Acoustic and perceptual evaluation of voice and speech quality: a study of patients with laryngeal cancer treated with laryngectomy vs irradiation

OBJECTIVE: To compare voice and speech function in patients who underwent laryngectomy with that of 2 control groups. DESIGN: A cross-sectional study comparing acoustic and temporal variables with perceptual evaluations in 3 subject groups. SETTING: University hospital in G?teborg, Sweden. SUBJECTS: Two groups of patients with laryngeal carcinoma were examined: 12 male patients who had laryngectomy and were using a tracheoesophageal prosthesis and 12 male patients treated with radical radiotherapy who had a preserved larynx. The third group consisted of 10 normal controls without laryngeal disease. MAIN OUTCOME MEASURES: Acoustic variables were fundamental frequency, absolute fundamental frequency perturbation, speech rate, and maximum phonation time. Perceptual evaluation included 15 listeners' perceptual evaluation and the patients' self-assessment of speech intelligibility, voice quality, and speech acceptability. RESULTS: No significant acoustic or temporal differences were found between the laryngectomy and radical radiotherapy groups. There was a significant difference between the patient groups in perceptual evaluation. Both groups of patients differed from normal controls in acoustic and temporal measures, where the laryngectomy group generally deviated more from the normal controls than the patient group treated with radiotherapy. There was a weak, but significant, correlation between absolute fundamental frequency perturbation and perceived voice quality. CONCLUSIONS: Perceptual evaluations could indicate significant differences between the patients who underwent laryngectomy and irradiated patients, where the acoustic analysis failed to reflect these differences. Both patient groups could be distinguished according to acoustic and temporal measures when compared with normal controls. The acoustic analyses were more sufficient in voices without severe dysfunction.     

48例喉全切除气管断端膜样部食管吻合分流发音重建术长期疗效观察

目的 研究喉全切除气管断端膜样部食管吻合分发音重建术的长期疗效。方法 利用自制的随访表，对白求恩国际和平医院48例患者做长期随访，其中喉癌行喉全切除发音重建术46例，下咽癌行喉全切除发音重建术2例。观察他们的发音和吞咽情况，并对手术并发症和生存率做了统计分析。结果 35例无喉者的言语水平接近正常喉言语水平，他们的最大的发音时程较长、听距较远、言语可懂度高、较流利。5例发音效果较差，但言语可懂度仍高。发音成功率83．3％（40／48）。成功组中，40．0％无喉言语者（16／40）有不影响正常进食的轻微误吸。另8例不能发音、也没有误吸。气管瘘口、气管－食管分流口感染和咽瘘是影响发音重建成功的重要因素。生存率与单纯喉全切除术相当。续集 该术式一期完成，操作简单，发音成功率高，一些病例虽有轻微误吸，但不影响正常进食，值得推广运用。     

Mechanism of esophageal speech after total laryngectomy]

OBJECTIVE: To evaluate the characteristics of esophageal speech after total laryngectomy. METHODS: Esophageal speech evaluation of 40 cases of esophageal phonation included acoustic parameters, intraesophageal pressures during phonation, speech intelligibility, fluency, communication, respiratory sound and cognate distinctions between voiced and voiceless sounds. RESULTS: In 8 poor speakers, the neoglottis was spasmodic and difficult to vibrate during phonation. In 32 good speakers, the neoglottis was relaxed and easy to vibrate during phonation. The training age, speech intelligibility, fluency, communication, respiratory sound, cognate distinctions between voiced and voiceless sounds and intraesophageal pressures during phonation were significantly different between good and poor esophageal speakers. Vocal characteristics of good speakers differed significantly from those in the normal (P < 0.05 or P < 0.01). The upper intraesphageal pressure during esophageal phonation was higher than that of the normal, especially for poor esophageal phonation. The middle to lower intraesphageal pressures was highest during poor esophageal phonation. CONCLUSIONS: Esophageal phonation was completely alaryngeal, and its activators also differ completely, so phonation could not maintain much longer. Patients with poor esophageal phonation could not drive the air through the neoglottis freely.     

喉全切除术食管发音机制研究

目的　探讨喉全切除术后食管言语的特点。方法　对北京同仁医院 40例训练食管发音患者的嗓音声学、言语、形态特征及发音时食管压力变化进行分析 ,以 5 0例健康男性作为对照。结果　食管发音不良 8例 ,发音良好 32例。发音不良者黏膜痉挛 ,气流无法送出 ;发音基频小于 6 0Hz无法评估。发音良好者食管入口黏膜松弛 ,振动明显 ;其嗓音声学特征与健康对照差异有显著性(P值 <0 0 5或 <0 0 1)。食管发音不良者训练发音年龄、言语清晰度、速度、呼吸发音协调程度与发音良好者差异有显著性 (P值 <0 0 5或 <0 0 1)。食管发音时食管上、中段压力明显高于健康对照组(P值 <0 0 5或 <0 0 1) ,其中发音不良者压力增加更为明显 ,特别是食管中段压力。结论　食管发音声道振动及动力器官均与正常发音存在本质区别 ,通过代偿机制瞬间发音可达良好效果 ,但在自然、持续言语交流中存在明显障碍     

两种无喉言语的比较研究

目的：比较无假体气管食管分流音与食道音在最大发声时间，可懂度和阅读时间等方面的差异，方法，研究对象包括年龄，性别和术后发声时间相当的两组无喉言语者，其中，食管音组21名，无假体气管食管音组30名，采集了两组的最大发声时间，可懂度和阅读时间的数据，用t检验分析最大发音时间和阅读时间（P＜0．05），H检验分析言语可懂度（P＜0．05），结果：食管音在这三个项目上均较气管食管分流音差；言语可懂度略差于气管食管分流音；言语流利度和最大发声时间均明显差于气管食管分流音。结论：无假体管食管音的言语效果优于食管音，而且其手术方法简单，容易训练，利于推广。     

48例喉全切除气管断端膜样部食管吻合分流发音重建术长期疗效观察

目的　研究喉全切除气管断端膜样部食管吻合分流发音重建术的长期疗效。方法　利用自制的随访表 ,对白求恩国际和平医院 48例患者做长期随访 ,其中喉癌行喉全切除发音重建术 46例 ,下咽癌行喉全切除发音重建术 2例。观察他们的发音和吞咽情况 ,并对手术并发症和生存率做了统计分析。结果　 35例无喉者的言语水平接近正常喉言语水平 ,他们的最大发音时程较长、听距较远、言语可懂度高、较流利。 5例发音效果较差 ,但言语可懂度仍高。发音成功率 83 3% (4 0 / 48)。成功组中 ,40 0 %无喉言语者 (16 / 40 )有不影响正常进食的轻微误吸。另 8例不能发音 ,也没有误吸。气管瘘口、气管 食管分流口感染和咽瘘是影响发音重建成功的重要因素。生存率与单纯喉全切除术相当。结论　该术式一期完成 ,操作简单 ,发音成功率高 ,一些病例虽有轻微误吸 ,但不影响正常进食 ,值得推广运用     

Acoustic parameters and speech analysis after supracricoid hemilaryngopharyngectomy

Selected characteristics of speech and voice were compared in 10 patients who had undergone supracricoid hemilaryngopharyngectomy (SCHLP) and 20 normal adult laryngeal (NAL) speakers. Durational features of tape-recorded speech samples were measured using a stopwatch. Frequency features were analyzed with the Computerized Speech Lab and the multidimensional voice program. SCHLP speech proved comparable to NAL speech in average fundamental frequency, speech rate, and group phrasing. SCHLP speech and voice were statistically less efficient than NAL speech in fundamental frequency range, jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time. Age, associated cricopharyngeal myotomy, postoperative radiation therapy, and time elapsed from SCHLP completion were not statistically related to the speech and voice parameters of SCHLP speakers.     

A comparative acoustic analysis of voice production by near-total laryngectomy and normal laryngeal speakers.

Limited objective data are available on voice characteristics of patients following near-total laryngectomy. Acoustic characteristics of near-total voice were quantified and compared to laryngeal voice production. High quality audio recordings were obtained from 11 subjects who had undergone near-total laryngectomy and 11 age-matched laryngeal speakers. Subjects performed vocal tasks which provided frequency, intensity and duration measures. These data were computer analyzed and indicated that substantial inter and intrasubject variability existed in the acoustic measures for near-total laryngectomy patients. These patients demonstrated a general restriction in fundamental frequency, reduced intensity and a limitation in duration of phonation when compared to laryngeal speakers.     

Mental health after laryngectomy and partial laryngectomy: a comparative study

Patients treated for laryngeal cancer are confronted daily with the effects of the operation. The choice of treatment method can have a significant impact on psychosocial adjustment. Three hundred and six out-patients who underwent surgical treatment for laryngeal cancer within the last two decades were interviewed in their own homes using the structured clinical interview for DSM-IV (SCID). Psychiatric disorders were diagnosed among 17.3% of the partial laryngectomy patients (PL) and 22.2% of the patients with total laryngectomy (LE). In comparing four variables (age, time elapsed since diagnosis, gender and subjective speech intelligibility), subjective speech intelligibility and age were the variables with a unique, significant effect on the frequency of psychiatric disorders, albeit only in the case of PL patients. The need for psychosocial rehabilitation for patients with partial laryngectomy tends to be underestimated. It is concluded that screening for psychological variables and subjective speech intelligibility can be beneficial for the identification of out-patients lacking appropriate treatment.     

食管发音患者的语音学分析

目的 观察喉全切除食管发音患者的语音声学特征。方法对16例喉全切除食管发音患者进行语音声学分析及最大发声时程的测定，并以健康男性作对照。同时比较食管发音者和健康人的声波周期性。结果同健康男性比较，食管发音患者的语音声学参数除振幅外，基频、基频微扰、振幅微扰、谐噪比、标准化噪声能量均有统计学差异，且声波周期性差。结论食管发音的声学特性与正常男性相比有显著差别，声音稳定性差、声时短、音调低钝，但食管发音仍是喉全切除术后患者获得发音的一种重要途径。     

Voice rehabilitation with Provox2 voice prosthesis following total laryngectomy for laryngeal and hypopharyngeal carcinoma

OBJECTIVE: To analyze the effectiveness of the Provox2 voice prosthesis for voice rehabilitation following total laryngectomy. METHODS: From September 2000 to December 2004, the Provox2 voice prosthesis was used for voice rehabilitation in 32 patients following total laryngectomy. The quality of speech with the Provox2 voice prosthesis was analyzed using the HRS rating scale, the maximum phonation time (MPT), incidence of complications and the in situ lifetime. The rate of speech restoration was further analyzed in 129 patients with total laryngectomy from 1996 to 2004. RESULT: Twenty-nine of 32 patients were able to restore speech using the Provox2 voice prosthesis, a speech restoration rate of 90.6%. The maximum phonation time (MPT) was measured in 18 patients using the Provox2 voice prosthesis. The mean MPT was 15.1 s, with a range of 8-28 s. MPT was not influenced by age, concurrent radiotherapy treatment, the location of the primary tumor or use of reconstructive surgery. The average lifetime of the Provox2 in patients with laryngeal carcinoma (12 patients) and hypopharyngeal carcinoma (17 patients) was 27.2 and 16.6 weeks, respectively, which was significantly different (P=0.024, non-parametric Mann-Whitney's U-test). The rate of speech restoration by the use of esophageal speech, and insertion of an artificial larynx was 62.7% for laryngeal carcinoma (59 cases) and 38.6% for hypopharyngeal carcinoma (70 cases), which was also significantly different (P<0.01, chi-square test). CONCLUSION: Provox2 voice prosthesis speech was very useful due to the higher rate of speech restoration, longer phonatory time, and better intelligibility. It was also thought that voice prosthesis speech was useful in conjunction with esophageal speech and an artificial larynx depending on the patient's condition or wishes.     

Assessment of irregular voices after total and laser surgical partial laryngectomy

OBJECTIVES: To assess the merits of computer-aided voice analysis procedures for very irregular voices of patients after total and laser surgical partial laryngectomy, and to characterize qualitative differences in speech and voice function between these 2 groups of patients. DESIGN: Cross-sectional study. SETTING: University hospital in G?ttingen, Germany PATIENTS: Twenty-nine patients with advanced laryngeal carcinomas (T3-T4; according to the Union Internationale Contre le Cancer, TNM staging system, stages III-IVa) were examined: 18 patients with tracheoesophageal speech (voice prosthesis) after total laryngectomy and 11 patients who underwent partial transoral resection of the larynx (by means of laser microsurgery without surgical voice rehabilitation). MAIN OUTCOME MEASURES: Speech intelligibility was measured by a standardized and validated telephone test, and voice quality was determined by 2 computerized voice analysis systems (multidimensional voice program and G?ttingen hoarseness diagram). RESULTS: The telephone test demonstrated a significantly better speech performance of the patients who had undergone organ-preserving surgery. The voices of both patient groups were too irregular for a qualitative differentiation with the multidimensional voice program. The multidimensional voice program results also failed to show significant correlations to speech intelligibility. The G?ttingen hoarseness diagram showed significantly more regular voices in patients with partial laryngectomy than total laryngectomy. These results were correlated with speech intelligibility. CONCLUSIONS: The G?ttingen hoarseness diagram is suitable for a qualitative assessment even of irregular voices. Voice prosthesis offers a voice quality that at best approaches that of patients with partial laryngectomy.     

Breath-group intelligibility in dysarthria: characteristics and underlying correlates.

PURPOSE: This study was designed to determine whether within-speaker fluctuations in speech intelligibility occurred among speakers with dysarthria who produced a reading passage, and, if they did, whether selected linguistic and acoustic variables predicted the variations in speech intelligibility. METHOD: Participants with dysarthria included a total of 10 persons with Parkinson's disease and amyotrophic lateral sclerosis; a control group of 10 neurologically normal speakers was also studied. Each participant read a passage that was subsequently separated into consecutive breath groups for estimates of individual breath group intelligibility. Sixty listeners participated in 2 perceptual experiments, generating intelligibility scores across speakers and for each breath group produced by speakers with dysarthria. RESULTS: Individual participants with dysarthria had fluctuations in intelligibility across breath groups. Breath groups of participants with dysarthria had fewer average words and reduced interquartile ranges for the 2nd formant, the latter a global measure of articulatory mobility. Regression analyses with intelligibility measures as the criterion variable and linguistic and acoustic measures as predictor variables produced significant functions both within and across speakers, but the solutions were not the same. CONCLUSIONS: Linguistic or acoustic variables that predict across-speaker variations in speech intelligibility may not function in the same way when within-speaker variations in intelligibility are considered.     

Acoustic Analyses Clarify Voiced-Voiceless Distinction in Tracheoesophageal Speech

In order to clarify the ability of the voice to achieve voiced-voiceless distinction in [ce1]tracheoesophageal (TE) speech, acoustic cues such as closure duration, onset and offset of vibration during closure period and voice onset time (VOT), in conjunction with intraoral pressure, were analyzed in 40 TE speakers. Both closure period and VOT during [p] production were longer in TE speakers with high intelligibility compared with laryngeal speakers; during [b] production these parameters were similar between the two groups. TE speakers with high intelligibility and laryngeal speakers showed significant differences between [p] and [b] production in terms of both closure duration and VOT. TE speakers with low intelligibility of [b] had higher values of VOT during [b] production compared with those with high intelligibility. TE speakers with low intelligibility of [p] had lower values of VOT during [p] production compared with those with high intelligibility. It is concluded that these characteristic acoustic cues reflect voicing ability in TE speech.     

Acoustic analyses clarify voiced-voiceless distinction in tracheoesophageal speech

In order to clarify the ability of the voice to achieve voiced voiceless distinction in [ce1]tracheoesophageal (TE) speech, acoustic cues such as closure duration, onset and offset of vibration during closure period and voice onset time (VOT), in conjunction with intraoral pressure, were analyzed in 40 TE speakers. Both closure period and VOT during [p] production were longer in TE speakers with high intelligibility compared with laryngeal speakers; during [b] production these parameters were similar between the two groups. TE speakers with high intelligibility and laryngeal speakers showed significant differences between [p] and [b] production in terms of both closure duration and VOT. TE speakers with low intelligibility of [b] had higher values of VOT during [b] production compared with those with high intelligibility. TE speakers with low intelligibility of [p] had lower values of VOT during [p] production compared with those with high intelligibility. It is concluded that these characteristic acoustic cues reflect voicing ability in TE speech.     

Intelligibility of laryngectomees’ substitute speech: automatic speech recognition and subjective rating

Substitute speech after laryngectomy is characterized by restricted aero-acoustic properties in comparison with laryngeal speech and has therefore lower intelligibility. Until now, an objective means to determine and quantify the intelligibility has not existed, although the intelligibility can serve as a global outcome parameter of voice restoration after laryngectomy. An automatic speech recognition system was applied on recordings of a standard text read by 18 German male laryngectomees with tracheoesophageal substitute speech. The system was trained with normal laryngeal speakers and not adapted to severely disturbed voices. Substitute speech was compared to laryngeal speech of a control group. Subjective evaluation of intelligibility was performed by a panel of five experts and compared to automatic speech evaluation. Substitute speech showed lower syllables/s and lower word accuracy than laryngeal speech. Automatic speech recognition for substitute speech yielded word accuracy between 10.0 and 50% (28.7±12.1%) with sufficient discrimination. It complied with experts subjective evaluations of intelligibility. The multi-rater kappa of the experts alone did not differ from the multi-rater kappa of experts and the recognizer. Automatic speech recognition serves as a good means to objectify and quantify global speech outcome of laryngectomees. For clinical use, the speech recognition system will be adapted to disturbed voices and can also be applied in other languages.     

Vocal Capacities in Esophageal and Tracheoesophageal Speakers

The present study investigated the vocal capacities of adult men who had undergone total laryngectomy. Esophageal (N = 10) and tracheoesophageal (N = 10) speakers were compared for the parameters maximum phonation time (MPT), maximum number of syllables that could be spoken on one air intake (SYLLS), dynamic range (DYN), frequency range (FREQ), and maximum intensity level (MIL). Statistical analyses yielded significant between-group differences for the parameters MPT, SYLLS, and MIL but not for DYN and FREQ. Thus, although the groups did not differ with respect to range of intensity and frequency measures, maximum performance on the durational and intensity measures was always less for the esophageal speakers than for the tracheoesophageal speakers. Pearson's product-moment correlations among these parameters were remarkably different for esophageal and tracheoesophageal subjects, suggesting that phonatory and aerodynamic factors interact differently in the two groups.     

Acoustic analysis of tracheoesophageal speech in comparison to esophageal speech after total laryngectomy

In order to evaluate the vocal quality of tracheo-oesophageal (TE) and oesophageal (E) speech, several acoustic parameters were measured in the acoustic waveform (fundamental frequency, maximum phonation time, maximum intensity) and in the frequency spectrum: harmonicity-to-noise ratio [HNR], pitch perturbation [Jitter], Shimmer. Thirteen patients using tracheo-oesophageal speech (Provox 2 valve) and 11 good oesophageal speakers were evaluated. The control group consisted of 10 healthy men with normal speech. Digital recordings were obtained from examined subjects as they sustained the vowel "a". Maximum phonation time in TE samples was significantly longer than in E speech recordings and similar to the normal speech. The tracheo-oesophageal voices more often showed a detectable fundamental frequency which was fairly stable and lower than in oesophageal and normal speech. In our cohort of patients maximum voice intensity in both groups of alaryngeal speakers was similar and lower than in control group. The Jitter and Shimmer results of TE speech were similar to those of E speech and higher than in controls. HNR was significantly higher in TE speech than in E voice and three times lower in comparison to normal speech. The results of this investigation indicate that TE speech is more like normal speech than is E voice.     

Acoustic and perceptual characteristics of esophageal and tracheoesophageal speech production

This study comprehensively compared the speech of laryngeal speakers (L), tracheoesophageal speakers (TE), good esophageal speakers (GE), and moderate esophageal speakers (ME) to determine the consequences of TE versus E speech rehabilitation. Twenty speakers (five in each group) were each recorded while reading 16 sentences, and their recordings were analyzed acoustically and perceptually. Acoustic analysis included duration, intensity, fundamental frequency (F0), intonation, and voice onset time measurements. Perceptual analysis included intelligibility and acceptability judgments by naive listeners. The main acoustic results showed that L speakers differ significantly from all alaryngeal speakers in F0 and intonation production. Moderate esophageal speakers differed significantly from all other groups in duration measures. Perceptual results revealed that L speakers were most intelligible and acceptable, whereas ME speakers were least so. Tracheoesophageal speakers were more acceptable than GE speakers but not more intelligible. Significant correlations emerged between F0, duration measures, and acceptability, and between F0 and intelligibility. Also, a significant correlation emerged between acceptability and intelligibility. Findings emphasized the importance of categorizing esophageal speakers into groups based on their speech proficiency level.