Alaryngeal Speech Research Articles

A Novel Technique: Stapler-Assisted Total Laryngectomy with Concurrent Tracheoesophageal Prosthesis Insertion.

Stapling-assisted closure of pharyngeal mucosa during total laryngectomy was described in 1973.Few authors have demonstrated that this technique provides a faster and more reliable pharyngeal closure with ashorter operative period. However, the simultaneous placement of tracheoesophageal prostheses is quitechallenging and affects the patient's speech rehabilitation. We are reporting our novel concurrent tracheoesophageal prosthesis insertion technique in stapler-assistedtotal laryngectomy. A patient with locally advanced laryngeal cancer underwent total laryngectomy with stapler-assistedcloser and concurrent primary tracheoesophageal prosthesis. In a closed stapler-assisted reconstruction of theneopharynx, an inflate folye ballon was utilised to identify the ideal TEP puncture site. The immediate postop course was uneventful, and the patient acquired fluent alaryngeal speech after thespeech rehabilitation. Our novel technique of concurrent tracheoesophageal prosthesis insertion in stapler-assisted totallaryngectomy is practically simple and shortens the operative time.

Alaryngeal Speech Enhancement for Noisy Environments Using a Pareto Denoising Gated LSTM

Loss of the larynx significantly alters natural voice production, requiring alternative communication modalities and rehabilitation methods to restore speech intelligibility and improve the quality of life of affected individuals. This paper explores advances in alaryngeal speech enhancement to improve signal quality and reduce background noise, focusing on individuals who have undergone laryngectomy. In this study, speech samples were obtained from 23 Lithuanian males who had undergone laryngectomy with secondary implantation of the tracheoesophageal prosthesis (TEP). Pareto optimized gated LSTM was trained on tracheoesophageal speech data to recognize complex temporal connections and contextual information in speech signals. The system was able to distinguish between actual speech and various forms of noise and artifacts, resulting in a 25% drop in the mean signal-to-noise ratio (SNR) compared to other approaches. According to acoustic analysis, the system significantly decreased the number of unvoiced frames (PVF) from 40% to 10% while maintaining stable proportions of voiced frames (PVS) and average voicing evidence (AVE), indicating the accuracy of the approach in selectively attenuating noise and undesired speech artifacts while preserving important speech information.

Synthesizing Lithuanian voice replacement for laryngeal cancer patients with Pareto-optimized flow-based generative synthesis network

This study presents a Pareto optimized flow-based generative network for speech synthesis - the P-GLOW model in Lithuanian speech synthesis for substituting original voices affected by cancer-related pathologies. Comparing this pure Lithuanian model with an English model trained on Lithuanian phonemes, the study emphasizes the impact of language-specific characteristics on performance, illustrating the advantages of tailored, language-specific models for speech substitution for impaired persons. Our methodology integrates generative models with an architecture based on 12 coupling layers, 1x1 invertible convolutions, and dilated convolutions with gated hyperbolic tangent activation functions. This design facilitates the effective transformation of waveform inputs into Mel spectrograms, enabling the synthesis of high-quality speech audio. The proposed, Pareto optimized, native Lithuanian model achieved a MOS of 4.2 ± 0.1 and an SMOS of 3.9 ± 0.2, while the baseline model (English language model trained on top with Lithuanian phonemes) scored lower with a MOS of 3.8 ± 0.2 and an SMOS of 3.4 ± 0.3. In terms of the Mel Cepstral Distortion (MCD), Voiced/Unvoiced Decision Error (VDE), Glottal-to-Noise Excitation Ratio (GPE), and Frame Fidelity Error (FFE) scores, the proposed method achieved an MCD of 3.2 dB ± 0.2, a VDE of 5.6% ± 1.0, a GPE of 7.9% ± 1.4, and an FFE of 9.7% ± 2.0, outperforming the baseline method which scored higher with an MCD of 4.6 dB ± 0.3, a VDE of 10.8% ± 1.9, a GPE of 14.5% ± 2.4, and an FFE of 18.7% ± 2.8. Log Likelihood Ratio (LLR), Weighted Spectral Slope (WSS), and Perceptual Evaluation of Speech Quality (PESQ) scores also showed strong improvement. The proposed method achieved an LLR of 0.5 ± 0.05, a WSS of 0.3 ± 0.03, and a PESQ of 4.2 ± 0.1, while the baseline method scored lower with an LLR of 0.8 ± 0.08, a WSS of 0.5 ± 0.05, and a PESQ of 3.6 ± 0.2. The Speech Intelligibility Index (SII) and Short-Time Objective Intelligibility (STOI) metrics for restored alaryngeal speech were also high. The proposed method achieved an SII of 0.75 ± 0.05 and an STOI of 0.85 ± 0.03, while the baseline method scored lower with an SII of 0.65 ± 0.05 and an STOI of 0.75 ± 0.04. The evaluation results demonstrate that our approach was able to effectively synthesize high-quality Lithuanian speech audio restoring the input signal from distorted alaryngeal speech.

The Influence of Stimulus Composition and Scoring Method on Objective Listener Assessments of Tracheoesophageal Speech Accuracy

Introduction: This study investigated the influence of stimulus composition for three speech intelligibility word lists and two scoring methods on the speech accuracy judgments of five tracheoesophageal (TE) speakers. This was achieved through phonemic comparisons across TE speakers’ productions of stimuli from the three intelligibility word lists, including the (1) Consonant Rhyme Test, (2) Northwestern Intelligibility Test, and (3) the Weiss and Basili list. Methodology: Fifteen normal-hearing young adults served as listeners; all listeners were trained in phonetic transcription (IPA), but none had previous exposure to any mode of postlaryngectomy alaryngeal speech. Speaker stimuli were presented to all listeners through headphones, and all stimuli were transcribed phonetically using an open-set response paradigm. Data were analyzed for individual speakers by stimulus list. Phonemic scoring was compared to a whole-word scoring method, and the types of errors observed were quantified by word list. Results: Individual speaker variability was noted, and its effect on the assessment of speech accuracy was identified. The phonemic scoring method was found to be a more sensitive measure of TE speech accuracy. The W&B list yielded the lowest accuracy scores of the three lists. This finding may indicate its increased sensitivity and potential clinical value. Conclusions: Overall, this study supports the use of open-set, phonemic scoring methods when evaluating TE speaker intelligibility. Future research should aim to assess the specificity of assessment tools on a larger sample of TE speakers who vary in their speech proficiency.

Psychological Factors of Effectiveness in Speech Rehabilitation After Laryngectomy: a Case Study

Relevance. The purpose of the study was to reveal and describe psychological factors of effectiveness in voice rehabilitation after laryngectomy. Authors submit the results of speech rehabilitation work of speech pathologist with patient M., who achieved alaryngeal communication without any limitations under conditions of extremely problematic state of health. Description of the clinical observation. Rehabilitation of voice function was conducted according to an esophageal speech training method. To study in detail the motivation of patient M., a narrative psychological interview and standardized tests were conducted. Despite the poor health, a lot of complex diagnoses and poor preconditions for speech rehabilitation, patient M. showed great success in alaryngeal communication, which is not always typical for patients with less severe conditions for rehabilitation. Conclusion. The study shows that the effectiveness of the alaryngeal speech rehabilitation course after laryngectomy can be ensured by meaning work of personality, designing creative motivation, focusing on asserting and affirming life, and creating new meanings.

Pareto-Optimized Non-Negative Matrix Factorization Approach to the Cleaning of Alaryngeal Speech Signals.

The problem of cleaning impaired speech is crucial for various applications such as speech recognition, telecommunication, and assistive technologies. In this paper, we propose a novel approach that combines Pareto-optimized deep learning with non-negative matrix factorization (NMF) to effectively reduce noise in impaired speech signals while preserving the quality of the desired speech. Our method begins by calculating the spectrogram of a noisy voice clip and extracting frequency statistics. A threshold is then determined based on the desired noise sensitivity, and a noise-to-signal mask is computed. This mask is smoothed to avoid abrupt transitions in noise levels, and the modified spectrogram is obtained by applying the smoothed mask to the signal spectrogram. We then employ a Pareto-optimized NMF to decompose the modified spectrogram into basis functions and corresponding weights, which are used to reconstruct the clean speech spectrogram. The final noise-reduced waveform is obtained by inverting the clean speech spectrogram. Our proposed method achieves a balance between various objectives, such as noise suppression, speech quality preservation, and computational efficiency, by leveraging Pareto optimization in the deep learning model. The experimental results demonstrate the effectiveness of our approach in cleaning alaryngeal speech signals, making it a promising solution for various real-world applications.

Communication competence and disability secondary to laryngectomy and tracheoesophageal puncture voice restoration.

There is a large body of research showing the negative impact of a total laryngectomy on the resultant voice signal across multiple outcomes (e.g., speech intelligibility/acceptability, listener comprehension, voice quality). However, there is limited information on the effects of laryngectomy on broader communication acts, particularly in the area of pragmatics, commonly referred to as the social use of language. Considering that individuals with a laryngectomy (IWL) frequently report reduced quality of life as well as reduced communicative competency, expanding the current research to include pragmatics is warranted. To explore the pragmatic changes in communication experienced by tracheoesophageal speakers. The current study adapted an existing 17-item measure to assess verbal, non-verbal, paralinguistic and receptive communication competence via self-report. This adapted measure was then distributed to 65 tracheoesophageal speakers (52 males, 13 females, mean age = 63.4±8.5 years). Both negative and positive pragmatic changes to communication were reported by participants secondary to laryngectomy. This included changes in verbal (negative -37.5%, positive -15.15%); non-verbal (negative -9.54%, positive -35.45%; and paralinguistic acts (negative -29.55%, positive -34.09%). Changes to receptive communication were also noted (negative -14.78%, positive -43.19%). The overall results suggest that communication changes post-laryngectomy exist well beyond the paralinguistic areas (e.g., intelligibility, voice quality) and that males and females may approach or respond to changes in communication differently. Results are discussed specific to clinical intervention and the importance of including assessment of pragmatic function post-laryngectomy. What is already known on this subject While there is a large body of research on the changes to the speaker and listener following laryngectomy, there is minimal information on how the use of alaryngeal speech affects overall communication, specifically in the area of pragmatics or the social use of language. What this paper adds to existing knowledge This study used an adapted version of the widely used Pragmatic Protocol to delineate changes in pragmatic components of communication for tracheoesophageal speakers. What are the potential or actual clinical implications of this work? Clinically, this information can be used by healthcare professionals to educate and prepare IWL on potential changes in the underrecognized area of pragmatics.

Chaos Behavior Analysis of Alaryngeal Voices Including Esophageal and Tracheoesophageal Voices

Hypothesis/Objectives: This study’s objective was to develop a method to evaluate the chaotic characteristic of alaryngeal speech. The proposed method will be capable of distinguishing between normal and alaryngeal voices, including esophageal (SE) and tracheoesophageal (TE) voices. It has been previously shown that alaryngeal voices exhibit chaotic characteristics due to the aperiodicity of their signals. The proposed method will be applied for future use to quantify both chaos behavior (CB) and the difference between SE and TE voices. Study Design: A total of 74 voice recordings including 34 normal and 40 alaryngeal (26 SE and 14 TE) were used in the study. Voice samples were analyzed to distinguish alaryngeal voices from normal voices and to investigate different chaotic characteristics of SE and TE speech. Methods: A chaotic distribution detection-based method was used to investigate the CB of alaryngeal voices. This CB was used to detect the difference between SE and TE voice types. Quantification of the CB parameter was performed. Statistical analyses were used to compare the results of the CB analysis for both the SE and TE voices. Results: Statistical analysis revealed that CB effectively differentiated between all normal and alaryngeal voice types (p < 0.01). Subsequent multiclass receiver operating characteristic (ROC) analysis demonstrated that CB (area under the curve) possessed the greatest classification accuracy relative to correlation dimension (D₂). Conclusions: The CB metric shows strong promise as an accurate, useful metric for objective differentiation between all normal and alaryngaeal, SE and TE voice types. The CB calculations showed expected results, as SE voices have significantly more CB than TE voices, constituting substantial improvement over previous methods and becoming the first SE and TE classification method. This metric can help clinicians obtain additional acoustic information when monitoring the efficacy of treatment for patients undergoing total laryngectomies.

Speech rehabilitation after total laryngectomy with voice prostheses: phonatory results

The approaches for voice rehabilitation after laryngectomy vary significantly, as they can be classified into natural and device-aided (external and surgical). The techniques differ in degree of accessibility, success and vocal results. Until the introduction of surgical methods, esophageal speech was the mainstay of rehabilitation. It is associated with long training period with questionable success. The electrolarynx, which in our country is still traditionally accepted as the main method of voice rehabilitation after laryngectomy, generates speech with a low degree of intelligibility and mechanical sound. The implantation of a voice prosthesis in a surgically shaped tracheoesophageal fistula is currently accepted as the gold standard. The aim of the study was phoniatric analysis of voice production in alaryngeal speech after tracheo-oesophageal puncture and implantation of a voice prosthesis. The characteristics of tracheoesophageal and oesophageal speech are compared. The obtained results show that the voice production after implantation of a voice prosthesis significantly exceeds the oesophageal voice in terms of average duration of phonation with one air bolus, number of words uttered with one bolus, and the pace and expressiveness of speech.

Clinical Experiences of People With a Laryngectomy During the SARS COVID-19 Pandemic.

Purpose This study described the clinical experiences of patients with a total laryngectomy (TL) during the COVID-19 pandemic and identified changes in communication, tracheostoma care, and heat-moisture exchange (HME) use that were recommended or self-implemented. Method An online survey addressing the study aims was completed by 173 people with a TL who live in the United States. The survey was open from July 5 to August 10, 2020. Results In-person clinic visits, appointment cancellations, and contact from their speech-language pathologists (SLPs) were reported by 42%, 19%, and 54% of the TL respondents, respectively. At clinic visits, 78% were required to wear a mask over their nose/mouth, and 73% were required to wear a mask over their tracheostoma. Masks, gloves, and face shields worn by the SLP at these visits were reported by 84%, 82%, and 70% of the TL patients, respectively. Alaryngeal communication changes were recommended by the SLP for 7%-18% of TL patients, depending on their method of communication, whereas 43%-45% implemented changes on their own. Changes in tracheostoma care and HME use were recommended by the SLP for 27% and 21% of the TL respondents, respectively, whereas 54% and 47% made changes on their own. Conclusions Individuals with a TL will require in-person care even during a pandemic, as reflected in this study. Many had not been contacted by their SLP or otolaryngologist about TL guidelines that were becoming available. Notably, larger percentages of TL patients reported self-initiated changes to their communication, tracheostoma care, and HME use because of the pandemic than their SLP had advised. The types of communication changes varied in part, depending on the method of alaryngeal speech a respondent used. Supplemental Material https://doi.org/10.23641/asha.16807270.

An acoustic study of vowels produced by Cantonese alaryngeal speakers using clear speech

Alaryngeal speech is an alternative method of verbal communication following the removal of the larynx. Common alaryngeal speaking methods include esophageal (ES) speech, tracheoesophageal (TE) speech, and speech produced using an electrolarynx (EL). A recent study [Hui et al., in press, Folia Phoniatr Logop] demonstrated better intelligibility in Cantonese alaryngeal speakers while using clear speech (CS) compared to their everyday ‘habitual speech’ (HS). Yet the correlated change in the acoustics associated with CS is still not clear. The purpose of this study was to assess the acoustic characteristics of vowels produced by Cantonese alaryngeal speakers during HS and CS conditions. Thirty-one alaryngeal speakers (9 EL users, 10 ES speakers, and 12 TE speakers) produced sentences from the Cantonese Sentence Intelligibility Test in HS and CS. Acoustic analyses considered formants (measured by reassigned spectrogram), vowel space area (VSA) and vowel duration across alaryngeal speaking methods and styles. We also examined these acoustic differences in relation to duration of alaryngeal speech use and intelligibility. Results suggest that EL users had larger VSAs and larger increases in vowel duration while using CS compared to ES and TE speakers. Future research will examine the effects of refined CS protocols on improving acoustic and perceptual characteristics of Cantonese alaryngeal speech.

Effect of total laryngectomy on vowel production: An acoustic study of vowels produced by alaryngeal speakers of Cantonese

Purpose: To investigate the effect of total laryngectomy on vowel production, the present study examined the change in vowel articulation associated with different types of alaryngeal speech in comparison with laryngeal speech using novel derived formant metrics. Method: Six metrics derived from the first two formants (F1 and F2) including the First and Second Formant Range Ratios (F1RR and F2RR), triangular and pentagonal Vowel Space Area (tVSA and pVSA), Formant Centralisation Ratio (FCR) and Average Vowel Spacing (AVS) were measured from vowels (/i, y, ɛ, a, ɔ, œ, u/) produced by oesophageal (ES), tracheoesophageal (TE), electrolaryngeal (EL), pneumatic artificial laryngeal (PA) speakers, as well as laryngeal speakers. Result: Data revealed a general reduction in articulatory range and a tendency of vowel centralisation in Cantonese alaryngeal speakers. Significant articulatory difference was found for PA and EL compared with ES, TE, and laryngeal speakers. Conclusion: The discrepant results among alaryngeal speakers may be related to the difference in new sound source (external vs internal). Sensitivity and correlation analyses confirmed the use of the matrix of derived formant metrics provided a more comprehensive profile of the articulatory pattern in the alaryngeal population.

Listener impressions of alaryngeal communication modalities

Purpose: Following a total laryngectomy in which the larynx is completely removed, individuals in the USA have three primary options for alaryngeal verbal communication including tracheoesophageal speech (TES), oesophageal speech (ES) and electrolarynx (EL). Using a large sample of participants from across the USA, this study investigated listener impressions of each primary type of alaryngeal communication. As these are the individuals more likely to be participating in social interactions and in positions of hiring for employment, the general public’s impressions of TES, ES and EL may be a vital consideration during the treatment process. Method: A total of 381 individuals rated eight speech samples, including samples from speakers of each alaryngeal communication modality as well samples from age and sex matched laryngeal speakers, with regards to three outcome measures: intelligence, likability and employability. Result: Listener impressions of alaryngeal speech samples were modulated by the type of communication mode. Further, the patterns of results differed by speaker sex, with ES speech rated consistently more favourable for female speakers across all outcome measures and TES rated consistently more favourable for male speakers across all outcome measures. Conclusion: An overall preference for laryngeal speech was noted, particularly with male speakers. The female ES stimuli, interestingly, was the highest rated alaryngeal communication modality. Regardless of speaker sex, all alaryngeal modes greatly affected impressions of employability relative to impressions of likeability and intelligence.

A Spanish multispeaker database of esophageal speech

A laryngectomee is a person whose larynx has been removed by surgery, usually due to laryngeal cancer. After surgery, most laryngectomees are able to speak again, using techniques that are learned with the help of a speech therapist. This is termed as alaryngeal speech, and esophageal speech (ES) is one of the several alaryngeal speech production modes. A considerable amount of research has been dedicated to the study of alaryngeal speech, with a wide range of aims such as helping speech therapists with evaluation and diagnosis, and improving its quality and intelligibility using digital signal processing techniques. We present to you a database of Spanish ES voices, named AhoSLABI, which is designed to allow the development of new support technologies for this speech impairment. The database primarily consists of recordings of 31 laryngectomees (27 males and 4 females) pronouncing phonetically balanced sentences. Additionally, it includes parallel recordings of the sentences by 9 healthy speakers (6 males and 3 females) to facilitate speech processing tasks that require small parallel corpora, such as voice conversion or synthetic speech adaptation. Apart from the sentences, the database includes sustained vowels and a small set of isolated words, which can be valuable for research on ES analysis, diagnosis and evaluation. The paper describes the main contents of the database, the recording protocols and procedure, as well as the labeling process. The main acoustic characteristics of the voices, such as speaking rate, durations of the recordings, phones and silences, and other such characteristics are compared with those of a reduced set of healthy voices. In addition, we describe an experiment using the database to improve the performance of an ASR system for ES speakers. This new resource will be made available to the scientific community with the hope that it will be used to improve the quality of life of the laryngectomees.

Terminology and frameworks used for the classification of voice disorders: a scoping review protocol.

This review aims to examine the literature on the terminology and descriptions for the broad classification of voice disorders, and outline the criteria described to guide clinicians in differential classification. The process of classifying the etiology of voice disorders is complex. A key challenge for clinicians and researchers is a lack of consensus on agreed terminology to define umbrella terms commonly used in the published literature. Consistency in the terminology for voice disorder classification, and well-defined conditions within those groups, will provide greater clarity for clinicians and researchers. Published and unpublished literature that include participants (adults and children) diagnosed with a voice disorder using any criteria or framework will be considered. Studies will be included provided they give a descriptive detail of the structure of the classification system and describe a methodological approach to determine classification criteria. Studies will be excluded if they include animal models or participants with alaryngeal speech, elective mutism, or resonance disorders. The following databases will be searched: MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Cochrane Database of Systematic Reviews, and Web of Science. Studies will be limited to those published in English from 1940 to present. Two independent reviewers will screen the retrieved articles against the eligibility criteria. A narrative synthesis of the main concepts will include classification terminology, classification criteria, commonly described specific diagnoses within the groups, test measures used to determine criteria, critical appraisal items, and gaps in research.

The Effects of Contextual Priming and Alaryngeal Speech Mode on Auditory-Perceptual Ratings of Listener Comfort

The effectiveness of postlaryngectomy communication methods (esophageal, tracheoesophageal, and electrolaryngeal speech) has been primarily evaluated using functional outcomes. This evaluation neglects the importance of listeners and their influence on communicative effectiveness. Listener comfort (LC), or the ease with which a listener interacts with alaryngeal speakers, may provide an important index of communicative effectiveness. The present study investigated the use of LC in the auditory-perceptual evaluation of alaryngeal speech modes, as well as evaluating the influence of contextual cues used to elicit ratings on listener judgments of all three alaryngeal modes. Thirty-three naïve listeners provided independent ratings of LC for 39 alaryngeal speech samples using a visual analogue scaling procedure. Each group of listeners rated alaryngeal speech in three imagined listening conditions (Telephone Conversation, Social Situation, and a non-specified Control Condition). To analyze LC ratings obtained, a 3×3 mixed factor analysis of variance was conducted. A significant interaction effect between alaryngeal speech mode and listening condition (P=0.04) was identified. Overall, pairwise comparisons of alaryngeal speech mode indicated that listeners were more comfortable when presented with tracheoesophageal speech samples compared to those of esophageal and electrolaryn geal speakers. Our data suggest that LC ratings are influenced by alaryngeal speech mode. Tracheoesophagea speech was perceived to have the most favorable LC ratings compared to the other alaryngeal speech modes in all listening conditions. Contextual cues (i.e., social condition and telephone condition) did not have an effect on LC ratings.

Pilot study for a novel and personalized voice restoration device for patients with laryngectomy.

The main modalities for voice restoration after laryngectomy are the electrolarynx, and the tracheoesophageal puncture [Correction added on 30 January 2020 after first online publication: The preceding sentence has been revised. It originally read "The main modalities for voice restoration after laryngectomy are the electrolarynx and the tracheoesophageal puncture."]. All have limitations and new technologies may offer innovative alternatives via silent speech. To describe a novel and personalized method of voice restoration using machine learning applied to electromyographic signal from articulatory muscles for the recognition of silent speech in a patient with total laryngectomy. Surface electromyographic (sEMG) signals of articulatory muscles were recorded from the face and neck of a patient with total laryngectomy who was articulating words silently. These sEMG signals were then used for automatic speech recognition via machine learning. Sensor placement was tailored to the patient's unique anatomy, following radiation and surgery. A personalized wearable mask covering the sensors was designed using 3D scanning and 3D printing. Using seven sEMG sensors on the patient's face and neck and two grounding electrodes, we recorded EMG data while he was mouthing "Tedd" and "Ed." With data from 75 utterances for each of these words, we discriminated the sEMG signal with 86.4% accuracy using an XGBoost machine-learning model. This pilot study demonstrates the feasibility of sEMG-based alaryngeal speech recognition, using tailored sensor placement and a personalized wearable device. Further refinement of this approach could allow translation of silently articulated speech into a synthesized voiced speech via portable devices.

Comparison of Voice Handicap Index in Patients with Esophageal and Tracheoesophageal Speech after Total Laryngectomy

Background: Successful speech rehabilitation has a great impact on the quality of life in totally laryngectomized patients. Objectives: The aim of this paper was to compare the self-assessed voice handicap of totally laryngectomized patients with two different methods of alaryngeal speech – esophageal (ES) and tracheoesophageal speech (TES). Method: The research comprised 83 totally laryngectomized, disease-free patients, split into two groups. The first group included 43 participants with successfully rehabilitated ES, and the second group included 40 participants with successfully established TES after secondary implantation of Provox 2^TM voice prosthesis. All subjects filled in the Serbian version of the Voice Handicap Index (VHI-30). The results (overall score and three VHI subscales) were analyzed and compared with those of the subjects of both groups. The impact of age in the subgroups (<65 years old and ≥65 years old) and previous irradiation on the examined VHI values were also analyzed. Results: The median value of the overall VHI score in the participants with TES was 29.03 ± 23.479 (range: 0–97), and in the participants with ES it was 64.51 ± 21.089 (range: 19–99). The VHI scores (overall and three VHI subscales) were significantly higher in participants with ES compared to those with TES (p < 0.01), indicating a larger voice handicap. No significant difference was found in the overall VHI score and VHI subgroups in terms of age subgroups and previous irradiation (p > 0.05). Conclusions: Our data reveal a significantly higher voice handicap in participants with ES compared to the TES group, with a large interindividual variation within both groups. VHI values are not significantly different between the two age subgroups, nor are they significantly influenced by irradiation.

Voice Rehabilitation After Laryngectomy: A Regional Cancer Centre Experience and Review of Literature.

Alaryngeal speech in laryngectomees has revolutionized the patient outlook toward the morbid procedure and the concept of permanent stoma unlike olden era when stigma of stoma with loss of voice was rampant. To analyse acceptance of voice rehabilitation options and their success and management of complications in a tertiary care centre. All patients who underwent laryngectomy from August 2014 to 2018 June at our institution were included in the study. The voice rehabilitation options like oesophageal speech, tracheao-oesophageal puncture and voice prosthesis insertion (TEP), and electrolarynx were explained to the patients. The options put forward to the patients, the importance of Taub test, Interval between treatment and secondary TEP insertion, life span of the prosthesis, Patients acceptance and success rates and the troubleshooting were noted. A total of 96 patients underwent total laryngectomy, 72 patients were willing for rehabilitation. 15% (11) patients had primary TEP, 22% (16) had secondary TEP insertion, esophageal speech in 36% (26) patients and 27% (19) patients opted for the electrolarynx. The rest 24 patients were not keen on any further interventions after laryngectomy. Speech rehabilitation is an integral part in surgical management of carcinoma of the larynx. Alaryngeal speech in laryngectomees have revolutionized the patient outlook towards the morbid procedure. Esophageal speech is the least successful method of rehabilitation but still the cheapest method and requires a lot of motivation. Primary and Secondary TEP insertions have similar success rates. Successful treatment for cancer of larynx ends with successful voice rehabilitation.

The use of the Lombard Effect in Improving Alaryngeal Speech

The present study examined and compared the Lombard effect among laryngeal and alaryngeal speakers including esophageal, tracheoesophageal, pneumatic artificial laryngeal, electrolaryngeal speakers of Cantonese. The subsequent change in intelligibility was also examined. A total of 52 native Cantonese-speaking laryngeal and alaryngeal speakers (10 laryngeal , 8 laryngeal , 13 electrolaryngeal , 11 esophageal, and 10 tracheoesophageal) participated in a reading task involving three 10-syllable Cantonese sentences under 10 background conditions: quiet, 60 dB, 65 dB, 70 dB, 75 dB, 80 dB, 85 dB, 90 dB, 95 dB, and 100 dB white background noise. Speech intelligibility associated with speaking conditions were evaluated by five naïve Cantonese speakers. Output intensity was significantly increased in all speaker types under all nine noisy background conditions when compared with the quiet condition. However, the amount of increase was different for different modes of phonation. In addition, significant difference in speech intelligibility between laryngeal and alaryngeal speakers was found at all conditions, but not among any alaryngeal speech. The Lombard reflex is still present after total laryngectomy. Yet, different alaryngeal speech was associated with different amount of loudness change, and subsequent improvement in intelligibility was not observed.