Study shows telemedicine not effective for voice, speech disorders

New York: Teleconferencing platforms like Zoom and Microsoft Teams helped people stay connected during the coronavirus pandemic. But the platforms could not capture sounds accurately enough for clinicians to successfully treat and evaluate patients with voice and speech disorders, according to a study.

In a virtual world, voice therapy presents a unique challenge because clinicians must rely on acoustic recordings of voice to evaluate the effectiveness of their treatments. But many teleconferencing platforms distorted sounds in their efforts to eliminate background noise, revealed the study led by a team of researchers at the Boston University in the US.

As the pandemic unfolded and lockdowns moved much voice and speech therapy online, "There was no consensus among (voice and speech) clinicians (who were) trying to convert to telepractice therapy, and we wanted to determine the accuracy of the acoustic measures they can get through telepractice," said Hasini Weerathunge, a graduate student at BU's Rafik B Hariri Institute for Computing and Computational Science and Engineering.

The team put five different HIPAA-compliant teleconferencing platforms to the test: Cisco Webex, Microsoft Teams, Doxy.me, VSee Messenger, and Zoom.

In a soundproof room, the team recorded voice samples from 29 patients, aged 18 to 82, that had a variety of speech or voice diagnoses. These recordings were then played back to researchers through an external speaker over the teleconferencing platforms, simulating telepractice conversations.

The team found that each platform has its own audio enhancement algorithm that affects the quality of the sound. Zoom was the only platform that enabled users to turn off these audio enhancement features, allowing the researchers to test the platform's original audio.

All the teleconferencing platforms did a poor job at capturing many measurements needed for accurate and clinically meaningful voice evaluations. Pitch varied significantly on all the virtual platforms compared to the real-life recordings. This might be due to internet connection or bandwidth issues that affect how and when sounds get transmitted through the platforms, the researchers said.

They also found the dynamic range of the vocal loudness measured over telepractice was very different from live recordings.

The effect was even true for Zoom, where the researchers could turn off the audio enhancements.

Overall, "Microsoft Teams performed the best, in that all our voice measures were the least affected in that platform," Weerathunge said.

Because many of the voice metrics collected from virtual platforms had clinically significant differences from those collected in person, Weerathunge and the team urge caution for voice and speech therapists using telepractice.