Cepstral Peak Prominence and Pitch Strength as Acoustic Indicators of Dysphonia in Children

OBJECTIVE: This study examined the extent to which Cepstral Peak Prominence Smoothed (CPPS) and pitch strength differentiate between healthy and dysphonic pediatric voices using sustained vowels and connected speech. METHODS: Voice samples were collected from 100 children between the ages of 4 and 12 years (mean = 7.8, SD = 2.4, 48% female). Forty-two children presented with benign vocal fold lesions, and 58 had no history of voice complaint. CPPS and pitch strength were calculated on sustained vowels and connected speech. Univariable and multivariable logistic regression models assessed associations between acoustic measures and voice-disorder status. Receiver operating characteristic analyses quantified classification accuracy and identified optimal thresholds. RESULTS: Children with voice disorders demonstrated significantly lower CPPS and pitch strength values on sustained vowel and connected speech when compared to vocally healthy controls. CPPS on sustained vowel was the strongest predictor of voice status; however, all measures effectively separated children with and without voice disorders. Despite significant group-level differences, substantial within-group variability limited the establishment of clear diagnostic cutoffs. Optimal thresholds for differentiating children with and without voice disorders were 11.19 dB for CPPS on sustained vowel (95% CI = 10.58-12.29), 9.48 dB for CPPS on connected speech (95% CI = 8.98-10.06), 0.30 for pitch strength on vowel (95% CI = 0.27-0.35), and 0.28 for pitch strength on connected speech (95% CI = 0.25-0.28). CONCLUSIONS: Findings support the use of CPPS in routine pediatric voice assessment and identify pitch strength as a promising adjunctive metric. Incorporating brief cepstral and pitch-based analyses into standard clinical protocols may enhance objectivity while minimizing testing burden in children.