Esophageal Speech Research Articles

Bedeutung psychosozialer Faktoren bei der Stimmrehabilitation nach Laryngektomie

Often it is assumed that psychosocial and sociodemographic factors cause the success of voice rehabilitation after laryngectomy. Aim of this study was to analyze the association between these parameters. Based on tumor registries of six ENT-clinics all patients were surveyed, who were laryngectomized in the years before (N = 190). Success of voice rehabilitation has been assessed as speech intelligibility measured with the postlaryngectomy-telephone-intelligibility-test. For the assessment of the psychosocial parameters validated and standardized instruments were used if possible. Statistical analysis was done by multiple logistic regression analysis. Low speech intelligibility is associated with reduced conversations (OR 0.970) and social activity (OR 1.049). Patients are more likely to talk with esophageal voice when their motivation for learning the new voice was high (OR 7.835) and when they assessed their speech therapist as important for their motivation (OR 4.794). The risk to communicate merely by whispering is higher when patients live together with a partner (OR 5.293), when they talk seldomly (OR 1.017) and when they are not very active in social contexts (OR 0.966). Psychosocial factors can only partly explain how voice rehabilitation after laryngectomy becomes a success. Speech intelligibility is associated with active communication behaviour, whereas the use of an esophageal voice is correlated with motivation. It seems that the gaining of tracheoesophageal puncture voice is independent of psychosocial factors.

Effects of Place of Articulation and Aspiration on Voice Onset Time in Mandarin Esophageal Speech

The ability of Mandarin esophageal speakers to distinguish between aspirated and unaspirated stops, and to distinguish between different places of articulation of stops were examined. Aspirated and unaspirated voiceless stops produced by normal laryngeal (NL) and standard esophageal (SE) speakers were studied. VOT values of the five different stops (/p^h, t^h, k^h, p, t/) of Mandarin followed by the vowel /a/ produced by NL and SE speakers were compared. Results from the perceptual experiment indicated that, while voiceless unaspirated stops produced by SE speakers were not signaled with a high level of accuracy, voiceless aspirated stops were perceived correctly by the listeners. Acoustic analysis showed that SE speakers consistently produced shorter VOT than NL speakers. Velar stops were associated with significantly longer VOT values than bilabial and alveolar stops in NL speakers. It was also found that, with the use of the PE segment, SE speakers were still able to use VOT to distinguish between aspirated and unaspirated stops, but they were unable to distinguish between bilabial, alveolar, and velar places of articulation.

In vivo experiments with tracheostoma tissue connector prototypes

In cancer patients who have undergone total surgical removal of the larynx, ideally voice rehabilitation should be performed using a shunt valve (placed in a fistula of the tracheo-esophageal wall) and a tracheostoma valve (TSV) to enable hands-free tracheo-esophageal speech. A tracheostoma is created by suturing the trachea into the lower anterior part of the neck, and a TSV is a device that can be placed at the stoma. Unfortunately, many patients are unable to use a TSV, mainly due to fixation difficulties. To improve the fixation of the TSV, tracheostoma tissue connector (TS-TC) prototypes have been designed. Prototype 1 consisted of a titanium ring, inner diameter 30 mm, with a circular polypropylene mesh glued to it with silicone adhesive. Four holes had been drilled into the ring for the insertion of sub- and percutaneous screws. Prototype 2 consisted of a silicone rubber ring, inner diameter 30 mm, combined with polypropylene mesh and four titanium inserts that functioned as a base plate for the insertion of sub- and percutaneous screws. In adult female goats a tracheostoma was created and the prototypes were implanted. After 6 weeks of subcutaneous implantation, percutaneous screws were inserted. After twelve weeks, the experiment was terminated and the implants with the surrounding tissues were processed and examined histologically. The clinical appearance during weeks 7-12 varied from very poor to relatively good. Histologically, the implants showed a uniform inflammatory response. We found that all the tissue surrounding the screws showed signs of epithelial down growth. It was concluded that the two-stage implantation procedure of our prototype TS-TCs in this animal model was unsuccessful. Additional research efforts are necessary to improve tissue immobilization and to devise reliable fixation systems for TSVs.

Generic health-related quality of life amongst patients employing different voice restoration methods following total laryngectomy

Three methods of voice restoration—tracheosophageal speech (TEP), oesophageal speech, electrolarynx—are available following total laryngectomy. TEP produces better voice quality compared with other methods and is assumed to result in better quality of life. Little evidence exists to support the relationship between voice quality and quality of life, however. Advertising this study through several leading laryngectomy charities resulted in the completion of 226 questionnaires (TEP = 147; oesophageal speech = 42; electrolarynx = 37) comprising the Short Form 36 (SF-36) quality of life measure and questions examining perceived voice intelligibility. Additionally, 89 questionnaires comprising only the SF-36 were completed by participants who reported having no serious medical problems, to form a healthy control group. Results indicate that improved voice quality does not result in widespread benefits to quality of life. On only a few dimensions were there differences between voice restoration method: electrolarynx and TEP better than oesophageal speech with respect to pain, TEP better than oesophageal speech with respect to role limitation: physical problems. Additionally whilst widespread differences between voice restoration methods did not occur, all three groups had a worse quality of life compared with the healthy control group. Implications of the results for the selection of voice restoration method to maximize quality of life are discussed.

Chirurgiczna rehabilitacja głosu chorych po laryngektomii całkowitej z zastosowaniem systemu Provox

Comparison the voice quality of patients after total laryngectomy using the Provox 2 voice prosthesis and patients with esophageal speech and to discuss difficulties and complications related with its implantation.The study group consists of 39 patients after total laryngectomy and Provox puncture. 36 patients underwent primary puncture, 3 patients - secondary puncture. 32 patients underwent radiotherapy. The time starting of speech learning was approx the 9th day after total laryngectomy and 1st-3th day after secondary implantation. The authors subjectively and objectively analyzed voice of 34 patients with fistular speech and it compared with esophageal speech of 10. The spectrograms analysis of the voice was based on Remacle's scale. The study showed juxtaposition of early and late complications of patients with voice prostheses.90% of patients (35 patients) learned the fistular speech. The speech was louder and more intelligible than esophageal voice in subjective estimation. The fistular voice had higher of mean volume (61,1 dB vs. 59 dB), mean longer maximum phonation time (9,5 s vs. 2,2 s), mean higher base frequency FO (108 Hz vs. 87Hz) and smaller variability of FO based on mean Jitter ratio (3,8% vs. 6,6%), mean Shimmer ratio (23,18% vs. 23,52%) and mean HPQ ratio (127,34 vs. 141,73) than esophageal voice in objective estimation. Mean range of frequency of the speech was smaller but it was in higher frequencies. The most frequent type of spectrogram was 3th type in experimental group and 2nd type in control group. The mean lifetime of prostheses was 295 days. The most common cause of replacement of the prosthesis was leakage associated with mycosis infection (26 cases). Early complications were observed. The most frequent of them was infection around the fistula during supplementary radiotherapy (7 cases after primary puncture). The most frequent of later complications was widening of fistula and leakage around prosthesis (4 cases).Rehabilitation of patients after total laryngectomy is better using Provox system than learning esophageal speech (according to voice quality aspect). Using of voice prostheses in patients after total laryngectomy can combine with appearance of complications.

Esophageal Speech Learning Process in Cancer Patients who underwent Laryngectomy

Esophageal Speech Learning Process in Cancer Patients who underwent Laryngectomy

Reaction Times of Normal Listeners to Laryngeal, Alaryngeal, and Synthetic Speech

The purpose of this study was to compare listener processing demands when decoding alaryngeal compared to laryngeal speech. Fifty-six listeners were presented with single words produced by 1 proficient speaker from 5 different modes of speech: normal, tracheosophageal (TE), esophageal (ES), electrolaryngeal (EL), and synthetic speech (SS). Cognitive processing load was indexed by listener reaction time (RT). To account for significant durational differences among the modes of speech, an RT ratio was calculated (stimulus duration divided by RT). Results indicated that the cognitive processing load was greater for ES and EL relative to normal speech. TE and normal speech did not differ in terms of RT ratio, suggesting fairly comparable cognitive demands placed on the listener. SS required greater cognitive processing load than normal and alaryngeal speech. The results are discussed relative to alaryngeal speech intelligibility and the role of the listener. Potential clinical applications and directions for future research are also presented.

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

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

Aerodynamic and Sound Intensity Measurements in Tracheoesophageal Voice

Background: In laryngectomized patients, tracheoesophageal voice generally provides a better voice quality than esophageal voice. Understanding the aerodynamics of voice production in patients with a voice prosthesis is important for optimizing prosthetic designs and successful voice rehabilitation. Objectives: To measure the aerodynamics and sound intensity in tracheoesophageal voice production. Study Design and Methods: We built a special setup, which consisted of a Pentium 200 MHz computer with an AD-DA interface card and Labview 4.01 software. In an oral/nasal mask we constructed several mass flow sensors and a microphone. This measured both the oral airflow and the level of sound. For the measurement of endotracheal pressure, which is the driving force behind the airflow, we used a transducer which was connected to the tracheostoma. The endoesophageal pressure was measured at the level of the prosthesis in the esophagus by a Mikrotip transducer. Using this we could determine how much the voice prosthesis contributes to the overall pressure drop of the phonatory tract. Furthermore, the average airflow rate as a function of the sound pressure levels could be determined. Results: In our population, 6 out of 7 patients showed a positive relationship between trans-source airflow and generated sound intensity. We compared our prosthesis pressure drop values with in vitro data and found that there are some differences, possibly due to difference in age of the prosthesis and physiological circumstances in vivo. The overall contribution of the voice prosthesis to the airway resistance depends on the level of phonation and the type of device. In our patient group it is apparent that the pharyngoesophageal (PE) segment has the greatest share of the total pressure drop, especially at higher airflow rates. We measured a 27% pressure drop in airflow over the voice prosthesis. Different tracheostoma occlusion methods did not have any effect on the aerodynamics and sound intensity. One patient that had had a jejunal graft for reconstruction showed, not unexpectedly, extremely different aerodynamic values. We were unable to define optimal airflow rates or optimal resistance values for sound production in the PE segment. Conclusion: The aerodynamic characteristics of voice production in laryngectomized patients with voice prostheses are determined by both prosthetic factors and PE segment tissue factors. In our patient group the PE segment is responsible for the greatest pressure drop. We found no significant difference in pressure drop and sound intensity for different tracheostoma occlusion methods.

The Effect of Tonal Changes on Voice Onset Time in Mandarin Esophageal Speech

The present study investigated the effect of tonal changes on voice onset time (VOT) between normal laryngeal (NL) and superior esophageal (SE) speakers of Mandarin Chinese. VOT values were measured from the syllables /pha/, /tha/, and /kha/ produced at four tone levels by eight NL and seven SE speakers who were native speakers of Mandarin. Results indicated that Mandarin tones were associated with significantly different VOT values for NL speakers, in which high-falling tone was associated with significantly shorter VOT values than mid-rising tone and falling-rising tone. Regarding speaker group, SE speakers showed significantly shorter VOT values than NL speakers across all tone levels. This may be related to their use of pharyngoesophageal (PE) segment as another sound source. SE speakers appear to take a shorter time to start PE segment vibration compared to NL speakers using the vocal folds for vibration.

Intrinsic vowel pitch in tracheo-esophageal speech

The tendency for high vowels to have higher fundamental frequency (f0) than low vowels, or intrinsic vowel pitch (IF0), has been found in both laryngeal and esophageal speech [e.g., Gandour and Weinberg, Phonetica 25, 140–164 (1980)]. In the present study, eight tracheo-esophageal speakers were asked to produce five repetitions of each of the four point vowels and f0 was measured. Results showed significantly higher f0 for high vowels than for low vowels, consistent with previous findings for laryngeal and esophageal speakers. In addition, f0 was measured from two laryngectomees over a period of 4 months immediately following surgery to determine whether IF0 is produced automatically or whether it develops over time. Neither of these subjects produced differences in IF0 at any time within the 4-month period. These preliminary data appear to indicate that IF0 is not an automatic consequence of either speech physiology or acoustics. More data from additional subjects will be presented. [Work supported by SSHRC.]

Effect of tone on voice onset time in laryngeal and esophageal speech of Mandarin

Defined as the time between the release of burst of a stop and the onset of the following vowel, voice onset time (VOT) directly indicates the interarticulator timing between the voicing source and the articulatory movement in the vocal tract. A number of studies have investigated the VOT characteristics of different languages. Yet, few have studied how VOT is affected by tone level in a tone language, and by the type of phonation. The present study investigated the possible effect of tone level and phonation type on such interarticulator timing characteristics. VOT values were measured from the syllables /pha/, /tha/, and /kha/ produced at four Mandarin tone levels by eight laryngeal (NL) and seven esophageal (SE) speakers who were native speakers of Mandarin. Results indicated that significant differences in VOT were found in the NL speaker group, but not in the SE speaker group. With respect to phonation type, SE speakers showed significantly shorter VOT values than NL speakers. Such differences may be related to the use of pharyngoesophageal (PE) segment as a new sound source. SE speakers appear to take a shorter time to start PE segment vibration as compared to NL speakers.

Behavior of the Cricopharyngeal Segment During Esophageal Phonation in Laryngectomized Patients

After total laryngectomy, the interruption of the upper digestive tube and the section of the cricopharyngeal segment alter the high-pressure zone of the pharyngoesophageal transition, which will not only start to have a digestive function, but also be stimulated to take on the production of voice and speech. The pressure observed in the cricopharyngeal segment seems to act as a critical factor for the development of esophageal sound production, and manometry is the procedure capable of quantifying the pressure observed in this region. The objective of the current study was to assess the upper esophageal sphincter pressure in laryngectomized patients who are either successful or unsuccessful esophageal speakers, both at rest and during esophageal phonation, using manometry. Twenty laryngectomized persons aged 32 to 83 years (mean, 44.2 years) were submitted to evaluation by a speech pathologist and divided into two groups, ie, successful esophageal speakers (N=12) and unsuccessful esophageal speakers (N=8), according to a scale validated by Wepman et al (1953). The upper esophageal sphincter (UES) pressure was assessed by manometry both at rest and during the following voice emissions in Portuguese: the vowel "a," the monosyllable "pa," and the sentence "papai papou pipoca." The amplitude, the duration of the pressure wave, and the area under the curve were measured. At rest, the mean UES pressure was 11.83 mm Hg for successful esophageal speakers and 9.92 mm Hg for unsuccessful esophageal speakers, with no significant difference between groups; the mean for the two groups as a whole was 11.06 mm Hg. During the voice and speech sequence tests, no significant difference was observed when the emissions in Portuguese of "a," "pa," and the sentence were analyzed separately. As the pressure observed at rest did not differ between the successful esophageal speakers and the unsuccessful esophageal speakers, and the amplitude, the duration of the pressure wave, and the area under the amplitude x duration curve were also equal for both groups, we conclude that the cricopharyngeal segment pressure is not a preponderant factor for the acquisition of esophageal voice and speech.

Voice and speech after laryngectomy

The aim of the investigation is to compare voice and speech quality in alaryngeal patients using esophageal speech (ESOP, eight subjects), electroacoustical speech aid (EACA, six subjects) and tracheoesophageal voice prosthesis (TEVP, three subjects). The subjects reading a short story were recorded in the sound‐proof booth and the speech samples were acoustically analysed. Speech sound production was judged by 15 students of phonetics. The following variables were considered: (1) voice quality: fo, jitter, shimmer and harmonic‐to‐noise ratio, (2) speech sound production: number of recognized VCV syllables, and (3) temporal organization of speech: duration of the phonetic block, number of syllables in the phonetic block, rate of speech, rate of articulation and number of syllables in the longest phonetic block. The results showed that nearly normal air‐stream source (lungs) in speech production of speakers with tracheoesophageal prosthesis significantly contributed to the speech timing and speech intelligibility of the alaryngeal speakers.

Evaluación espectral cualitativa de la voz esofágica

ObjectivesThe aim of the study is to determine the accuracy of acoustic spectrography as an outstanding tool in the characterization and monitoring of esophageal voice. Material and MethodsOur subjects were comprised of 33 laryngectomized patients (all male) that underwent qualitative acoustic (spectrography of vowel /a/ and a sentence), quantitative acoustic (phonation time, fundamental frequency, maximun intensity sound level, speech rate) and perceptual protocol. ResutsThere is a significant statistical relationship among Yanagihara-like spectrographic chart classification, psycho-acoustical perception and quantitative acoustic parameters. ConclusionWe consider that acoustic spectrography is an easy, effective method for studying esophageal voice, seeking for improving oral communication skills and rehabilitation in the laryngectomee population.

The intelligibility of tracheoesophageal speech, with an emphasis on the voiced-voiceless distinction

Total laryngectomy has far-reaching effects on vocal tract anatomy and physiology. The preferred method for restoring postlaryngectomy oral communication is prosthetic tracheoesophageal (TE) speech, which like laryngeal speech is pulmonary driven. TE speech quality is better than esophageal or electrolarynx speech quality, but still very deviant from laryngeal speech. For a better understanding of neoglottis physiology and for improving rehabilitation results, study of TE speech intelligibility remains important. Methods used were perceptual evaluation, acoustic analyses, and digital high-speed imaging. First results show large variations between speakers and especially difficulty in producing voiced-voiceless distinction. This paper discusses first results of our experiment.

Communication strategies and interpersonal skills of instructors of esophageal speech: An observation study

Objective In this article, the way that the Instructor of Esophageal Speech (IES) works is considered from an interactive-analytic perspective. Methods The observation project data were gathered during 6 months in 2004 at the training sessions of the Ginreikai-Asian Federation of Laryngectomees’ Association using the Six Category Intervention Analysis framework (6CIA) by a trained communication specialist as an active-observer. Results Mean scores of each of the six categories and a series of percentage distributions were extracted from the usage-frequency data and interpreted together with the results of Chi-square analysis of usage-frequency units. We found the IES used more frequently authoritative categories and used less facilitative categories. Our results of the data analysis show that the 30 IES used more authoritative interventions and used more frequently the prescription and information giving than the confrontation or cathartic interventions. Conclusion The results of the present study show that the 6CIA framework has its potential and value as an analytic tool to explore the IES’ actual behavior in a specific therapy related context. Practice Implications We argue for the utility of the 6CIA as an analytic framework to investigate the interpersonal behavior of the IES in the Japanese cultural setting.

The Use of Pedicled and Free Flaps in Laryngeal Cancer Recurrences

The objective of the study was to compare the rate of complications and the functional outcomes following reconstructive surgery with pedicled and free flaps for recurrences after laryngeal cancer treatment. A retrospective analysis was conducted among the clinical records of the Department of Otolaryngology Head Neck Surgery of the University of Pavia from January 1995 to December 2004. Twenty-three patients were identified as having been reconstructed with pedicled or free flaps for hypopharyngeal recurrences after laryngeal cancer treatment. We observed a higher rate of postoperative complications after pedicled flaps (60%) than free flaps reconstructions (23%). The pedicled flaps group evidenced a longer hospitalization time (35 versus 14 days); a lower rate of patients with pedicled flaps (14% versus 69%) was able to resume a normal feeding 1 year after surgery; no patient achieved an esophageal voice, but the entire free flaps group reached an intelligible voice with the positioning of a voice prosthesis. The possibility to achieve such functional results in this kind of patient justifies the use of a surgical approach that generally requires a longer operation time than pedicled flaps, and the need for a surgical team with special skills in microsurgical techniques.

Techniques chirurgicales de réhabilitation vocale après laryngectomie totale

Total laryngectomy remains indicated in the treatment of extended invasive squamous cell carcinomas of the larynx; its major consequence is the loss of voice. For more than 20 years, numerous specialists work on voice rehabilitation following total laryngectomy. Rehabilitation techniques include oesophageal speech, artificial larynx, tracheo-oesophageal shunt operations and, more recently, surgical restoration of voice with prosthesis. Several techniques have been described for the restoration of voice, such as the surgical technique by button voice prosthesis and the tracheo-oesophageal fistula. Compared to button voice prosthesis the tracheo-oesophageal fistula induces more important technical requirements and complications but less cost. We associated the extended hemi-laryngectomy of Pearson nearest speech reconstruction than sub total laryngectomy.

Acoustic characteristics of Mandarin esophageal speech

The present study attempted to investigate the acoustic characteristics of Mandarin laryngeal and esophageal speech. Eight normal laryngeal and seven esophageal speakers participated in the acoustic experiments. Results from acoustic analyses of syllables /ma/and /ba/ indicated that, F0, intensity, and signal-to-noise ratio of laryngeal speech were significantly higher than those of esophageal speech. However, opposite results were found for vowel duration, jitter, and shimmer. Mean F0, intensity, and word per minute in reading were greater but number of pauses was smaller in laryngeal speech than those in esophageal speech. Similar patterns of F0 contours and vowel duration as a function of tone were found between laryngeal and esophageal speakers. Long-time spectra analysis indicated that higher first and second formant frequencies were associated with esophageal speech than that with normal laryngeal speech.