Analysis of Voice Quality in Children With Smith-Magenis Syndrome.

The production of phonation involves very complex processes, linked to the physical, clinical, and emotional state of the speaker. Thus, in populations with neurological diseases, it is possible to find the imprint in the voice signal left by the deterioration of certain cortical areas or part of the neurocognitive mechanisms that are involved in speech. In previous works, the authors determined the relationship between the pathological characteristics of the voice of the speakers with Smith-Magenis syndrome (SMS) and a lower value in the cepstral peak prominence (CPP) with respect to normative speakers. They also described the presence of subharmonics in their voices.

Objectives: The present study aims to verify whether both characteristics can be used simultaneously to differentiate SMS voices from neurotypical voices. It will also be analyzed if there is variation in the trajectory of the formants coinciding with the subharmonics.

Methods: To do this, the effect of subharmonics in the voices of 12 SMS individuals was isolated to see if they were responsible for the lower CPP values. An evaluation of the CPP was also carried out in the areas of subharmonic presence, from the peak that reflected the value of f0, rather than using the most prominent peak. This offered us a baseline for the CPP value in the presence of subharmonics. It was checked if changes in the formants occurred synchronously to the appearance of those subharmonics. If so, the muscles that control the position of the jaw and tongue would be affected at the same time as the larynx. The latter was difficult to observe since the samples were very short. A comparison of phonatory performance of a sustained /a/ between a normotypical group and non-normotypical group of children was carried out. These groups were balanced and matched in age and gender. The Spanish Association of Smith-Magenis Syndrome (ASME) provides almost 20% of the population in Spain.

Results: The CPP allows differentiating between normative speakers and those with SMS, even when isolating the effect of subharmonics.

Conclusions: The CPP is a robust index for determining the degree of dysphonia. It makes it possible to differentiate pathological voices from healthy voices even when subharmonics are present. The presence of subharmonics is a characteristic of voices of SMS individuals and is not present in healthy ones. Both indexes can be used simultaneously to differentiate SMS voices from neurotypical voices.