Au-M-ol: A Unified Model for Medical Audio and Language Understanding
Authors: Meizhu Liu, Nistha Mitra, Paul Li, Amine Abdaoui, Adam Ledyard, Tao Sheng
Organizations: Oracle AI Science · Neuramill
Abstract
In this work, we present Au-M-ol, a novel multimodal architecture that extends Large Language Models (LLMs) with audio processing. It is designed to improve performance on clinically relevant tasks such as Automatic Speech Recognition (ASR). Au-M-ol has three main components: (1) an audio encoder that extracts rich acoustic features from medical speech, (2) an adaptation layer that maps audio features into the LLM input space, and (3) a pretrained LLM that performs transcription and clinical language understanding. This design allows the model to interpret spoken medical content directly, improving both accuracy and robustness. In experiments, Au-M-ol reduces Word Error Rate (WER) by 56% compared to state-of-the-art baselines on medical transcription tasks. The model also performs well in challenging conditions, including noisy environments, domain-specific terminology, and speaker variability. These results suggest that Au-M-ol is a strong candidate for real-world clinical applications, where reliable and context-aware audio understanding is essential.
Clinical audio diagnosis in low-resource settings requires models that identify conditions from minimal examples without large annotated corpora. We propose Federated Self-Contextualization (FSC), a multimodal language model framework for in-context clinical audio diagnosis across federated hospital clients. FSC constructs pseudo-label episodes via unsupervised clustering of audio representations, bypassing scarce real diagnostic labels, and enables contextual reasoning from support-query pairs. Our progressive three-stage pipeline first aligns audio embeddings with the language model via caption-based pretraining, then adapts it for episodic in-context inference through federated optimization. At test time, given a small labeled support set, the model diagnoses an unseen query through multimodal reasoning. On held-out respiratory and cardiac conditions, FSC achieves 71.6% accuracy in 2-way 2-shot evaluation, outperforming audio-language baselines by over 9%.
Audio intelligence involves understanding, reasoning about, and generating both audio and speech. In this work, we introduce Nemotron-Labs-Audex-30B-A3B (Audex), a unified audio-text LLM built on Nemotron-Cascade-2-30B-A3B, a strong text-only MoE LLM. Audex adopts a simple unified design with a single Transformer decoder: audio inputs are encoded and projected into the text embedding space, while text tokens and quantized audio output tokens are treated uniformly during generation. This architecture enables strong audio-text fusion, seamless multimodal generation, and compatibility with standard LLM training and inference infrastructure. For training, we meticulously curate audio-text datasets comprising 157.4B audio tokens and 320.5B text tokens. We apply multi-stage supervised training on these datasets, followed by text-only Cascade RL and multi-domain on-policy distillation. Audex delivers state-of-the-art audio understanding, speech recognition and translation, text-to-speech, audio generation, and speech-to-speech generation, while preserving very compelling reasoning, alignment, knowledge, long-context, and agentic capabilities of its text-only LLM backbone with marginal or no regression. We release the model checkpoints to facilitate open research.
While multi-audio understanding is critical for large audio-language models (LALMs), it remains underexplored. We introduce MUGEN, a comprehensive benchmark evaluating this capability across speech, general audio, and music. Our experiments reveal consistent weaknesses in multi-audio settings, and performance degrades sharply as the number of concurrent audio inputs increases, identifying input scaling as a fundamental bottleneck. We further investigate training-free strategies and observe that Audio-Permutational Self-Consistency, which diversifies the order of audio candidates, helps models form more robust aggregated predictions, yielding up to 6.28% accuracy gains. Combining this permutation strategy with Chain-of-Thought further improves performance to 6.74%. These results expose blind spots in current LALMs and provide a foundation for evaluating complex auditory comprehension.