Esophageal Speech Research Articles

Vocal Tract Area Functions to Assist in Determining Voiced Epochs in Esophageal Speech

Esophageal talkers may have reduced intelligibility due to both time domain and frequency domain variability. The unpredictable nature of esophageal speech can cause problems when automatic procedures are used in applications such as long-distance telephone messages. The current study compared a standard coding algorithm (LPC-10e) with a novel approach to determining voiced periods (vocal tract area functions) in the speech of esophageal talkers. The results of the study showed that the sentences synthesized with the vocal tract area function algorithm were more intelligible than those synthesized with the standard LPC-10e algorithm. Supplemental information, such as vocal tract area functions, may be useful in determining voiced epochs when variability in vocal parameters is high.

Chirurgische Stimmrehabilitation nach Laryngektomie

In spite of the progress made in organ-preserving therapy modalities, including endoscopic or external partial laryngectomies, radiotherapy or chemoradiation in many patients with advanced laryngeal and hypopharyngeal carcinomas, total laryngectomy remains the only safe possibility for long lasting local tumour control. The existing strategies for a sufficient restoration of voice following total laryngectomy are still controversial. Besides the strictly conservative methods of esophageal voice and electronic devices, different surgical procedures are carried out worldwide. At present, the exclusively surgical voice shunt techniques are only offered in a few very specialized centres. In Germany, three surgical methods are in use: (1) microvascular laryngoplasty according to Hagen (> 300 cases), (2) the "jejunal speaking siphon" according to Ehrenberger modified by Remmert (> 60 cases), and (3) the modified Asai-technique according to Maier and Weidauer (> 80 cases).

Proximal Esophageal Contractions in Laryngectomized Patients

After laryngectomy for treatment of laryngeal cancer, the distal esophageal contractions have low amplitude. Our hypothesis is that proximal esophageal contractions are also impaired. We studied the proximal esophageal contractions in 20 laryngectomized patients (16 men) with a mean age of 44.2 years, 12 rehabilitated patients with esophageal speech, and 12 controls (7 men, mean age of 46.5 years). We used the manometric method with continuous perfusion. All subjects were studied in the sitting position and performed five swallows of a 5-ml bolus of water alternated with five dry swallows. The contractions were measured 2 cm below the high-pressure zone of the pharyngoesophageal transition. The results showed that the amplitude and duration of contractions were different in laryngectomized patients compared with controls. The amplitude of contractions of patients (wet swallows: 37.3+/-20.7 mmHg, mean+/-SD) was lower than that of controls (81.1+/-31.7 mmHg). The duration of contractions was also lower in laryngectomized patients (2.2+/-0.7 s) than in controls (2.6+/-0.6 s). We conclude that the proximal esophageal contraction amplitude and duration of laryngectomized patients are lower than controls, a fact suggesting that laryngectomy may affect the proximal esophageal contractions.

Nonmuscular closure of the pharyngeal defect post laryngectomy and oesophageal speech acquisition

Nonmuscular closure of the pharyngeal defect post laryngectomy and oesophageal speech acquisition

Voice onset time in Mandarin esophageal speech

As an important perceptual cue for voicing and aspiration of stops, voice onset time (VOT) is mainly determined by the aerodynamic interaction between the intraoral and subglottal regions. However, since the PE segment serves as a new vibratory source in esophageal phonation, aerodynamic events are very different from laryngeal phonation. VOT associated with esophageal speech of English has been reported previously. However, few studies have reported VOT characteristics of esophageal speech of tone languages. The present study will investigate the possible VOT difference between esophageal and normal laryngeal speakers of Mandarin Chinese. Seven superior esophageal speakers and 7 normal laryngeal speakers will participate in the present investigation. They will be native male speakers of Mandarin Chinese. The participants will produce the syllable /ta/ embedded in a carrier phrase at a comfortable loudness level for three times. VOT values will be measured from a time domain waveform. With reference to a wide-band (300 Hz) spectrogram, VOT will be defined as the release of stop and the first identifiable period of the vocalic portion. An independent sample t-test will be used to determine if VOT values of esophageal and normal laryngeal speakers were significantly different.

A realtime clarification filter of dysphonic speech and its evaluation by listening experiments

This paper presents a digital filtering algorithm which clarifies dysphonic speech with the speaker’s individuality preserved. The study deals with the clarification of oesophageal speech and the speech of patients with cerebral palsy, and the filtering ability is being evaluated by listening experiments. Over 20,000 patients are currently suffered from laryngeal cancer in Japan, and the only treatment for the terminal symptoms requires the removal of the larynx including vocal cords. The authors are developing a clarification filtering algorithm of oesophageal speech, and the primal algorithm of software clarification and its effectiveness was reported in the previous ICDVRAT. Several algorithms for the clarification have been newly developed and implemented, and are being evaluated by questionnaires. The algorithms were extended and applied for the clarification of the speech by the patients of cerebral palsy. A voice is the most important and effective medium employed not only in the daily communication but also in logical discussions. Only humans are able to use words as means of verbal communication, although almost all animals have voices. Vocal sounds are generated by the relevant operations of the vocal organs such as a lung, trachea, vocal cords, vocal tract, tongue and muscles. The airflow from the lung causes a vocal cord vibration to generate a source sound, then the glottal wave is led to the vocal tract, which works as a sound filter as to form the spectrum envelope of a particular voice. If any part of the vocal organs is injured or disabled, we may be involved in the impediment in the vocalization and, in the worst case, we may lose our voices. Over 20,000 patients are currently suffered from laryngeal cancer in Japan, and the only treatment for the terminal symptoms is to remove the larynx. The removal of vocal cords means the loss of the voice, and causes various difficulties in the communication with other people, since the employment of a voice is essentially important for humans to make verbal communications. There are mainly two ways to recover voice. One is to use an artificial larynx, which is a hand-held device with a pulse generator that produces a vocal cord-like vibration. An electrolarynx has a vibrating plastic diaphragm, which is placed against the neck during the speech. The vibration of the diaphragm generates a source sound in the throat, and the speaker then articulates with the tongue, palate, throat and lips as he does for the usual vocalization. The device has an advantage to be used by just being held to the neck and to be easily mastered, but the sound quality is rather electronic and artificial. Furthermore one hand is occupied to hold the device during the speech, which disturbs the gestural communication. The other way is to train oesophageal speech, which is a method of speech production using an oesophagus (Sato, 1993; Max et al, 1996). In the speech, air is inhaled and caught in the upper oesophagus instead of being swallowed, and then the released air generates the oesophagus vibration to produce a “belch-like” sound that can be shaped into speech. A patient has difficulties to master the oesophageal speech (several years are ordinary required for the practice), however the voice is able to keep the speaker’s individuality since the speech is generated by his own vocal organs, although several distinctive characteristics exist. Moreover the speaker is able to employ his body parts such as hands and facial expressions freely and actively for the communication to assist the speech. Cerebral palsy (CP) is a condition caused by an injury to the parts of the brain which controls the ability to use muscles and bodies. The injury may happen before birth, sometimes during delivery, or soon after

Difficulties in the fixation of prostheses for voice rehabilitation after laryngectomy

In most patients with advanced or recurrent laryngeal or hypopharyngeal cancer, total laryngectomy is indicated. This means the loss of three main functions: phonation; respiration; and the prevention of aspiration during deglutition. Laryngectomy patients have various options to restore phonation: an oesophageal voice; an electrolaryngeal voice; or a tracheo-oesophageal voice. In the last case a silicone rubber shunt valve is placed in the tracheo-oesophageal wall and phonation is generated when exhaled air is forced through the oesophagus and neopharynx. This method is widely applied in Western Europe. In this paper we review the literature on fixation problems with shunt valves, tracheostoma valves and heat and moisture exchange (HME) filters. Tracheo-oesophageal speech without a valve is not considered. Despite 22 years of experience with the implantation of tracheo-esophageal shunt valves and many improvements in the design, problems still remain, such as biofilm formation with subsequent leakage through the valve, the need for frequent and inconvenient replacements, fistula enlargement leading to leakage around the device and reduced fixation, and infections. The high cost of shunt valves is a drawback to their use worldwide. To enable hands-free speech, different types of tracheostoma valve have been developed. These valves are fixed to the skin or to the tracheostoma by means of an intra-tracheal device. An HME filter is used to protect the airway and maintain physiological balance. Such devices are only suitable for a selected group of patients as fixation to the skin or trachea can be a major problem. Speaking and coughing cause pressure increases, which often result in mucous leakage and disconnection of the valve and/or HME filter. Recommendations are made for future improvements in fixation techniques.

Caracterización acústica y aerodinámica de la voz esofágica

ObjectiveThe aim of the study is to determine the physiology and pathophisiology of esophageal voice according to objective aerodynamic and acoustic parameters (quantitative and qualitative parameters) Material and MethodsOur subjects were comprised of 33 laryngectomized patients (all male) that underwent aerodynamic, acoustic and perceptual protocol ResultsThere is a statistical association between acoustic and aerodynamic qualitative parameters (phonation flow chart type, sound spectrum, perceptual analysis) among quantitative parameters (neoglotic pressure, phonation flow, phonation time, fundamental frequency, maximum intensity sound level, speech rate) ConclusionNevertheles, not always such observations bring practical resources to clinical practice. We consider that the facts studied may enable us to add, pragmatically, new resources to the more effective vocal rehabilitation to these patients. The physiology of esophageal voice is well understood by the method we have applied, also seeking for rehabilitation, improving oral communication skills in the laryngectomee population

Use of tubed gastro-omental free flap for hypopharynx and cervical esophagus reconstruction after total laryngo-pharyngectomy.

In case of total laryngo-pharyngectomy (TLP), replacement of the pharyngoesophageal segment is more often done with jejunal flap; however, in some cases, this flap doesn't represent the best surgical technique of reconstruction. The tubed gastro-omental free flap (TGO) offers an alternative procedure in selective cases. The objective of the study was to assess the TGO as a method of pharyngoesophageal reconstruction. Our study was based on a literature review and a retrospective study of six consecutive cases of TGO reconstruction after TLP. Six patients aged from 52 to 70 years underwent TGO reconstruction after TLP. Five patients had previously received systemic chemotherapy and external irradiation at curative doses, and three had undergone previous surgery. No abdominal complication occurred. Partial necrosis of the gastric flap occurred in one case. Except for this case, the feeding tube could be removed after 15 days. One patient was successfully treated with pneumatic esophageal dilatation for stricture 2 months after surgery. Four patients died of loco-regional tumor evolution or distant metastatic disease. For both of the patients who survived (mean follow-up, 40 months), a normal diet and an esophageal voice were obtained. The TGO offers a safe method of reconstructing the pharyngoesophageal segment in a surgical field compromised of previous multimodal therapy.

Comparison of alaryngeal voice and speech

The aim of the research was to compare voice and speech in three groups of alaryngeal speakers: 1) patients using esophageal speech, 2) patients with electro-acoustical speech aids and 3) patients with voice prostheses. Acoustic analysis and pronunciation tests were used for the analysis. Acoustic analysis included fundamental frequency, maximum phonation time, jitter, shimmer and intensity. Pronunciation parameters were: phonetic block duration, number of syllables in a phonetic block, rate of speech, maximum number of syllables in a phonetic block and rate of articulation in a maximal phonetic block. Our results demonstrated the advantages of tracheoesophageal puncture with implantation of a voice prosthesis over the other two techniques of alaryngeal speech. Voice and pronunciation with voice prostheses were closer to normal in many parameters: fundamental frequency, maximum phonation time, jitter, shimmer, duration of a phonetic block, number of syllables in a phonetic block, rate of speech and rate of articulation in maximal phonetic block.

Objective evaluation of the quality of substitution voices.

This paper describes our first attempts to develop a method for the objective assessment of quality in substitution voices. The objective analysis deals with acoustic parameters characterising short voice and speech samples like a sequence of isolated vowels, a sequence of VCV and CVCVCV syllables, a short sentence, etc. A database of 113 registrations from 68 patients (53 total laryngectomy patients with tracheo-esophageal speech, 14 total laryngectomy patients with esophageal speech and 5 patients with partial frontolateral laryngectomy) and 6 registrations from healthy control persons was collected. Each registration consisted of seven speech utterances and was subjected to an acoustic analysis as well as to a perceptual evaluation, the latter involving eight parameters like "overall impression", "tonicity", etc. Since the goal of our work is to find out the best acoustical measurement for supporting perception and making it precise, it seemed logical to strive for a perceptually based acoustic analysis. We therefore performed the analysis by means of a peripheral auditory model with a built-in fundamental frequency (pitch) extractor. From the frame-level outputs (a frame is 10 ms) of the analyser, global objective parameters, such as (1) the percentage of voiced frames, (2) the average voicing evidence, (3) the voicing length distribution and (4) the fundamental frequency jitter, were computed for the different speech utterances. So as to reduce the parameter variability arising from the nature of the speech utterances (e.g., the presence of pauses in the signal, errors caused by the pitch extractor, etc.), the objective parameters were computed using non-standard averaging schemes involving energy weighting and frame selection. A statistical analysis of the objective parameters confirms that the quality of tracheo-esophageal speech is superior to that of esophageal speech, but inferior to that of normal speech and speech with the preservation of one vocal fold. Correlations between the objective parameters and the perceptual parameters are moderate.

Advances in Alaryngeal Communication and the Art of Tracheoesophageal Voice Restoration

Advances in Alaryngeal Communication and the Art of Tracheoesophageal Voice Restoration

Uticaj obima hirurske resekcije kod totalne laringektomije na uspostavljanje ezofagusnog glasa i govora

The study of functional results of total laryngectomy cannot be separated from articulation of esophageal voice and speech. To achieve success of phoniatric rehabilitation in laringectomized patients, it is necessary to be well aware of pathological sequelae of the very operation, long-term adverse effect of oncological risk factors as well as postoperative anatomo-physiological changes. Anatomic results of total laryngectomy depend on the type of surgical intervention and probable radiotherapy. The extent of surgical procedure, primary dictated by oncological indications, has the essential effect to articulation of esophageal voice and speech. If possible for oncological reasons, hyoid bone should be particularly left intact. Extensive surgical interventions of hypopharynx and the base of the tongue during laryngectomy, neck dissection--especially the radical one, and subsequent radiotherapy, all of them significantly reduce the possibility to produce esophageal voice and speech. Total laryngectomy eliminates the creator of voice and vibrations, which are acoustically perceived as esophageal voice, proceeding at the level of pharyngoesophageal junction. For this reason, the quality of newly created vibrating narrowing is especially important.

Ten-year experience with voice prosthesis

The E.N.T. Clinic of Tepecik Educational Hospital Izmir, Turkey, has been using voice prosthesis for 10 years. We tried using all of the prostheses sold on the market. Several scientific studies had been carried out to find the most eligible one. A total of 251 laryngectomies have been performed at our clinic since 1993: 204 Provox, 17 Blom-Singer, 5 Groningen and Turvox were used. Twenty cases were speaking with oesophageal speech. The intelligibility of the prostheses was measured with phonetically balanced word lists. The results were 72–92% with mono- and double-syllable words with Provox, 53–77% with Blom-Singer, 52–75% with Groningen and 67–87% with Turvox. The average device life was 18 months with Provox and 5 with the others. The complications were minor. There were a small number of fungal colonisations. The reason for this is the antifungal activity of Turkish Yougurt, especially Kephir.As a result, we can say that Provox is the most eligible prosthesis. The Turkish prosthesis, Turvox, is new, and the scientific studies are still ongoing. It is very cheap, but we still have a long way to go.

Voice rehabilitation after total laryngectomy using a simple cheap prosthesis

The basic idea of most procedures for vocal reconstruction after total laryngectomy is to provide an airway communication between the trachea and the pharynx. These procedures have advantages over esophageal speech in being better controlled and having more words per phrase.Different techniques and procedures were applied using this principle.A simple cheap prosthesis to communicate between the tracheostome and a surgically constructed pharyngeo-cutaneous fistula is introduced. Advantages, disadvantages, and limitations are discussed, together with video show for the surgical procedure.

Quality of Life in Laryngectomees after Prosthetic Voice Restoration

Background: In oncology, the paradigms for evaluating the results of treatment have shifted over the last few years. Preserving or restoring the quality of life has become an equally important aim of medical treatment as complete excision of the tumor and the duration of patient survival. Following laryngectomy, adequate speech restoration is one major aim of therapy. Different replacement strategies of voice production such as tracheoesophageal speech, esophageal speech, or electrolarynx are in use. The reporting department is able to restore speech in more than 90% of the patients; the majority uses tracheoesophageal speech with Provox^® voice prosthesis. The purpose of the study was to assess the quality of life in laryngectomees after successful voice restoration with Provox voice prosthesis. Patients and Methods: In a cross-sectional study 25 laryngectomees whose voice had been restored by tracheoesophageal puncture and Provox voice prosthesis were examined for quality of life. The Short Form 36-Item Health Survey (SF-36) was used as an international and highly standardized test. Results: In comparison with a standardized healthy German male population, the patients showed more limited physical functioning as well as more restricted physical and emotional role functions. However, the laryngectomees did not attain lower scores for bodily pain. According to the patients’ statements their social functioning, vitality, and their mental health were not excessively limited; mental health and vitality were even better than in patients with heart or renal failure and hepatitis C. General health was fairly similar to a standard population. Conclusions: After laryngectomy, patients have deficits in physical and emotional well-being. Concepts of therapy should increasingly focus on how to deal with physical limitations and the patient’s apperception. Successfully restored voice minimizes social, mental and vitality limitations. The SF-36 is a suitable instrument for quality of life assessment in order to define disease-dependent and individual limitations of quality of life in laryngectomees and should lead to individual interventions.

Voice Rehabilitation after Total Laryngectomy Using the Provox R Voice Prosthesis

Esophageal speech is the first choice for vocal rehabilitation in laryngectomized patients. However, shunt speech is a needed alternative for patients who cannot succeed at esophageal speech. Many kinds of voice prostheses, with good results, have been reported. Provox was selected for 15 laryngectomized patients who were treated in our department. Voice rehabilitation was successful in 13 patients. However, removal of the prosthesis was required in one patient because of stomal stenosis. Voice rehabilitation was not successful in one patient who exhibited esophageal stenosis. The rate of voice rehabilitation was not influenced by the extent of surgery, the dose of radiation, etc.. The maximum phonation time was more than 10 minutes in the 13 patients who succeeded at shunt speech. Prosthetic rehabilitation was requested by two patients who had been successful at esophageal speech. These results suggest that prosthetic voice rehabilitation may be indicated for a wide range of conditions.

Análisis discriminante aplicado a los formantes de las vocales castellanas en la fonación con prótesis y erigmofonía tras laringuectomía total

AbstractThe objective of the present work consists, in analyzing if there is statistically significant differences between certain quantitative variables of acoustic parameters of the voice, in three samples of individuals, using a discriminative analysis. The study groups are formed by: 20 patients with total laringectomy and esophageal voice, 20 patients with total laringectomy and tracheoesophageal voice with phonatory prosthesis, and 20 normal individuals. We analyzed the energy, bandwidth and frequency of the four first formants of the five Castilian vowels in the context of an established phrase. Based on our results the method of discriminative analysis of the used variables is valid to establish differences between the three studied groups; that is they display their own characteristics from the acoustic point of v i e w. This method allows us to affirm that the tracheoesophageal voice does not come closer to the normal voice that the esophageal voice does.

Voice restoration with low pressure blom singer voice prosthesis after total laryngectomy.

The main problem after total laryngectomy is permanent loss of voice. Current methods of vocal rehabilitation after total laryngectomy include development of esophageal speech, use of artificial larynx, tracheoesophageal shunt operations and more recently surgical restoration of the voice with prosthesis. Primary voice restoration using Blom- Singer voice prosthesis after total laryngectomy and pharyngeal myotomy was performed in 187 patients between October 1992 and July 2000. There were 184 male and 3 female patients of average age 63.7 years (range 42-76). Mean follow up period was 62 months. Satisfactory speech was achieved in 156 patients (83.5%). During the follow-up period, we experienced complaints of insufficient voice in 31 (16.5%) patients, due to partial spasm in 17 and total spasm in the pharyngoesophageal segment in 14. Furthermore, 24 (12.8%) patients preferred esophageal speech or electro larynx because of low socioeconomic level. The overall success rate was 70.7%. In this study the results of the surgical technique and prosthesis insertion, as well as the associated complications and socioeconomic levels of the patients, are discussed.

616 声道フィルタ特性を用いた声帯振動信号からの音声生成

The voice communications are important to spend in our daily life smoothly. Patients who remove his or her larynx lose all vocal function. A variety of alternative voices have been designed and made practicable for such a functional disorder person up to now. A functional disorder person who lost the language function uses the uttered esophageal speech method by vibrates the mucous membrane of the vocal tract as a substitute voice. However, there are problems which tone quality is bad and difficult to hear it. Vocal chords vibration signal is necessary to correct because it is does not make a plain voice. In this study, we try to make the speech production by correcting the vocal chords vibration signal by using of the voice tract filter characteristics.