Esophageal Speech Research Articles

Assessment of Self-Supervised Denoising Methods for Esophageal Speech Enhancement

Esophageal speech (ES) is a pathological voice that is often difficult to understand. Moreover, acquiring recordings of a patient’s voice before a laryngectomy proves challenging, thereby complicating enhancing this kind of voice. That is why most supervised methods used to enhance ES are based on voice conversion, which uses healthy speaker targets, things that may not preserve the speaker’s identity. Otherwise, unsupervised methods for ES are mostly based on traditional filters, which cannot alone beat this kind of noise, making the denoising process difficult. Also, these methods are known for producing musical artifacts. To address these issues, a self-supervised method based on the Only-Noisy-Training (ONT) model was applied, consisting of denoising a signal without needing a clean target. Four experiments were conducted using Deep Complex UNET (DCUNET) and Deep Complex UNET with Complex Two-Stage Transformer Module (DCUNET-cTSTM) for assessment. Both of these models are based on the ONT approach. Also, for comparison purposes and to calculate the evaluation metrics, the pre-trained VoiceFixer model was used to restore the clean wave files of esophageal speech. Even with the fact that ONT-based methods work better with noisy wave files, the results have proven that ES can be denoised without the need for clean targets, and hence, the speaker’s identity is retained.

Quality of Life of Patients Using Esophageal Speech after Total Laryngectomy: A Systematic Review Study.

(1) Background: The present systematic study aimed to assess whether using esophageal speech (ES) as a method of vocal rehabilitation in patients after total laryngectomy enhances their quality of life (QoL) and vocal functionality based on patients' reports. (2) Methods: Data collection was conducted from PubMed, Google Scholar, and Speech Bite, and the PRISMA Flow Diagram tool was used to record different stages of the literature search process. In the review, nine studies were included, while a bias check was carried out using the Critical Appraisal Skills Programme (CASP) checklists. Survey analysis incorporated quantitative and qualitative data, including standardized questionnaires and audio analyses. (3) Results: A technique's effectiveness depends on the method's functionality and the patient's abilities. Furthermore, the findings revealed that ES use unexpectedly affects quality of life regarding patients. While statistical analysis of the studies showed that some patients reported improvement in quality of life and vocal functionality, others faced challenges such as difficulty in learning the technique, long-term intervention, and unsatisfactory phonetic performance. Some studies observed quantitative measures, such as improved Voice Impairment Index (VHI) scores and Voice-Related Quality of Life (V-RQOL) scores. However, results were not uniformly positive across studies, with a subset of patients reporting minimal improvement. (4) Conclusions: The limited literature on the effect of ES on patients' QoL appears to influence the results in different ways. However, research data support that patients' communication and psychological state seem to improve significantly compared to patients who have not been rehabilitated. The final assessment of the technique's effectiveness on quality of life must depend on many factors.

Esophageal speech training system and needs for esophageal speech training in a laryngectomy patient association in Japan.

To study the esophageal speech training system and needs for esophageal speech training in one laryngectomy patient association in Japan. The esophageal speech training system of Association X for laryngectomy patients was observed through participation. Needs for esophageal speech training were analyzed qualitatively and inductively by semi-structured interviews with 7 esophageal speech (ES) trainers, 11 ES learners, and 8 family members of the association conducted according to an interview guide. Association X was organized, and its teaching system was established, by the Japan Federation of Laryngectomy Patient Associations (Nikkoren), and 12 ES trainers were appointed for esophageal speech and electrolarynx speech training. The training was based on the "Speech Practice Manual" published by the association, but the teaching methods and training contents and methods were left to the discretion of the individual ES trainers. The survey by Association X showed that there were needs for "Improvement of the methods and contents of esophageal speech training" and "Organizational reform of the association." The former category included "Improvements for evidence-based training that ensures vocalization" and "Improving training methods and assigning roles for advanced ES learners"; the latter category included "Development of a system for trainers to continue receiving training from better qualified trainers" and "Reforming the association to allow learners and families to voice their opinions about training." Each category consisted of three subcategories. In Association X, substitute vocalizations were taught by 12 ES trainers. "Improvement of the methods and contents of esophageal speech training" and "Organizational reform of the association" were expressed as needs for Association X concerning esophageal speech training.

Objective evaluation of the pharyngoesophageal segment as a source of substitute phonation in patients after total laryngectomy

The study aimed to identify objective predictors of the successful voice rehabilitation after total laryngectomy to select the optimal method of voice restoration.Material and Methods. The study included 60 laryngectomized male patients who were stratified into 2 equal groups depending on the patient’s choice of voice restoration: tracheoesophageal puncture or esophageal voice. A comprehensive assessment of the qualitative and quantitative parameters of the pharyngoesophageal segment was carried out using the diagnostic procedures, such as: fiberoptic endoscopic evaluation of swallowing, high-speed video endoscopy, and high-resolution pharyngoesophageal manometry. The results of examination of the pharyngoesophageal segment were compared with the results of voice rehabilitation.Results. A significant difference in the resting pressure in the pharyngoesophageal segment between patients with successful and unsuccessful voice rehabilitation was found. The resting pressure in the pharyngoesophageal segment was higher in patients with unsuccessful voice rehabilitation than in patients with successful voice rehabilitation. Among patients with failed voice rehabilitation, 64 % had pseudodiverticula, 25 % had cicatricial strictures and 11 % had pharyngospasm. Pseudodiverticula were found only in patients who underwent vertical or apparatus pharyngeal closure. We described vibrating patterns of substitute phonation in laryngectomized patients and identified 5 different types of pseudoglottis. No significant differences between the methods of substitute phonation were found.Conclusion. The state of pharyngoesophageal segment is an objective predictor of successful substitute phonation and depends on the surgical technique of pharyngeal closure, the volume of cancer treatment and the course of the postoperative period. A comprehensive assessment of the qualitative and quantitative parameters of the pharyngoesophageal segment using fiberendoscopic, fuoroscopic studies and highresolution pharyngoesophageal manometry allows prediction of voice rehabilitation outcomes.

무후두 음성에 대한 성문 역 여과 분석의 유용성

The purpose of this study was to present basic data for voice rehabilitation by acoustically analyzing the voices of subjects who lost their voice due to laryngeal excision and used esophageal vocalization as an alternative method. We aimed to investigate the usefulness of esophageal speech analysis using open source software that can automatically run glottic inverse filtration (GIF) analysis and analyze various parameter values. GIF analysis was performed on 20 normal adults and 20 people with negative esophageal vocalization. Analysis variables included open quotient, speed quotient, closure quotient, amplitude quotient, normalized amplitude quotient, and semi-open quotient. As a result of glottal inverse filtration analysis of normal voice and esophageal vocalization, the values of esophageal vocalization were lower in all variables compared to normal vocalization, and the average score of esophageal vocalization was found to be 1/4 of that of normal vocalization. In this study, objective values for the glottal waveform of normal adults were obtained, and these parameter values were applied to esophageal voice to determine the extent to which they differ from normal voice, and the GIF value was used to determine the degree of voice progress in esophageal voice rehabilitation. It is believed that it can be used for prediction.

Patterns of alaryngeal voice adoption and predictive factors of vocal rehabilitation failure following total laryngectomy.

We aimed to determine patterns of alaryngeal voice acquisition and predictive factors of vocal rehabilitation (VR) failure following total laryngectomy (TL) at a large Canadian tertiary care center. All consecutive patients having undergone a TL between January 1st, 2011 and December 31st, 2019, at the Centre Hospitalier de l'Université de Montréal were included. One hundred and ninety-seven laryngectomized patients were identified. Successful VR was achieved in 86 (59.0%) patients, while 59 (41.0%) failed to use a method of alaryngeal voice as their principal means of communication at 1 year postoperatively. The use of tracheoesophageal puncture (TEP) was associated with higher VR success rates (70.6%) when compared with the artificial larynx (48.6%), and esophageal voice (18.8%). The only independent predictor of VR failure on multivariate analysis at all time points was a low socioeconomic status. Failure to adopt an alaryngeal voice following TL is highly prevalent, despite comprehensive and free speech language pathologist services being offered at our center. A low resort to TEP at our institution and a poor acceptability and accessibility of alternative VR methods may contribute to this trend. The challenges of VR may be further exacerbated by the barriers linked to a lower socioeconomic status, which in turn may contribute to reduced candidacy for TEP.

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.

Vocal Rehabilitation and Quality of Life after Total Laryngectomy: State-of-the-Art and Systematic Review

The objective of this study was to meticulously examine the diverse vocal rehabilitation techniques that are employed following total laryngectomy, with emphasis on their implications on patients’ quality of life and on the determinants influencing the selection of one technique over another. We embarked on a comprehensive literature review, which concentrated on three primary rehabilitation approaches: tracheoesophageal puncture (TEP) accompanied by a vocal prosthesis, esophageal speech acquisition, and electrolarynx utilization. The outcomes assessed included quality of life, functional performance, communication effectiveness, patient satisfaction, and factors governing the choice of technique, such as patient demographics, disease stage, and treatment history. Our findings demonstrated that TEP with vocal prosthesis yielded the most favorable overall quality of life and patient satisfaction. Individuals who underwent TEP exhibited superior speech intelligibility, voice quality, and communication ease compared with those who employed esophageal speech acquisition or electrolarynx utilization. While esophageal speech learning exhibited inferior speech quality and functional performance, it offered cost-effectiveness and diminished maintenance advantages. Electrolarynx utilization emerged as the least preferred approach due to suboptimal speech intelligibility and voice quality. The determinants influencing the choice of vocal rehabilitation technique included patient age, sex, disease stage, and previous treatment history. Patient preferences also substantially contributed to the selection of a specific technique. It is essential for clinicians to consider individual factors and patient inclinations when deliberating on an appropriate vocal rehabilitation method following total laryngectomy. Our investigation underscores the significance of collaborative decision making between clinicians and patients to pinpoint the most fitting rehabilitation technique. Future research endeavors should be directed towards enhancing existing approaches, devising innovative methods, and probing long-term outcomes and cost-effectiveness to optimize patient care in the aftermath of total laryngectomy.

Laryngectomy: Phonation Alternatives and Their Impact on the Quality of Life.

Background The decision to consent to surgery is a life-changing moment. This study addresses the impact of total laryngectomy (TL) on phonation and its effect on the quality of life (QoL) of patients. The primary objective of this cohort study is to compare the alternatives in phonation rehabilitation, and the secondary objective is to identify concurrent predictors of vocal outcomes. Methodology To perform a comprehensive analysis, we reviewed data from patients who underwent TL with bilateral radical neck dissection in the Department of Otolaryngology, Head and Neck Surgery at Centro Hospitalar Universitário de Santo António between January 2010 and October 2022.Adult patients who consented to participate in the study and underwent subjective evaluation were included in this study. Data regarding clinical history was primarily collected. Statistical analysis was performed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Different types of vocal rehabilitation formed the subgroups to be compared. An additional analysis was performed for baseline variables collected in the clinical records, and vocal outcomes were measured using the Self-Evaluation of Communication Experiences After Laryngectomy (SECEL) questionnaire. Furthermore, linear models taking SECEL scores as the outcome were developed. Results The first search identified a total of 124 patients operated during the study period. In total, 63 patients were alive at the time of the current follow-up, with 61 deaths (49%). Overall, 26 of the 63 alive patients completed the SECEL questionnaire. All patients were male. The mean age at diagnosis was 62.2 ± 10.6 years. The mean age at the time of subjective vocal assessment with the SECEL questionnaire was 66.3 ± 10.4 years. The mean time of follow-up after the initial diagnosis was 4 ± 3.8 years. A statistically significant difference was observed in esophageal speech (ES), which was inferior to other modalities (mean SECEL total score for ES: 46.6 ± 12.2 vs. mean SECEL total score for all other modalities: 33 ± 15.1; p = 0.03). The follow-up time correlated significantly with vocal function, as measured by the SECEL questionnaire (p = 0.013). Conclusions The SECEL questionnaire can be a valuable tool to evaluate QoL in laryngectomy patients, given its usefulness in assessing the psychological impact derived from vocal functionality in this group. ES appears inferior to other modalities regarding voice-related QoL.

The French way of voice rehabilitation post total laryngectomy: current clinical practices and tendencies

Background Vocal rehabilitation post total laryngectomy (TL) lacks clinical guidelines, especially with the presence of multiple modalities. Objectives To describe the tendencies of vocal rehabilitation post TL in France and compare it with other countries. We try to identify the most practiced modalities and recognize statistically significant influencing factors. Materials and methods An electronic anonymous survey was answered by 75 ENT surgeons from France. The survey outlined the common practiced vocal rehabilitation modalities and had two versions depending on if the participant practices the tracheoesophageal speech (TES) or not. Results 96% use TES in their practice. Single modality TES and double modality TES with esophageal speech (ES) are the two most practiced modalities. 99% agreed that there is no age limit for the TES. Single modality ES was offered 92% more when more than 10 TL were performed per year (p < .05). No influencing factors found for single modality TES or double modality TES with ES (p > .05). Conclusion: In line with tendencies from other countries, the TES is the most practiced modality of vocal rehabilitation coupled or not with the ES. TES has no age limit as per our participants. The least practiced modality is the singe modality ALS.

An acoustic study of Cantonese alaryngeal speech in different speaking conditions.

Esophageal (ES) speech, tracheoesophageal (TE) speech, and the electrolarynx (EL) are common methods of communication following the removal of the larynx. Our recent study demonstrated that intelligibility may increase for Cantonese alaryngeal speakers using clear speech (CS) compared to their everyday "habitual speech" (HS), but the reasoning is still unclear [Hui, Cox, Huang, Chen, and Ng (2022). Folia Phoniatr. Logop. 74, 103-111]. The purpose of this study was to assess the acoustic characteristics of vowels and tones produced by Cantonese alaryngeal speakers using HS and CS. Thirty-one alaryngeal speakers (9 EL, 10 ES, and 12 TE speakers) read The North Wind and the Sun passage in HS and CS. Vowel formants, vowel space area (VSA), speaking rate, pitch, and intensity were examined, and their relationship to intelligibility were evaluated. Statistical models suggest that larger VSAs significantly improved intelligibility, but slower speaking rate did not. Vowel and tonal contrasts did not differ between HS and CS for all three groups, but the amount of information encoded in fundamental frequency and intensity differences between high and low tones positively correlated with intelligibility for TE and ES groups, respectively. Continued research is needed to understand the effects of different speaking conditions toward improving acoustic and perceptual characteristics of Cantonese alaryngeal speech.

Analysis of Phonetic Segments of Oesophageal Speech in People Following Total Laryngectomy

This paper presents an approach to extraction techniques for speaker recognition following total laryngectomy surgery. The aim of the research was to develop a pattern of physical features describing the oesophageal speech in people after experiencing laryngeal cancer. Research results may support the speech rehabilitation of laryngectomised patients by improving the quality of oesophageal speech. The main goal of the research was to isolate the physical features of oesophageal speech and to compare their values with the descriptors of physiological speech. Words (in Polish) used during speech rehabilitation were analyzed. Each of these words was divided into phonetic segments from which the physical features of speech were extracted. The values of the acquired speech descriptors were then used to create a vector of the physical features of oesophageal speech. A set of these features will determine a model that should allow us to recognize whether the speech-rehabilitation process is proceeding correctly and also provide a selection of bespoke procedures that we could introduce to each patient. This research is a continuation of the analysis of oesophageal speech published previously. This time, the effectiveness of parameterization was tested using methodologies for analyzing the phonetic segments of each word.

Acoustic characteristics of tracheoesophageal and oesophageal voice

Acoustic characteristics of tracheoesophageal and oesophageal voice

Validation and Cross-Cultural Adaptation of Croatian Self-Evaluation of Communication Experiences after Laryngectomy Questionnaire

Introduction: The Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) is a 35-item patient-reported questionnaire developed to address the communication needs of patients with laryngectomies. The aim was to translate, cross-culturally adapt, and validate the Croatian version. Methods: The SECEL was translated from English by two independent translators and back-translated by a native speaker, after which it was approved by an expert committee. The Croatian version of the Self-Evaluation of Communication Experiences after Laryngectomy questionnaire (SECEL:HR) was filled in by 50 laryngectomised patients who had completed their oncological treatment a year prior to inclusion in the study. Patients also filled in the Voice Handicap Index (VHI) and the Short Form Health Survey (SF-36) on the same day. All patients completed the SECEL:HR twice, the second time being 2 weeks after the initial test. Maximum phonation time and diadochokinesis of articulation organs were used for objective assessment. Results: Among the Croatian patients, the questionnaire was well-accepted and demonstrated good test-retest reliability and internal consistency for two out of three subscales. The correlations between VHI, SF-36, and SECEL:HR were moderate to strong. There were no significant differences between patients who are using oesophageal speech, tracheoesophageal speech, or the electrolarynx based on the SECEL:HR. Conclusion: Preliminary findings of the research indicate that the Croatian version of the SECEL has sufficient psychometric qualities, high reliability, and good internal consistency, with a Cronbach’s alpha of 0.89 for the total score. The Croatian version of SECEL can be recommended as a reliable and clinically valid measure for the assessment of substitution voices in Croatian-speaking patients.

Olfactory function in laryngectomised patients: tracheo-oesophageal versus oesophageal speech.

This study aimed to evaluate olfactory function in patients rehabilitated with oesophageal (ES) voice or tracheo-oesophageal (TES) prosthesis to further verify whether there were differences in smell alterations depending on voice rehabilitation modality. A total of 40 patients who had undergone total laryngectomy participated in the study. Speech rehabilitation was achieved through TES in 20 patients (Group A) or ES in 20 patients (Group B). Olfactory function was evaluated using the Sniffin' Sticks test. At olfactory evaluation, in Group A, 4/20 patients (20%) were anosmic, whereas 16/20 patients (80%) were hyposmic; in Group B, 11/20 patients (55%) were anosmic whereas 9/20 patients (45%) were hyposmic. A significant difference (p = 0.04) was found at global objective evaluation. The study shows that the rehabilitation with TES contributes to maintaining a functioning, albeit limited, sense of smell.

Historical and modern aspects of rehabilitation of voice function after laryngectomy

The literature review presents historical and modern aspects of the rehabilitation of vocal function after laryngectomy, in particular, external devices, tracheopharyngeal bypass surgery, esophageal speech, tracheoesophageal bypass surgery without the use of a prosthetic device, voice prostheses are described. The advantages and disadvantages of each voice restoration technique, functional results, complications, prosthesis designs, their service life, bypass techniques, methods of prevention and treatment of damage to the valve apparatus of the prosthesis by colonies of microorganisms, fungal flora are analyzed.

An Evaluation Pertaining to Esophageal Speech Outcomes in Alaryngeal Patients

Background: Previous studies have reported on the treatment of alaryngeal patients in order to improve their speech in several ways, but little focus was placed on esophageal speech. Objectives: To determine the time duration of esophageal speech training after which alaryngeal patients can speak, and to analyze the factors affecting esophageal speech training outcomes. Methods: A retrospective study, 29 alaryngeal patients who visited the Speech Clinic at Ramathibodi Hospital participated in the study. Data were collected from patients’ medical records after speech therapy with the esophageal speech and the combination of esophageal speech and electrolarynx. Data was analyzed by descriptive and inferential statistics. Results: Of 29 alaryngeal patients, 7 patients from the esophageal speech group and 6 patients from the combination of esophageal speech and electrolarynx training group could produce a first speech sound. The median duration of time that alaryngeal patients needed to speak after esophageal speech training was 11 weeks. Chemotherapy and the frequency of speech training sessions were factors that significantly affected the time durations needed by alaryngeal patients who succeeded in speaking because of esophageal speech training (P &lt; .05). Alaryngeal patients who were not treated with chemotherapy and attended speech training sessions more than once per month had shorter time durations for esophageal speech training than the others. Conclusions: Alaryngeal patients could speak after esophageal speech training for at least 11 weeks. Chemotherapy and frequency of speech training sessions impacted esophageal speech training outcomes.

A New Substitute Voice Using a Smartphone Application

Although widely used by patients who have undergone laryngectomy, vocalization using an electronic artificial larynx, tracheoesophageal shunt vocalization, and esophageal speech cannot reproduce a patient’s original voice, and this negatively affects their quality of life. In 2020, our department introduced a smartphone app called “coestation®,” an AI-based software that can reproduce voices with great similarity to the patient’s original voice by synthesizing 200 voice-recorded sentences.Our user survey revealed a high level of satisfaction with the similarity between the synthesized voices and the patients’ original voices. However, patients also showed dissatisfaction with the time lag and complexity of the app. In fact, only four of the six patients who agreed to participate in the survey were able to use the app properly. Consequently, the average voice-related quality of life among the app users was 61.9%, which is slightly lower than that among patients who used traditional substitute voices. Despite the remarkable quality of the voices reproduced by this innovative app, it should be constantly improved based on the patient feedback in order to meet their expectations.

Current Status of Voice Restoration after Total Laryngectomy – Tracheoesophageal Shunt Voice –

In the treatment of advanced laryngeal or pharyngeal cancer, while progress has been made in larynx-sparing therapies such as chemoradiotherapy, induction chemotherapy, and partial laryngectomy, total laryngectomy still plays an important role in terms of local control and salvage surgery. The importance of rehabilitation after total laryngectomy has been recognized. Regarding voice substitution, it is important to select the most appropriate means in accordance with the patient’s social background and wishes, and we believe it is important that all facilities offer patients equal opportunities to choose. Although guidance on esophageal speech is often mainly provided by patient groups, it is becoming increasingly important to build partnerships not only with physicians but also with speech-language pathologists, nurses, physicians in charge of community medicine, caregivers, social workers, etc., in order to perform shunt speech. We believe that by successfully coordinating with multiple professions and reducing the burden on physicians, it will be possible to provide voice restoration in accordance with the patient’s wishes. We introduce the current status of voice restoration and explain the multidisciplinary efforts to select voice restoration in our department. We also discuss our attempts to provide voice therapy for patients with shunt dysphonia.

Has Esophageal Speech Returned as an Increasingly Viable Postlaryngectomy Voice and Speech Rehabilitation Option?

The literature on postlaryngectomy voice and speech rehabilitation is long-standing. Although multiple rehabilitation options have existed over the years, the acquisition and use of esophageal speech (ES) has decreased significantly over the past 40 years. This reduction coincides with the increased application of tracheoesophageal puncture (TEP) voice restoration. The literature suggests that voice acquisition failures observed secondary to TEP may represent a similar phenomenon that led to ES acquisition failures. A comprehensive review of the literature on ES and TEP voice/speech was conducted. Specific attention was directed toward information on ES and TEP speech failures. Information on pharyngoesophageal segment (PES) spasm in the context of ES and TEP voicing failures was of specific importance. Similarities between voicing failures with both ES and TEP were identified. In order to resolve spasm in TEP speech, proactive efforts to eliminate it were undertaken, and regardless of the method used, voicing improvements were observed. These data suggest that both ES and TEP speech acquisition failures may be related to the same control mechanisms influencing the PES. The elimination of PES spasm provides evidence that justifies the reconsideration of ES. Consequently, ES may return as an increasingly viable postlaryngectomy voice and speech rehabilitation option.