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2,480篇论文匹配“Speech”
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Juze Zhang, Changan Chen, Xin Chen, Heng Yu, Tiange Xiang, Ali Sartaz Khan, Shrinidhi K. Lakshmikanth, Ehsan Adeli

Human communication is inherently multimodal and social: words, prosody, and body language jointly carry intent. Yet most prior systems model human behavior as a translation task--co-speech gesture or text-to-motion that maps a fixed utterance to motion clips--without requiring agentic decision-making about when to move, what to do, or how to adapt across multi-turn dialogue. This leads to brittle timing, weak social grounding, and fragmented stacks where speech, text, and motion are trained or inferred in isolation. We introduce ViBES (Voice in Behavioral Expression and Synchrony), a conversational 3D agent that jointly plans language and movement and executes dialogue-conditioned body actions. Concretely, ViBES is a speech-language-behavior (SLB) model with a mixture-of-modality-experts (MoME) backbone: modality-partitioned transformer experts for speech, facial expression, and body motion. The model processes interleaved multimodal token streams with hard routing by modality (parameters are split per expert), while sharing information through cross-expert attention. By leveraging strong pretrained speech-language models, the agent supports mixed-initiative interaction: users can speak, type, or issue body-action directives mid-conversation, and the system exposes controllable behavior hooks for streaming responses. We further benchmark on multi-turn conversation with automatic metrics of dialogue-motion alignment and behavior quality, and observe consistent gains over strong co-speech and text-to-motion baselines. ViBES goes beyond "speech-conditioned motion generation" toward agentic virtual bodies where language, prosody, and movement are jointly generated, enabling controllable, socially competent 3D interaction.

Ruixiang Zhao, Zhihao Xu, Bangxiang Lan, Zijie Xin, Jingyu Liu, Xirong Li

For video-text retrieval, the use of CLIP has been a de facto standard. However, as CLIP provides only image and text encoders, this consensus has led to a biased paradigm that entirely ignores the sound track of videos. While several attempts have been made to reintroduce audio -- typically by incorporating an audio encoder and fusing its output with visual features -- these methods face two challenges: ineffective representation of speech content and suboptimal vision-audio fusion. To address these issues jointly, we propose SAVE, a Speech Aware Video rEpresentation learning method. SAVE improves upon AVIGATE, a SOTA audiovisual method, with a dedicated speech branch for more effective speech embedding. Furthermore, we introduce soft-ALBEF for early vision-audio alignment that facilitates fusion. Extensive experiments on five benchmarks show that SAVE compares favorably against the SOTA, outperforming AVIGATE by +4.1% on MSRVTT-1k, +1.9% on MSRVTT-3k, +2.5% on VATEX, +9.8% on Charades, and +2.1% on LSMDC, in light of the SumR metric.

Taekyung Ki, Sangwon Jang, Jaehyeong Jo, Jaehong Yoon, Sung Ju Hwang

Talking head generation creates lifelike avatars from static portraits for virtual communication and content creation. However, current models do not yet convey the feeling of truly interactive communication, often generating one-way responses that lack emotional engagement. We identify two key challenges toward truly interactive avatars: generating motion in real-time under causal constraints and learning expressive, vibrant reactions without additional labeled data. To address these challenges, we propose Avatar Forcing, a new framework for interactive head avatar generation that models real-time user-avatar interactions through diffusion forcing. This design allows the avatar to process real-time multimodal inputs, including the user's audio and motion, with low latency for instant reactions to both verbal and non-verbal cues such as speech, nods, and laughter. Furthermore, we introduce a direct preference optimization method that leverages synthetic losing samples constructed by dropping user conditions, enabling label-free learning of expressive interaction. Experimental results demonstrate that our framework enables real-time interaction with low latency (about 500ms), achieving 6.8x speedup compared to the baseline, and produces reactive and expressive avatar motion, which is preferred over 80% against the baseline.

Jiaxin Ye, Gaoxiang Cong, Chenhui Wang, Xin-Cheng Wen, Zhaoyang Li, Boyuan Cao, Hongming Shan

Video-to-Speech (VTS) generation aims to synthesize speech from a silent video without auditory signals, and holds substantial promise for applications such as film dubbing and voice restoration for individuals with aphonia. However, existing VTS methods disregard the hierarchical nature of speech, which spans coarse speaker-aware semantics to fine-grained prosodic details. This oversight hinders direct alignment between visual and speech features at specific hierarchical levels during property matching. In this paper, leveraging the hierarchical structure of Residual Vector Quantization (RVQ)-based codec, we propose HiCoDiT, a novel Hierarchical Codec Diffusion Transformer that exploits the inherent hierarchy of discrete speech tokens to achieve strong audio-visual alignment. Specifically, since lower-level tokens encode coarse speaker-aware semantics and higher-level tokens capture fine-grained prosody, HiCoDiT employs low-level and high-level blocks to generate tokens at different levels. The low-level blocks condition on lip-synchronized motion and facial identity to capture speaker-aware content, while the high-level blocks use facial expression to modulate prosodic dynamics. Finally, to enable more effective coarse-to-fine conditioning, we propose a dual-scale adaptive instance layer normalization that jointly captures global vocal style through channel-wise normalisation and local prosody dynamics through temporal-wise normalization. Extensive experiments demonstrate that HiCoDiT outperforms baselines in fidelity and expressiveness, highlighting the potential of discrete modelling for VTS. The code and speech demo are both available at https://github.com/Jiaxin-Ye/HiCoDiT.

Qin Li, Wenbo Zhang, Limei Liu, Han Peng, Junfeng Yang, Guanying Xu

Multimodal intent recognition (MIR) is hindered by substantial redundancy and noise originating from text, speech, and visual inputs, which weakens feature distinctiveness and ultimately harms recognition performance. Although recent approaches based on the information bottleneck (IB) principle mitigate this issue via feature compression and reconstruction to obtain compact and noise-reduced representations, they still encounter two major drawbacks. First, conventional IB employs a fixed bottleneck dimension, making it unable to accommodate sample-dependent variations in redundancy and noise. Second, simultaneously handling redundancy and noise within a single compression process leads to incomplete feature purification. In this paper, we propose a novel framework named SeD-UD, which incorporates influence-driven input-adaptive bottleneck (IDAB) modules following a hierarchically-decoupled IB structure. Given a redundancy/noise influence factor, IDAB dynamically adjusts dimensions and selects the optimal parameters for compression and reconstruction, thereby achieving the best trade-off between information preservation and interference suppression. The IB structure performs hierarchically-decoupled processing of redundancy and noise via separated de-redundancy and unified denoising based on IDAB modules. Extensive experiments on benchmark datasets show SeD-UD outperforms current state-of-the-art models.

Youngseo Kim, Kwan Yun, Seokhyeon Hong, Sihun Cha, Colette Suhjung Koo, Junyong Noh

The surge of highly realistic synthetic videos produced by contemporary generative systems has significantly increased the risk of malicious use, challenging both humans and existing detectors. Against this backdrop, we take a generator-side view and observe that internal cross-attention mechanisms in these models encode fine-grained speech-motion alignment, offering useful correspondence cues for forgery detection. Building on this insight, we propose X-AVDT, a robust and generalizable deepfake detector that probes generator-internal audio-visual signals accessed via DDIM inversion to expose these cues. X-AVDT extracts two complementary signals: (i) a video composite capturing inversion-induced discrepancies, and (ii) audio-visual cross-attention feature reflecting modality alignment enforced during generation. To enable faithful, cross-generator evaluation, we further introduce MMDF, a new multi-modal deepfake dataset spanning diverse manipulation types and rapidly evolving synthesis paradigms, including GANs, diffusion, and flow-matching. Extensive experiments demonstrate that X-AVDT achieves leading performance on MMDF and generalizes strongly to external benchmarks and unseen generators, outperforming existing methods with accuracy improved by +13.1%. Our findings highlight the importance of leveraging internal audio-visual consistency cues for robustness to future generators in deepfake detection. The code and dataset will soon be available.

Weiguo Pian, Saksham Singh Kushwaha, Zhimin Chen, Shijian Deng, Kai Wang, Yunhui Guo, Yapeng Tian

In this paper, we propose Universal Holistic Audio Generation (UniHAGen), a task for synthesizing comprehensive auditory scenes that include both on-screen and off-screen sounds across diverse domains (e.g., ambient events, musical instruments, and human speech). Prior video-conditioned audio generation models typically focus on producing on-screen environmental sounds that correspond to visible sounding events, neglecting off-screen auditory events. While recent holistic joint text-video-to-audio generation models aim to produce auditory scenes with both on- and off-screen sound but they are limited to non-speech sounds, lacking the ability to generate or integrate human speech. To overcome these limitations, we introduce OmniSonic, a flow-matching-based diffusion framework jointly conditioned on video and text. It features a TriAttn-DiT architecture that performs three cross-attention operations to process on-screen environmental sound, off-screen environmental sound, and speech conditions simultaneously, with a Mixture-of-Experts (MoE) gating mechanism that adaptively balances their contributions during generation. Furthermore, we construct UniHAGen-Bench, a new benchmark with over one thousand samples covering three representative on/off-screen speech-environment scenarios. Extensive experiments show that OmniSonic consistently outperforms state-of-the-art approaches on both objective metrics and human evaluations, establishing a strong baseline for universal and holistic audio generation. Project page: https://weiguopian.github.io/OmniSonic_webpage/

Muyan Zhong, Erfei Cui, Sen Xing, Weiyun Wang, Wen Wu, Yuchen Hu, Yanting Zhang, Xiaowei Hu, Wenhai Wang, Chao Zhang 等

Multimodal large language models (MLLMs) have expanded from vision-language systems to include audio, unlocking new capabilities in cross-modal reasoning and interaction. To address the limitation that existing benchmarks focus mainly on perception tasks and lack a unified cognitive evaluation framework, we propose Hierarchical Audio-Visual Evaluation Benchmark (HAVE-Bench). It systematically evaluates the audio-related capabilities of MLLMs along a three-level cognitive hierarchy: Perception, Reasoning, and Interaction, utilizing 2,451 curated samples and manually annotated multi-turn interaction-level tasks. Experiments using this unified framework reveal significant gaps in existing models at the reasoning and interaction levels, with speech-driven visual question answering (VQA) performance significantly lagging behind the text-image setting. These findings underscore the urgency of enhancing models' handling of long and complex audio and facilitating the transfer of reasoning capabilities from the vision-text to the audio-visual domain.

Muhammad Usama Saleem, Mayur Jagdishbhai Patel, Ekkasit Pinyoanuntapong, Zhongxing Qin, Li Yang, Hongfei Xue, Ahmed Helmy, Chen Chen, Pu Wang

We propose LiveGesture, the first fully streamable, speech-driven full-body gesture generation framework that operates with zero look-ahead and supports arbitrary sequence length. Unlike existing co-speech gesture methods--which are designed for offline generation and either treat body regions independently or entangle all joints within a single model--LiveGesture is built from the ground up for causal, region-coordinated motion generation. LiveGesture consists of two main modules: the Streamable Vector-Quantized Motion Tokenizer (SVQ) and the Hierarchical Autoregressive Transformer (HAR). The SVQ tokenizer converts the motion sequence of each body region into causal, discrete motion tokens, enabling real-time, streamable token decoding. On top of SVQ, HAR employs region-eXpert autoregressive (xAR) transformers to model expressive, fine-grained motion dynamics for each body region. A causal spatio-temporal fusion module (xAR-Fusion) then captures and integrates correlated motion dynamics across regions. Both xAR and xAR-Fusion are conditioned on live, continuously arriving audio signals encoded by a streamable causal audio encoder. To enhance robustness under streaming noise and prediction errors, we introduce autoregressive masking training, which leverages uncertainty-guided token masking and random region masking to expose the model to imperfect, partially erroneous histories during training. Experiments on the BEAT2 dataset demonstrate that LiveGesture produces coherent, diverse, and beat-synchronous full-body gestures in real time, matching or surpassing state-of-the-art offline methods under true zero-look-ahead conditions.

Sicheng Xu, Yu Deng, Shoukang Hu, Yichuan Wang, Yizhong Zhang, Zhan Chen, Jiaolong Yang, Baining Guo

Video diffusion models have significantly advanced portrait video generation, yet their high computational demands limit their use in interactive applications. This work presents a framework for streamable talking portrait video generation conditioned on speech audio and reference images. Designed meticulously for streaming scenarios, it features a causal video VAE for deep latent compression and an auto-regressive latent denoising model. Our causal VAE integrates a variable number of reference images as guidance, allowing the network to focus on dynamic information rather than static appearance, thereby enhancing compression efficacy and reconstruction quality. Additionally, we extend the residual auto-encoding paradigm to improve spatial-temporal causality handling in our VAE. The generator is based on a Rectified Flow Transformer architecture and produces video latents in a blockwise auto-regressive manner. Our method enables the real-time generation of high-quality talking portrait videos, achieving speeds significantly faster than baseline models. Furthermore, comprehensive experiments demonstrate that it is on par with or even outperforms these large models in realism, vividness, and video quality.

Chanhyuk Choi, Taesoo Kim, Donggyu Lee, Siyeol Jung, Taehwan Kim

Talking face generation has gained significant attention as a core application of generative models.To enhance the expressiveness and realism of synthesized videos, emotion editing in talking face video plays a crucial role.However, existing approaches often limit expressive flexibility and struggle to generate extended emotions.Label-based methods represent emotions with discrete categories, which fail to capture a wide range of emotions.Audio-based methods can leverage emotionally rich speech signals--and even benefit from expressive text-to-speech (TTS) synthesis--but they fail to express the target emotions because emotions and linguistic contents are entangled in emotional speeches.Images-based methods, on the other hand, rely on target reference images to guide emotion transfer, yet they require high-quality frontal views and face challenges in acquiring reference data for extended emotions (e.g., sarcasm).To address these limitations, we propose Cross-Modal Emotion Transfer (C-MET), a novel approach that generates facial expressions based on speeches by modeling emotion semantic vectors between speech and visual feature spaces.C-MET leverages a large-scale pretrained audio encoder and a disentangled facial expression encoder to learn emotion semantic vectors that represent the difference between two different emotional embeddings across modalities.Extensive experiments on the MEAD and CREMA-D datasets demonstrate that our method improves emotion accuracy by 14% over state-of-the-art methods, while generating expressive talking face videos--even for unseen extended emotions. Code, checkpoint, and demo are available at https://chanhyeok-choi.github.io/C-MET/.

Xuangeng Chu, Ruicong Liu, Yifei Huang, Yun Liu, Yichen Peng, Bo Zheng

Generating lifelike conversational avatars requires modeling not just isolated speakers, but the dynamic, reciprocal interaction of speaking and listening.However, modeling the listener is exceptionally challenging: direct audio-driven training fails, producing stiff, static listening motions. This failure stems from a fundamental imbalance: the speaker's motion is strongly driven by speech audio, while the listener's motion primarily follows an internal motion prior and is only loosely guided by external speech. This challenge has led most methods to focus on speak-only generation. The only prior attempt at joint generation relies on extra speaker's motion to produce the listener.This design is not end-to-end, thereby hindering the real-time applicability.To address this limitation, we present UniLS, the first end-to-end framework for generating unified speak-listen expressions, driven by only dual-track audio.Our method introduces a novel two-stage training paradigm.Stage 1 first learns the internal motion prior by training an audio-free autoregressive generator, capturing the spontaneous dynamics of natural facial motion. Stage 2 then introduces the dual-track audio, fine-tuning the generator to modulate the learned motion prior based on external speech cues.Extensive evaluations show UniLS achieves state-of-the-art speaking accuracy. More importantly, it delivers up to 44.1% improvement in listening metrics, generating significantly more diverse and natural listening expressions. This effectively mitigates the stiffness problem and provides a practical, high-fidelity audio-driven solution for interactive digital humans.

Dragos-Alexandru Boldisor, Stefan Smeu, Dan Oneata, Elisabeta Oneata

Self-supervised representations excel at many vision and speech tasks, but their potential for audio-visual deepfake detection remains underexplored. Unlike prior work that uses these features in isolation or buried within complex architectures, we systematically evaluate them across modalities (audio, video, multimodal) and domains (lip movements, generic visual content). We assess three key dimensions: detection effectiveness, interpretability of encoded information, and cross-modal complementarity. We find that most self-supervised features capture deepfake-relevant information, and that this information is complementary. Moreover, models primarily attend to semantically meaningful regions rather than spurious artifacts (such as the leading silence). Among the investigated features, audio-informed representations generalize best and achieve state-of-the-art results. However, generalization to realistic in-the-wild data remains challenging. Our analysis indicates this gap stems from intrinsic dataset difficulty rather than from features latching onto superficial patterns.

Girish, Mohd Mujtaba Akhtar, Orchid Chetia Phukan, Arun Balaji Buduru

The rapid advancement of Audio Large Language Models (ALMs), driven by Neural Audio Codecs (NACs), has led to the emergence of highly realistic speech deepfakes, commonly referred to as CodecFakes (CFs). Consequently, CF detection has attracted increasing attention from the research community. However, existing studies predominantly focus on English or Chinese, leaving the vulnerability of Indic languages largely unexplored. To bridge this gap, we introduce Indic-CodecFake (ICF) dataset, the first large-scale benchmark comprising real and NAC-synthesized speech across multiple Indic languages, diverse speaker profiles, and multiple NAC types. We use IndicSUPERB as the real speech corpus for generation of ICF dataset. Our experiments demonstrate that state-of-the-art (SOTA) CF detectors trained on English-centric datasets fail to generalize to ICF, underscoring the challenges posed by phonetic diversity and prosodic variability in Indic speech. Further, we present systematic evaluation of SOTA ALMs in a zero-shot setting on ICF dataset. We evaluate these ALMs as they have shown effectiveness for different speech tasks. However, our findings reveal that current ALMs exhibit consistently poor performance. To address this, we propose SATYAM, a novel hyperbolic ALM tailored for CF detection in Indic languages. SATYAM integrates semantic representations from Whisper and prosodic representations from TRILLsson using through Bhattacharya distance in hyperbolic space, and subsequently performs the same alignment procedure between the fused speech representation and a input conditioning prompt. This dual-stage fusion framework enables SATYAM to effectively model hierarchical relationships both within speech (semantic–prosodic) and across modalities (speech–text). Extensive evaluations show that SATYAM consistently outperforms competitive end-to-end and ALM-based baselines on the ICF benchmark.

Jonas Waldendorf, Bashar Awwad Shiekh Hasan, Evgenii Tsymbalov

Hallucinations in Speech Large Language Models (SpeechLLMs) pose significant risks, yet existing detection methods typically rely on gold-standard outputs that are costly or impractical to obtain. Moreover, hallucination detection methods developed for text-based LLMs do not directly capture audio-specific signals. We investigate four attention-derived metrics: AudioRatio, AudioConsistency, AudioEntropy, and TextEntropy, designed to capture pathological attention patterns associated with hallucination, and train lightweight logistic regression classifiers on these features for efficient inference-time detection. Across automatic speech recognition and speech-to-text translation tasks, evaluations on Qwen-2-Audio and Voxtral-3B show that our approach outperforms uncertainty-based and prior attention-based baselines on in-domain data, achieving improvements of up to +0.23 PR-AUC, and generalises to out-of-domain ASR settings. We further find that strong performance can be achieved with approximately 100 attention heads, improving out-of-domain generalisation compared to using all heads. While effectiveness is model-dependent and task-specific training is required, our results demonstrate that attention patterns provide a valuable tool for hallucination detection in SpeechLLMs

Kosuke Doi, Mana Makinae, Yusuke Sakai, Hidetaka Kamigaito, Taro Watanabe

In simultaneous interpretation (SI), interpreters perform real-time translation by segmenting the source speech into chunks and translating them in the order they appear.Since surface-matching metrics such as BLEU correlate poorly with human evaluations, translation quality is often evaluated using neural metrics that measure semantic similarity, such as COMET.However, while SI translation ideally exhibits high monotonicity, COMET tends to assign higher scores to offline translations with long-distance reordering, because it is trained on such offline translation data.To address this gap, we propose Simul-COMET, a variation of COMET adapted for SI evaluation specifically designed for monotonicity.We train Simul-COMET on the SI-style translation data, which was converted from the offline translation of the COMET training data by leveraging large language models.In English–Japanese translation experiments, we demonstrate that Simul-COMET assigns higher scores to SI-style translations than to offline ones.Moreover, Simul-COMET shows stronger alignment with evaluation scores provided by professional interpreters than the original COMET.Simul-COMET is available at https://github.com/kosuked/simul-comet.

Sonal Kumar, Sreyan Ghosh, Yueqian Lin, S Sakshi, Ashish Seth, Yiran Chen, Ramani Duraiswami, Dinesh Manocha

Large Audio Language Models have shown impressive performance on single-clip audio language tasks such as automatic speech recognition, captioning, and sound event recognition. Yet, their ability to reason over interleaved multi-audio contexts-where answering a query requires relating information across multiple audio clips-remains limited. We present PolyAudio, a LALM built on Audio Flamingo 3 that targets multi-audio understanding via instruction tuning rather than massive-scale pre-training, and PolyAudio-Instruct, a high-quality instruction-tuning dataset consisting of 1.3M+ QA pairs, spanning over 14 task subsets to empower multi-audio understanding and reasoning. PolyAudio uses an explicit interleaved representation with clip indexing to encourage faithful grounding and reduce ambiguity in multi-clip references. We evaluate PolyAudio on a diverse suite of multi-audio benchmarks alongside standard single-audio tasks. PolyAudio achieves strong performance on multi-audio reasoning, outperforming competitive baselines that are also often limited to reasoning over up-to 2 audio clips, while preserving robust single-clip performance. Overall, our results suggest that precise, academic-scale multi-audio instruction tuning can unlock advanced cross-clip reasoning capabilities, enabling more capable audio-centric assistants.

Hao Pang, Changcheng Li, Yingxue Liu

Language evolution is cognitively motivated by the reduction of communicative effort. Current research exploring this reported tendency has been constrained by the heavy reliance on manually annotated resources (e.g., dependency parsing) as well as a narrow focus (e.g., syntax as the single metric). To transcend these limitations, we propose two measures: Attention-based Structural Distance (ASD) and Semantic Space Distance (SSD). ASD is a parser-free measure of syntactic locality derived from the attention mechanism of pretrained large language models (LLM), while SSD is a measure of lexical distances that quantify the degree of separation between different parts of speech in the word vector space. Based on multiple diachronic and multilingual corpora, our experiments show a significant decrease of ASD while an increase of SSD, which implies a language developmental trend towards structural compactness and semantic divergence. Our research pioneers a novel lens grounded in LLM for studying language evolution, which has two major contributions. Linguistically, our study corroborates the hypothesized law of human language evolution by demonstrating that its development optimizes syntactic locality as well as functional semantic discriminability. Cognitively, our study shows that human and LLMs share common characteristics in language processing, lending support to the potential of employing LLMs in the study of human cognition.

Rishabh Kumar, Abhinav Painuli, Chriss Philip Saji, Devesh Soni, Amrith Krishna, Ganesh Ramakrishnan

Quality management when creating large-scale speech datasets is essential for building reliable downstream models, yet verification pipelines are often brittle, domain-specific, and expertise-intensive. We introduce SpeechQM-Agent, a natural language-driven agentic framework that compiles user requirements into dependency-aware DAG workflows over modular tools for audio, transcript, and metadata verification. A central planner LLM enforces prerequisites and supports execution-time replanning (e.g., re-running failed steps or swapping tools), reducing manual pipeline engineering and improving robustness across heterogeneous vendor formats and multilingual settings. We also release SpeechQM-Dataset, a multilingual benchmark with controlled, vendor-inspired quality artifacts spanning 24 verification tasks. Across experiments, SpeechQM-Agent attains 80-90% agreement with expert verification while requiring <20% of the cost and time of manual QC, and we further validate transfer to real vendor-supplied corpora. Planner LLM comparisons highlight fidelity-efficiency trade-offs.

Kyusik Kim, Hyunwoo Yoo, Jaehoon Choi, Kitae Kim, Gail Rosen, Bongwon Suh

Recent Large Audio-Language Models (LALMs) integrate acoustic capabilities into reasoning, yet whether they reliably ground clinical judgments in audible evidence remains unproven. We introduce CliniCAST (Clinical Controlled Acoustic Synthetic Triage), a controlled benchmark that disentangles clinically meaningful acoustic cues from lexical content and speaker demographics. CliniCAST comprises 5,856 synthetic samples across 12 disease conditions: 4,800 audio samples forming 2,400 tagged–untagged pairs for five-level emergency triage, and 1,056 audio–text inconsistent samples in which reassuring speech is paired with high-risk acoustic cues. Evaluating a diverse suite of audio-capable foundation models, we find that LALMs exhibit fragile acoustic grounding and a pronounced “text dominance” failure mode: reassuring lexical content suppresses response to audible distress signals even under safety-critical conditions. Age and gender interactions are weak across conditions, indicating that the primary failure mode is insufficient cross-modal integration rather than demographic bias. These results suggest current LALMs are not yet robust enough for high-stakes medical triage, and motivate training objectives that explicitly enforce reliance on clinically grounded audible evidence.