Journal of Voice · Mar 19, 2026

Subjective and Objective Evaluation of Voice in Persian Elderly Speakers

By Hozhabr M, Ahmadi SS, Khaniki SH et al.

AIM: This study investigated the relationship between subjective (patient-based and clinician-based) and objective (acoustic) voice evaluation parameters in Persian elderly speakers. STUDY DESIGN: A cross-sectional study was conducted to explore the abovementioned relationships. METHODS: Ninety-two elderly participants (50 females, 42 males; aged 60 years and above) were recruited. The Persian version of the Aging Voice Index (AVI) was used for patient-reported assessment. Acoustic measures, including jitter, shimmer, harmonic-to-noise ratio (HNR), and cepstral peak prominence (CPP) were analyzed using Praat software. The auditory-perceptual evaluation was conducted using the GRBAS scale by skilled, experienced clinicians. RESULTS: Based on GRBAS ratings, 41.9% of voices were normal, 51.6% mild, and 6.5% moderate dysphonia. CPP significantly differed across severity groups for both /i/ (P = 0.019) and /a/ (P = 0.006), with lower CPP corresponding to greater dysphonia. AVI also varied across groups (P = 0.020), with values increasing in mild dysphonia and decreasing in moderate dysphonia. AVI showed weak and nonsignificant correlations with CPP (|r| < 0.23, P > 0.22) and acoustic measures (|r| < 0.20, P > 0.08). Female speakers demonstrated lower jitter and shimmer and higher HNR for /a/ (P = 0.044, P = 0.013, and P = 0.028, respectively), while F0 was significantly higher in females for both vowels (P < 0.001). AVI did not differ by gender (P = 0.807). Age showed a significant positive correlation with shimmer for /a/ (r = 0.211, P = 0.043), with stronger age-related increases in shimmer and decreases in HNR among males (P ≤ 0.008). CONCLUSION: The findings reveal a complex relationship between the subjective and objective voice measures in elderly speakers. While GRBAS ratings correlated moderately with acoustic parameters, patient-reported AVI scores showed no significant relationship with objective measures. These results emphasize the importance of using multiple assessment tools for the comprehensive evaluation of voice disorders in aging populations.

doi.org/10.1016/j.jvoice.2026.02.039PubMed 41862290Biomarkers