /i/ /u/
Fig. 1 Gender comparison of F0 in control group
(n = 40) and females (n = 40) in control group. Patholog-
ical acoustic voice parameters were compared with normal
control parameters as shown in Table 3. Unpaired student
T-test was used for statistical significance with 95% con-
fidence limit.
In present study, pathological acoustic voice parameters
jitter local (%) and shimmer local (%) had statistically
significant higher values as compare to control group for all
three vowels /a/, /i/ and /u/. HNR of pathological voices
had statistically significant lower values than normal
healthy voices for vowels /a/, /i/ and /u/.

Discussion
Table 2 Range of fundamental frequency (F0) for control group
Vowel Male Female Voice is a personal feature; no voice is perfectly equal to
any other. There are well known differences in male and
/a/ 121–153 194–256
female voices and in various languages and ethnological
/i/ 124–161 218–276
background. Dysphonia is a descriptive medical term
/u/ 121–157 223–280
meaning disorder of voice. Diseases that affect larynx

123
Indian J Otolaryngol Head Neck Surg
Table 3 Comparison of pathological voice with normal healthy voice
Vowel Parameters Control values (n = 80)
/a/ Jitter local (%) 0.34 ± 0.13
Shimmer local (%) 3.23 ± 1.20
HNR 21.89 ± 1.84
/i/ Jitter local (%) 0.25 ± 0.10
Shimmer local (%) 2.52 ± 0.60
HNR 23.22 ± 2.40
/u/ Jitter local (%) 0.27 ± 0.12
Shimmer local (%) 2.79 ± 0.68
HNR 25.69 ± 3.78
cause changes in the patient’s vocal quality. The most
common signs that may indicate changes in the larynx
relate hoarseness, breathiness and roughness. The transient
hoarseness may result from abuse of voice or the casual flu,
but when the hoarseness persist and become a character-
istic voice, is indicative of pathology of the larynx [13, 14].
Hoarseness can also be an early symptom of cancer of the
larynx, Teixeira et al. [15] The most common pathologies
affecting voice are vocal nodule, the laryngitis, and
paralysis of the vocal cord, polyps, cysts and Reinke’s
edema. Other pathologies of the larynx that may lead to
dysphonic speech are ulcers of contact, as Lopes. [9] With
the existence of normative databases characterizing voice
quality or using intelligent tools combining several
parameters, it is intended to distinguish between normal
and pathological voice or even identify or suggest the
pathology. [9]
Acoustic analysis has been reported in literature as a
useful tool to evaluate and characterize pathological vocal
signals [16, 17] and to show statistically significant dif-
ferences with respect to normal subjects. [18, 19] Leiber-
man recorded 23 voices from the speakers who had
pathologic growths on their vocal cords. It was found that
they had larger perturbations than did normal speakers with
the same median fundamental periods. This may be related
to size of pathological growth. [20] This showed that study
of perturbation measures is important for assessment of
voice. Hence voice parameters like Jitter [20], shimmer
[21], and harmonics-to-noise ratio [22] were extensively
studied. Many authors studied both normal and pathologi-
cal voices using the acoustic parameters as well as funda-
mental frequency (F0), jitter, shimmer and HNR.
The F0 is one of the most frequently used measures by
clinicians to characterize human voice; it yields cues about
age, sex and individual height and is related with mecha-
nisms such as vocal fold length, mass and strain. Thus,
lengthening the vocal folds will cause the glottic cycles to
occur faster, yielding more acute resulting frequencies. [7]
Case value (n = 40) P value
0.89 ± 0.87 0.0041
6.11 ± 2.09 0.0001
14.80 ± 6.56 \ 0.0007
1.23 ± 1.07 0.002
4.86 ± 2.15 0.0006
16.98 ± 6.76 0.0006
1.30 ± 0.60 \ 0.00001
6.59 ± 1.99 \ 0.00001
14.29 ± 4.82 \ 0.00001
In present study, normal healthy females had higher values
of F0 than comparative males, which is consistent with
reports in literature. [6] The gender differences in F0 can
be justified because there are marked anatomic differences
in the larynges of men and women. A male larynx appears
to be approximately 40% bigger than that of a female and
the male vocal folds consist of a thicker mass [6].
In the present study, we found local jitter (%) for vowels
/a/, /i/ and /u/ have no gender differences for control group
but have statistically significant higher values for case
group as compared to controls, this result is consistent with
the study done by Paulo et al. [12] The jitter is affected
mainly by the lack of control of vibration of the cords and
the voices of patients with pathologies often have higher
values of jitter [8], similar findings reported in this study
for vowels /a/, /i/ and /u/.
The shimmer changes with the reduction of glottal
resistance and mass lesions on the vocal cords and is cor-
related with the presence of noise emission and breathiness
and it is expected that patients with pathologies have higher
values of shimmer [12], similar results were observed in
current study for relative shimmer (%) for vowels /a/, /i/
and /u/.
HNR parameter is usually measured as an overall
characteristic of the signal, and not as a function of fre-
quency. The overall value of the HNR of the signal varies
because different vocal tract configurations involve dif-
ferent amplitudes for the harmonics. Analyzing the result,
we found no statistical difference in gender comparison in
control group for HNR for vowel /a/, /i/ or /u/, which is not
supported by Ambreen et al. [6], but supported by the study
done by Toran et al. [23], while pathological case group
have lower values compare to control group for vowels /a/,
/i/ and /u/.
Limitation of this study: As this study primarily focuses
on to evaluate voices by objective method of acoustic voice
analysis using Praat software, so we did not evaluate voices
completely/thoroughly by perceptual assessment methods
123

and/or other objective voice analysis methods other than
acoustic voice analysis using Praat software. GRBAS scale
was used just for inclusion and exclusion of the subjects,
but it was not further analysed for voice analysis.
Conclusion
This study establishes normative acoustic voice parameters
for both genders. Normal healthy female voices have
higher fundamental frequency value as compare to male
voices. Patients who are with dysphonic voices due to
laryngeal pathologies had altered values of acoustic voice
parameters compared to normophonic adults and health
professionals precisely can differentiate pathological voi-
ces from normophonics.
Author Contributions (Optional: please review the submission
guidelines from the journal whether statements are mandatory):
Additional declarations for articles in life science journals that report
the results of studies involving humans and/or animal. No use of
animals in this study.
Funding (Information that explains whether and by whom the
research was supported):NIL No funds, grants, or other support was
received.
Declaration
Conflict of interest (Include appropriate disclosures): The authors
have no relevant financial or non-financial interests to disclose.
Consent to Participate Informed consent was obtained from all
individual participants included in the study.
Consent to Publication The participant has consented to the sub-
mission of the case report to the journal.
Ethical Approval (Include appropriate approvals or waivers)
approved by the Research Ethics Committee on Human Beings of the
home institution. All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the institutional and/or national research committee and with the 1964
Helsinki Declaration and its later amendments or comparable ethical
standards.
References
1. Sataloff RT, Benninger MS (eds) (2016) Sataloff’s comprehen-
sive textbook of otolaryngology: head and neck surgery (laryn-
gology), vol 4. JAYPEE. https://doi.org/10.5005/jp/books/12711
2. Lara E, Tavares M, De Labio RB, Helena R, Martins G (2010)
Normative study of vocal acoustic parameters from children from
4 to 12 years of age without vocal symptoms A pilot study. Braz J
Otorhinolaryngol 76(4):485–490
3. Almeida, N (2010) Sistema Inteligente para Diagnostico da
Patologias na Laringe Utilizando Maquinas de Vetor de Suporte.
Msc., Universidade Federal Rio Grande do Norte – Natal – Brasil
123
Indian J Otolaryngol Head Neck Surg
4. Boersma P, Weenink D (2007) Praat: doing phonetics by com-
puter (Version 4.5.)[Computer program],’’ Retrieved from http//
www.praat.org/
5. Smits I, Ceuppens P, De Bodt MS (2005) A comparative study of
acoustic voice measurements by means of Dr. Speech and com-
puterized speech Lab. J Voice 19(2):187–196
6. Ambreen S, Bashir N, Tarar SA, Kausar R (2017) Acoustic
analysis of normal voice patterns in pakistani adults. J Voice
pp 1–28
7. Finger LS, Cielo CA, Schwarz K (2009) Acoustic vocal measures
in women without voice complaints and with normal larynxes.
Braz J Otorhinolaryngol 75(3):432–440. https://doi.org/10.1016/
S1808-8694(15)30663-7
8. Paulo J, Odete P (2015) Acoustic analysis of vocal dysphonia.
Procedia Procedia Comput Sci 64:466–473
9. Teixeira JP, Oliveira C, Lopes C (2013) Vocal acoustic analy-
sis—Jitter Shimmer and HNR Parameters. Procedia Technol
9:1112–1122
10. Spazzapan EA, Cardoso VM, Fabron EMG, Berti LC, Brasolotto
AG, de Castro Marino VC (2018) Acoustic characteristics of
healthy voices of adults: from young to middle age. CoDAS
[Internet] 30(5):e20170225
11. Hirano M, McCormick KR (1986) Clinical examination of voice.
J Acoust Soc Am 80(4):1273
12. Paulo J, Gonçalves A (2014) Accuracy of jitter and shimmer
measurements. Procedia Technol 16:1190–1199
13. Teixeira JP, Goncalves A (2016) Algorithm for jitter and shim-
mer measurement in pathologic voices. Procedia Comput Sci
100:271–279
14. Teixeira JP, Fernandes PO (2014) Jitter, Shimmer and HNR
classification within gender, tones and vowels in healthy voices.
Procedia Technol 16:1228–1237
15. Teixeira JP, Ferreira D, Carneiro S (2011) Análise acústica vocal
- determinação do Jitter e Shimmer para diagnóstico de patalogias
da fala. In 68 Congresso Luso-Moçambicano de Engenharia.
Maputo, Moçambique
16. Shaoa J, MacCallumb JK, Zhangb Y, Sprecherb A, Jianga JJ
(2010) Acoustic analysis of the tremulous voice: assessing the
utility of the correlation dimension and perturbation parameters.
J Commun Disord 43:35–44
17. Barsties B, Bodt MD (2015) Assessment of voice quality: current
state-of-the-art. Auris Nasus Larynx 42:183–188
18. Sussman JE, Tjaden K (2012) Perceptual measures of speech
from individuals with Parkinson’s disease and multiple sclerosis:
intelligibility and beyond. J Speech Lang Hear Res 55:1208–1219
19. Rusz J, Cmejla R, Ruzickova H, Ruzicka E (2011) Quantitative
acoustic measurements for characterization of speech and voice
disorders in early untreated Parkinson’s disease. J Acoust Soc Am
129:350–367
20. Leiberman P (1963) Some acoustic measures of fundamental
periodicity of normal and pathologic larynges. J Acoust Soc Am
35:344
21. Horii Y (1979) Fundamental frequency perturbation observed in
sustained phonation. J Speech Hearing Res 22(1):5–19
22. Yumoto E, Sasaki Y, Okamura H (1984) Harmonics-to-noise
ratio and psychophysical measurement of the degree of hoarse-
ness. J Speech Hear Res 27(1):2–6
23. Toran KC, Lal BK (2009) Objective analysis of voice in normal
young adults. Kathmandu Univ Med J 7(4):374–377
Publisher’s Note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.