Listeners' attitudes towards voice disorders: An interaction between auditory and visual stimuli

Objective: People with dysphonia are judged more negatively than peers with normal vocal quality. This preliminary study aims to (1) investigate correlations between both auditory -perceptual and objective measures of vocal quality of dysphonic and non-dysphonic speakers and attitudes of listeners, and (2) discover whether these attitudes towards people with dysphonia vary for different types of stimuli: auditory (A) stimuli and combined auditory-visual (AV) stimuli. Visual (V) stimuli were included as a control condition. Method: Ten judges with no experience in the evaluation of dysphonia were asked to rate A, AV and V stimuli of 14 different speakers (10 dysphonic and 4 non-dysphonic speakers) Cognitive attitudes, evaluation of voice characteristics and behavioral attitudes were examined. Pearson and Spearman correlation coefficients were calculated to examine correlations between both Dysphonia Severity Index (DSI) values and perceptual vocal quality as assessed by a speech -language pathologist (PVQSLP) or perceptual vocal quality as assessed by the judges (PVQjudge). Linear mixed model (LMM) analyses were conducted to investigate differences between speakers and stimuli conditions. Results: Statistically significant correlations were found between both perceptual and objective measures of vocal quality and mean attitude scores for A and AV stimuli, indicating increasingly negative attitudes with increasing dysphonia severity. Fewer statistically significant correlations were found for the combined AV stimuli than for A stimuli, and no significant correlations were found for V stimuli. LMM analyses revealed significant group effects for several cognitive attitudes. Conclusion: Generally, people with dysphonia are judged more negatively by listeners than peers without dysphonia. However, the findings of this study suggest a positive influence of visual cues on the judges' cognitive and behavioral attitudes towards dysphonic speakers. Further research is needed to investigate the significance of this influence.