Laryngeal Speech Research Articles

Comparison of TEVA vs. PRAAT in the Acoustic Characterization of the Tracheoesophageal Voice in Laryngectomized Patients.

Background: Previous studies have assessed the capability of PRAAT for acoustic voice analysis in total laryngectomized (TL) patients, although this software was designed for acoustic analysis of laryngeal voice. Recently, we have witnessed the development of specialized acoustic analysis software, Tracheoesophageal Voice Analysis (TEVA). This study aims to compare the analysis with both programs in TL patients. Methods: Observational analytical study of 34 TL patients where a quantitative acoustic analysis was performed for stable phonation with vowels [a] and [i] as well as spectrographic characterization using the TEVA and PRAAT software. Results: The Voice Handicap Index (VHI-10) showed a mean score of 11.29 ± 11.16 points, categorized as a moderate handicap. TEVA analysis found lower values in the fundamental frequency vs. PRAAT (p < 0.05). A significant increase in shimmer values was observed with TEVA (>20%). No significant differences were found between spectrographic analysis with TEVA and PRAAT. Conclusions: Tracheoesophageal speech is an alaryngeal voice, characterized by a higher degree of irregularity and noise compared to laryngeal speech. Consequently, it necessitates a more tailored approach using objective assessment tools adapted to these distinct features, like TEVA, that are designed specifically for TL patients. This study provides statistical evidence supporting its reliability and suitability for the evaluation and tracking of tracheoesophageal speakers.

Acoustic Analysis of Taiwanese Tones in Esophageal Speech and Pneumatic Artificial Laryngeal Speech.

This study examined the acoustic properties of Taiwanese (Southern Min) lexical tones produced in esophageal speech (ES) and pneumatic artificial laryngeal speech (PAL), including onset fundamental frequency (F0), slope of F0 contour, duration, and amplitude (intensity) of the vowel portion of syllables carrying seven Taiwanese tones. Seven ES speakers, seven PAL speakers, and 18 normal laryngeal (NL) speakers (all male) read aloud target syllables carrying the tones in monosyllables, disyllables, and sentences. Acoustic features were measured with Praat. Acoustic analysis revealed (a) no significant effects of linguistic level on acoustic parameters except for duration, which generally significantly decreased from monosyllables to disyllables to sentences for Tones 1 and 5; (b) significant differences across the speaker groups in onset F0 (PAL > ES > NL), duration (PAL > NL and PAL > ES for all tones), and mean amplitude (PAL > NL > ES); and (c) no significant difference in mean slope of F0 contour across the speaker groups. These preliminary data on acoustic properties of Taiwanese tones produced by ES and PAL speakers could facilitate the design of therapeutic strategies for improving the intelligibility of alaryngeal lexical tones. Further studies are recommended to examine the relative perceptual importance of the acoustic parameters.

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.

Outcome of Surgery and Radiotherapy as Treatment of Early Laryngeal Cancer

Background: Carcinoma of the larynx is the most common cancer affecting the head and neck region. Among the different stages of this disease, early cancer (T1T2N0M0) has greater possibility of cure. Its modalities of treatment are surgery and radiotherapy.&#x0D; Methods: The study was done to compare between outcome of surgery and radiotherapy in early carcinoma larynx T1N0 catagory only. 60 cases of early carcinoma larynx were selected purposive sampling technique from all the patients of carcinoma larynx admitted into Otolaryngology and Head-Neck Surgery Department of Bangabandhu Sheikh Mujib Medical University,Dhaka; Dhaka Medical College Hospital, Dhaka; Shaheed Suhrawardy Medical College Hospital, Dhaka; Taqwah Specialized Hospital, Dhaka from January 2010 to June 2011.&#x0D; Results. Study showed 16.67% of the radiotherapy group had a primary site recurrence compared with 20.0% in the surgery group at 12th months (p = 0.59) and 6.67% of those who were treated with irradiation had a recurrence in the neck. 16.67% of patients in the surgery group had a recurrence in the neck (p &lt; 0.05). There was no significant difference in primary site recurrence rates for the two treatment modalities, but regional recurrence was higher in the surgery group. Regarding speech and voice quality, radiotherapy was far superior to surgery. All patients in the radiotherapy group but only 3 of 10 in the surgery group had good or normal voice (p = .0017).&#x0D; Conclusions: Both surgery and irradiation are equally effective in treating early laryngeal carcinoma but Speech and voice quality were significantly better in patients treated by radiotherapy than those treated by surgery.&#x0D; Bangladesh J Otorhinolaryngol; April 2019; 25(1): 34-40

Intelligibility and Listening Effort of Spanish Oesophageal Speech

Communication is a huge challenge for oesophageal speakers, be it for interactions with fellow humans or with digital voice assistants. We aim to quantify these communication challenges (both human–human and human–machine interactions) by measuring intelligibility and Listening Effort (LE) of Oesophageal Speech (OS) in comparison to Healthy Laryngeal Speech (HS). We conducted two listening tests (one web-based, the other in laboratory settings) to collect these measurements. Participants performed a sentence recognition and LE rating task in each test. Intelligibility, calculated as Word Error Rate, showed significant correlation with self-reported LE ratings. Speaker type (healthy or oesophageal) had a major effect on intelligibility and effort. More LE was reported for OS compared to HS even when OS intelligibility was close to HS. Listeners familiar with OS reported less effort when listening to OS compared to nonfamiliar listeners. However, such advantage of familiarity was not observed for intelligibility. Automatic speech recognition scores were higher for OS compared to HS.

Sense of Effort and Articulatory Contact Pressure Associated with Talking by Individuals Using Tracheoesophageal Speech

Background/Aims: The aims of this study were (1) to determine locations of increased effort in the body when talking using tracheoesophageal speech (TES); (2) to compare talking effort for participants using TES and those using laryngeal speech; (3) to compare tongue-palate contact pressure during talking for TES and laryngeal speech; and (4) to assess the relationship between talking effort and articulatory contact pressure (ACP). Methods: This cohort comparison study included 16 individuals using TES and 10 using laryngeal speech. Participants rated talking effort on a visual analog scale and then rated effort in the lungs, throat, oral cavity, brain (cognitive) and arm/shoulder. ACP for /t/, /d/, and /n/ produced in sentences was measured using a pressure sensor on the alveolar ridge. Results: Factor analysis of effort ratings across body locations by participants using TES revealed two latent variables associated with non-voice production locations and voice production. Ratings of effort and ACP were statistically significantly higher in participants using TES. The correlation between overall talking effort and ACP was strong and statistically significantly. Conclusions: The effort ratings suggest adults with functional TES experience talking as more effortful than adults with a larynx. Some increased effort was focused in the voice production process, but regions outside of voicing were also implicated.

A preliminary study on improving the recognition of esophageal speech using a hybrid system based on statistical voice conversion.

In this paper, we propose a hybrid system based on a modified statistical GMM voice conversion algorithm for improving the recognition of esophageal speech. This hybrid system aims to compensate for the distorted information present in the esophageal acoustic features by using a voice conversion method. The esophageal speech is converted into a “target” laryngeal speech using an iterative statistical estimation of a transformation function. We did not apply a speech synthesizer for reconstructing the converted speech signal, given that the converted Mel cepstral vectors are used directly as input of our speech recognition system. Furthermore the feature vectors are linearly transformed by the HLDA (heteroscedastic linear discriminant analysis) method to reduce their size in a smaller space having good discriminative properties. The experimental results demonstrate that our proposed system provides an improvement of the phone recognition accuracy with an absolute increase of 3.40 % when compared with the phone recognition accuracy obtained with neither HLDA nor voice conversion.

Talker identification across source mechanisms: experiments with laryngeal and electrolarynx speech.

The purpose of this study was to determine listeners' ability to learn talker identity from speech produced with an electrolarynx, explore source and filter differentiation in talker identification, and describe acoustic-phonetic changes associated with electrolarynx use. Healthy adult control listeners learned to identify talkers from speech recordings produced using talkers' normal laryngeal vocal source or an electrolarynx. Listeners' abilities to identify talkers from the trained vocal source (Experiment 1) and generalize this knowledge to the untrained source (Experiment 2) were assessed. Acoustic-phonetic measurements of spectral differences between source mechanisms were performed. Additional listeners attempted to match recordings from different source mechanisms to a single talker (Experiment 3). Listeners successfully learned talker identity from electrolarynx speech but less accurately than from laryngeal speech. Listeners were unable to generalize talker identity to the untrained source mechanism. Electrolarynx use resulted in vowels with higher F1 frequencies compared with laryngeal speech. Listeners matched recordings from different sources to a single talker better than chance. Electrolarynx speech, although lacking individual differences in voice quality, nevertheless conveys sufficient indexical information related to the vocal filter and articulation for listeners to identify individual talkers. Psychologically, perception of talker identity arises from a "gestalt" of the vocal source and filter.

Larynx cancer: quality of life and voice after treatment

IntroductionTreatments for patients with laryngeal cancer often have an impact on physical, social, and psychological functions. ObjectiveTo evaluate quality of life and voice in patients treated for advanced laryngeal cancer through surgery or exclusive chemoradiation. MethodsRetrospective cohort study with 30 patients free from disease: ten total laryngectomy patients without production of esophageal speech (ES); ten total laryngectomy patients with tracheoesophageal speech (TES), and ten with laryngeal speech. Quality of life was measured by SF-36, Voice-Related Quality of Life (V-RQOL), and Voice Handicap Index (VHI) protocols, applied on the same day. ResultsThe SF-36 showed that patients who received exclusive chemoradiotherapy had better quality of life than the TES and ES groups. The V-RQOL showed that the voice-related quality of life was lower in the ES group. In the VHI, the ES group showed higher scores for overall, emotional, functional, and organic VHI. DiscussionQuality of life and voice in patients treated with chemoradiotherapy was better than in patients treated surgically. ConclusionThe type of medical treatment used in patients with laryngeal cancer can bring changes in quality of life and voice.

Comparison of esophageal and tracheoesophageal speech modes in dual-mode alaryngeal speakers

Objective: The main purpose of this study was to compare different speech related parameters in dual-mode esophageal and tracheoesophageal speakers. A second purpose was to compare the speech characteristics of these (tracheo) esophageal speakers with age- and gender matched controls. Materials and Methods: Four male laryngectomees who were proficient esophageal and tracheoesophageal speakers provided audio recordings of sustained vowels and connected speech using both alaryngeal methods. The participants from the control group also followed the same procedure. From the recorded samples, fundamental frequency (F0), maximum phonation duration (MPD), formant frequencies, and speech rate related parameters were extracted. Results: Although there was no statistically significant difference between the two alaryngeal modes for any of the measured parameters, the absolute fundamental frequency and MPD values were higher in TE mode. However, when compared to controls, both the alaryngeal modes depicted significantly shorter MPD values, higher first formant frequency values, slower speech rate, and higher frequency of pauses. Conclusion: The results suggest that most group differences found between esophageal and tracheoesophageal speech in the past may be due to large inter-subject variability, and that within speakers, similarity is more between esophageal and tracheoesophageal speech than with laryngeal speech. These results have implications for understanding the pseudoglottic voice mechanism.

The quantal larynx revisited

Quantal effects signify nonlinear relations in the properties of speech sounds, traditionally emphasizing articulatory-acoustic relations [Stevens, J. Phonet. 17, 3–45 (1989)]; these relations hold important clues to how continuous phonetic parameters map onto discrete phonological categories. Stevens described quantal states in laryngeal speech function, showing how the vocal fold abduction-adduction continuum can be partitioned into breathy, modal, and pressed phonatory quanta. This account, however, relies on a one-dimensional conceptualization of the larynx, which recent developments in laryngeal phonetic theory reveal to be inadequate [Edmondson and Esling, Phonology 23, 157–191 (2006)]: a more realistic model must include the epilarynx. We reopen the issue of quantal laryngeal speech behavior in the context of recent research demonstrating quantal biomechanical properties in labial articulation [Gick et al., Can. Acoust. 39, 178–179 (2011)]. Our “whole larynx” approach [Moisik and Esling, ICPhS, 1406–1409 (2011)] countenances epilaryngeal influence on laryngeal articulatory and phonatory possibilities through quantal biomechanical and aero-mechanical effects. We demonstrate, through computer simulation, three novel cases of laryngeal quantality: (1) vocal-ventricular interaction in glottal stop, glottalization, and laryngealization; (2) aryepiglotto-epiglottal stricture in pharyngeal consonants; (3) epilaryngeal predisposition for growl-like or harsh phonation.

Analyzing Neoglottal Vibration of Cantonese Tracheoesophageal Speech: Preliminary Aerodynamic Study Using Inverse Filtering

Objective: Despite the many studies on tracheoesophageal (TE) speech, the actual vibratory characteristics of the neoglottis in TE speech are not known. The present study examined the neoglottal vibratory pattern of Cantonese TE speakers by comparison with the glottal waveform produced by laryngeal speakers. Subjects and Methods: Eight superior TE and 8 laryngeal speakers of Cantonese participated in the study. All speakers were instructed to produce the vowels /i, ᴂ, a, ᴐ, u/ 3 times, and both acoustic and aerodynamic signals were recorded. While the airflow signals were later inverse-filtered to obtain the neoglottal and glottal waveforms, the acoustic signals were analyzed to obtain vowel formants, which were used as inputs to inverse filtering. Aerodynamic parameters including open quotient (OQ), speed quotient (SQ), and area under the curve (AUC) were compared between TE and laryngeal speakers. -Results: Results revealed that TE speakers exhibited comparable OQ and AUC, but significantly reduced SQ when compared with laryngeal speakers. Conclusions: Both inverse-filtered airflow signals associated with TE and laryngeal speech of Cantonese appear to be triangular in shape, indicating the opening, closing and closed phases of the (neo)glottis. However, neoglottal waveforms are highly variable. Such variability and inconsistency in neoglottal waveforms might be related to the lack of complete control over the neoglottis in TE speakers.

Abstracts of the 14th British Academic Conference in Otolaryngology Posters ‐ Head and Neck

Objectives: Thirty years ago, McNeil concluded that patients with laryngeal cancer would trade life years to avoid total laryngectomy (TL) and maintain laryngeal speech. This influential study was never repeated, despite subsequent changes in management. We aimed to revisit her time trade off method using current treatment options. Methods: Participants: 33 COPD patients and 39 demographically matched healthy volunteers recruited to date. Protocol: Participants ranked four model T3 laryngeal cancer treatment outcome scenarios: TL good outcome, TL with complications, chemoradiotherapy (CRT) good outcome, CRT with complications. They then assigned Utility Values to these health states using a time trade-off technique. Results: For 42/69 participants (61%), CRT with a good outcome was the preferred scenario. The average Utility values were ranked: 1 0.63 CRT good outcome 2 0.58 TL good outcome 3 0.34 TL with complications 4 0.31 CRT with complications The average survival advantage required for a participant to change their preferred choice is 3.1 years. Conclusions: Despite CRT being promoted near universally as the 'standard of care' for T3 laryngeal cancer, in our cohort, if given the choice, almost 40% may opt for TL with a good outcome. Conversely, CRT poor outcome is regarded as the worst health state. People's preferences are consistent - only a substantial putative survival advantage would change participants' primary treatment choice. Research is required on the relative risks of treatment to inform patient choice and participation in decision making. Meanwhile, clinicians should not assume all T3 laryngeal cancer patients want CRT.

Acoustic analysis of tracheo-oesophageal voice in male total laryngectomy patients

The aim of this study was to test the null hypothesis that voice parameters of post-laryngectomy patients using tracheo-oesophageal (TO) prosthetic valves are similar to those of normal laryngeal subjects. Thirty total laryngectomy patients and thirty normal controls were subjected to acoustic analysis of single voice recordings using a sustained vowel. Acoustic parameters including fundamental frequency, jitter, shimmer, harmonics-to-noise ratio and maximum phonation time were analysed. Poorer values were found as well as larger variability for all the voice parameters for the total laryngectomy patients using TO voice compared with those of normal subjects. There were statistically significant differences (p<0.05) for all studied parameters between the TO and normal speech. Alaryngeal speech with TO voice prosthesis is not yet comparable to laryngeal speech.

Acoustic Analysis of the Voiced-Voiceless Distinction in Dutch Tracheoesophageal Speech

Confusions between voiced and voiceless plosives and voiced and voiceless fricatives are common in Dutch tracheoesophageal (TE) speech. This study investigates (a) which acoustic measures are found to convey a correct voicing contrast in TE speech and (b) whether different measures are found in TE speech than in normal laryngeal (NL) speech. The main focus was on plosives. Nine TE and 5 NL speakers were included in this study. Fourteen acoustic measures were selected and analyzed. Comparisons were made between voiced and voiceless for the groups separately and between TE and NL speakers. Conditional inference trees were used to establish the most important distinguishing cue. TE speakers do not differ significantly from NL speakers, except for pitch-related measures. For plosives, all measures distinguished between voiced and voiceless for both speaker groups. The main distinguishing measure for the plosives was relative phonation time in the closure. TE and NL speakers differ less in the way the voiced-voiceless distinction is conveyed than expected. Further research is needed to show whether the main acoustic cue is also perceptually most relevant.

Microvascular Flap Reconstruction of Major Pharyngeal Resections With the Intent of Laryngeal Preservation

To determine the functional outcome in patients undergoing pharyngeal reconstruction with free tissue transfer with the intent of functional laryngeal preservation. Retrospective medical record review. Academic tertiary care hospital. The study population comprised 45 patients who underwent a major pharyngeal resection with or without a partial laryngeal resection (2 patients died perioperatively, leaving 43 to evaluate). The majority (n = 35 [81%]) had advanced (T3 or T4) primary tumors at presentation and underwent subsequent reconstruction using free tissue transfer at a tertiary care hospital. The rate of functional larynx preservation, best swallow score based on the Functional Outcome Swallowing Scale, and need for tracheostomy. Thirteen independent variables relevant to function and 6 postoperative outcome variables were studied following treatment, and their correlation with laryngeal function was determined. Of the 43 patients, 35 (81%) had T3 (n = 9) or T4 (n = 26) squamous cell carcinoma at presentation. There was 100% flap survival. Thirty-one patients (72%) tolerated an oral diet, with 24 (56%) achieving an exclusively oral diet. Only a history of gastroesophageal reflux disease had a statistically significant correlation with poor swallowing; having had a cranial nerve removed did not achieve statistical significance (P = .06). The majority of patients had their best swallow by 10 months. Of the 43 patients, 42 (97%) achieved native laryngeal speech and 36 (84%) were decannulated. The need for a tracheostomy did not correlate with any of the preoperative independent variables. Free tissue transfer allows for successful reconstruction of complex pharyngeal defects that functionally threaten the remaining larynx. In properly selected patients, functional laryngeal preservation, decannulation, and use of laryngeal speech can be reliably achieved. Excellent swallowing function can less reliably be predicted.

Long-term average spectral characteristics of Cantonese alaryngeal speech

Objective In Hong Kong, esophageal (SE), tracheoesophageal (TE), electrolaryngeal (EL), and pneumatic artificial laryngeal (PA) speech are commonly used by laryngectomees as a means to regain verbal communication after total laryngectomy. While SE and TE speech has been studied to some extent, little is known regarding the EL and PA sound quality. The present study examined the sound quality associated with SE, TE, EL, and PA speech, and compared with that associated with laryngeal (NL) speech by using long-term average speech spectra (LTAS). Methods Continuous speech samples of reading a 136-word passage were obtained from NL, SE, TE, EL, and PA speakers of Cantonese. The alaryngeal speakers were all superior speakers selected from the New Voice Club of Hong Kong, which is a self-help organization for the laryngectomees in Hong Kong. TE speakers were fitted with Provox valve, and EL speakers used Servox-type electrolarynx. Speech samples were digitized at 20 kHz and 16 bits/sample by using Praat, based on which LTAS contours were developed. First spectral peak (FSP), mean spectral energy (MSE), and spectral tilt (ST) derived from the LTAS contours associated with different speaker groups were compared. Results Data revealed all speakers generally exhibited similar LTA contours. However, PA speakers exhibited the lowest average FSP value and the greatest average MSE value. NL phonation was associated with a significantly greater ST value than alaryngeal speech of Cantonese. Conclusion The differences in FSP, MSE, and ST values in different speaker groups may be related to the different sound sources being used by the laryngectomees, and the difference in the way the sound source is coupled with the vocal tract system.

The role of source and filter characteristics in human talker identification: Experiments with laryngeal and electrolarynx speech.

Differences in individuals’ vocal anatomy and physiology result in unique acoustic features of their vocalizations. Humans are exceptionally attuned to these variations and use them to identify familiar individuals. Although these abilities are often called “voice recognition,” talker identity cues actually arise through interactions between acoustic excitation produced at the source (typically, the larynx) and both static and dynamic properties of the filter (vocal tract, articulators, and their manipulations during speech). We investigated the differential contributions of source‐ and filter‐related information to talker identification through four experiments using laryngeal (typical) and electrolarynx speech from five talkers. Using an electrolarynx energy source removed individual differences in vocal anatomy, leaving only unique filter properties for talker identification. Listeners learned talker identity best from typical, laryngeal speech, which contained both unique source and filter cues. Liste...

Voice Onset Time Characteristics of Esophageal, Tracheoesophageal, and Laryngeal Speech of Cantonese

To investigate the ability of standard esophageal (SE) and tracheoesophageal (TE) speakers of Cantonese to differentiate between aspirated and unaspirated stops produced at 3 places of articulation were investigated. Six Cantonese stops, /p, t, k, p(h), t(h), k(h)/, followed by the vowel /a/ produced by 10 SE, TE, and normal laryngeal (NL) speakers were examined through perceptual tasks and voice onset time (VOT) analysis. Perceptual experiments showed lower accuracy of identification of stops produced by SE and TE than by NL speakers, with mostly misidentification of aspirated stops as their unaspirated counterparts. Acoustic analysis revealed that aspirated stops produced by NL, SE, and TE speakers were associated with significantly longer VOT values than their unaspirated counterparts. Unaspirated velar stops showed significantly longer VOT than bilabial and alveolar stops in NL and SE speech. SE and TE speakers were still able to use VOT to signal aspiration contrast, but TE was unable to differentiate among different places of articulation.