Laryngeal Voice Research Articles

P442: The value of SSR recordings in the assessment of autonomic nervous dysfunction in patients with sacral-pudendal impairment

P442: The value of SSR recordings in the assessment of autonomic nervous dysfunction in patients with sacral-pudendal impairment

Impaired laryngeal voice production in a patient with foreign accent syndrome

We report a Japanese-speaking monolingual woman who developed foreign accent syndrome (FAS) following an infarction in the precentral and premotor cortices (Brodmann Area 6) at and around the inferior frontal sulcus. Her speech sounded Chinese or Korean to our bilingual coauthor who speaks Chinese and Japanese. Quantitative acoustic analyses of words and sentences showed that pitch (fundamental frequency variation) and intensity variances appeared lowered and fully voiced glottal pulses were reduced. These findings suggest laryngeal dysfunction that contributes to the unusual speech production in a case of FAS. This may be caused by damage to a restricted area of the motor and premotor cortices that controls laryngeal function.

Comparision of Transoral Laser and Open Partial Laryngectomy for T1 and T2 Glottic Cancer: A Review of literature.

T1–T2 glottic carcinomas may be treated with conservative surgery or radiotherapy. The goals of treatment are cure and laryngeal voice preservation. The aim of the current study was to review the literature and discuss the optimal management of T1 and T2 glottic carcinoma. Literature review indicated that the local control, laryngeal preservation, and survival rates of patients were similar after transoral laser resection and open partial laryngectomy. Voice quality depended on the extent of resection for patients undergoing surgery; results for patients undergoing laser resection for limited lesions showed better Voice Handicap Index scores, whereas open partial laryngectomy yielded poorer results. The cost of treatment was more for open partial laryngectomy. Patients with well defined lesions suitable for transoral laser excision with a good functional outcome were treated with laser. Open partial laryngectomy was reserved for patients with locally recurrent tumors. This review has been conducted by analyzing the Data which has been displayed in Pubmed literature in the last 25 years on the topics of Transoral Laser and Open partial Laryngectomy in the management of T1 and T2 glottic cancer. The various original articles and review articles were analyzed and compared and a conclusion derived.

Novel therapeutic approach to relieve pharyngoesophageal spasm after total laryngectomy

Total laryngectomy results in a variety of functional changes including the loss of normal laryngeal voice and alterations in swallowing physiology.1 The current literature recognizes tracheoesophageal (TE) voice restoration as the preferred alaryngeal speech alternative in most patients with total laryngectomy. The method depends on the use of a unidirectional valved prosthesis that maintains the TE puncture and also allows pulmonary air flow into the esophagus for phonation while preventing aspiration during swallowing.

Vocal Handicap and Quality of Life After Treatment of Advanced Squamous Carcinoma of the Larynx and/or Hypopharynx

To evaluate and correlate voice-specific quality of life (QOL) and health-related QOL (HR-QOL) after treatment for advanced cancer of the larynx and/or hypopharynx. Cross-sectional study. Patients submitted to partial laryngectomy (PL), salvage PL (sPL), concomitant radiotherapy and chemotherapy (RT+Chemo), total laryngectomy (TL), salvage TL (sTL), total pharyngolaryngectomy (TP) and salvage total pharyngolaryngectomy (sTP). The following questionnaires were used: (1) Voice Handicap Index (VHI) and (2) University of Washington Quality of Life Questionnaire (UW-QOL; version 4). Eighty-four patients participated in the study. All the patients PL (10), sPL (1), and RT+Chemo (24) communicated by laryngeal voice. Of the 49 patients submitted to total removal of the larynx, 30 communicated with alaryngeal phonation, the major part being tracheoesophageal prosthesis (17). The worst subscale of VHI for the total patient group was functional (mean=13.15), and the value of the total score was 31. Patients submitted to PL, RT+Chemo, and TL presented slight handicap (medians of 27, 14, and 21.5, respectively). Patients treated with sTL, TP, and sTP presented moderate handicap (medians of 45, 37.5, and 31.5, respectively). HR-QOL was considered between good and excellent for 78.6% of the patients, and poor for 21.4%. The correlation between voice-specific QOL and HR-QOL was significant (P=0.0001). Patients treated for advanced cancer of the larynx/hypopharynx present slight to moderate voice handicap and good/excellent HR-QOL. Stricter analysis of both the VHI and UW-QOL data suggests that more attention be given to the vocal handicap of the individual patient.

Photodynamic therapy of laryngeal cancers

Carcinoma of the larynx accounts for 25-30 percent of all carcinomas of the head and neck. Early carcinomas of the larynx (Tis or T1) and severe dysplasia are presently treated with either radiation therapy or surgery alone. Radiation therapy, however, has significant disadvantages including mucositis during and for potential prolonged periods after therapy, permanently altered voice quality, dysphagia, chondroradionecrosis of the larynx and trachea, and the extensive length of therapy (6-7 weeks). Surgical therapy for early carcinomas of the larynx includes performing a partial cordectomy or hemilaryngectomy. Although cure rates are high, surgical removal of portions of the vocal cord or hemilarynx results in significant alteration of the quality of voice. Photodynamic therapy has been demonstrated to be effective in the treatment of early carcinomas of the larynx, Tis and T1, with cure rates of 90% with follow-up to 236 months. The advantage of PDT therapy for early carcinomas of the larynx is the ability to preserve normal endolaryngeal tissue while effectively treating the carcinomas. This results in improved laryngeal function and voice quality. Furthermore, PDT requires a short duration of therapy as compared to radiation therapy, is repeatable and carries less risk than surgical therapy and is performed as an outpatient noninvasive treatment. Importantly, the use of PDT does not preclude the use of radiotherapy or surgery in the future for new primary or recurrent disease.

Laryngeal function preservation and voice reconstruction in surgical treatment of free radical forearm flap for laryngocarcinoma and hypopharyngeal carcinoma

Objective To evaluate the application of free radical forearm flap transferred in surgical treatment of laryngocarcinoma and hypopharyngeal carcinoma for laryngeal function preservation mad voice reconstruction.Methods Of the 5 consecutive cases who recieved free radical forearm flaps,3 cases with laryngocarcinma were treated with near-total laryngectomy and 2 cases with pyriform sinus carcinoma were treated with homonymy demi-pharyngectomy and homonymy 3/4 laryngectomy.All cases were performed homonymy modifled-radical neck dissection.Results All the 5 free radial forearm flaps survived completely,without partial or total flap necrosis.One case was obvious aspiration and undergone leftover-laryngectomy and permanent trecheostomy after nine months,the other four cases swallowing and pronunciation function well,follow-up 6 to 30 months and without cancer recurrence.Conclusion In selected cases,the free forearm flaps is a preferable choice in reconstructive surgical procedure of laryngocarcinoma and hypopharyngeal carcinoma for laryngeal function preservation and voice reconstruction. Key words: Laryngocarcinoma and Hypopharyngeal carcinoma; Free radical forearm flap; Microvascular surgery; Functional rehabilitation

Outcomes in Patients With Early-Stage Hypopharyngeal Cancer Treated With Radiotherapy

To analyze the outcome in patients with early-stage hypopharyngeal cancer (HPC) who were treated with radiotherapy (RT). Between February 1988 and February 2007, 77 patients with Stage I or Stage II HPC underwent definitive RT in the Division of Radiation Oncology at the National Cancer Center Hospital. Eleven of the patients received local irradiation, and the other 66 patients received elective bilateral neck irradiation and booster irradiation to the primary lesion. The median follow-up period for all the patients was 33 months from the start of RT, ranging from 3 to 229 months. The rates of overall survival, HPC-specific survival, HPC recurrence-free survival, and local control with laryngeal voice preservation for the 77 patients at 5 years were 47%, 74%, 57%, and 70%, respectively. The survival rates were not affected by the patient characteristics or treatment factors, but the RT field was significantly correlated with local control in a multivariate analysis. Seven of the patients had Grade 3 or greater complications, but these complications occurred after salvage surgery in 6 of the patients. Of the 77 patients, 83% had synchronous or metachronous malignancies, but these malignancies did not influence the survival of the patients if the malignancies were detected at an early stage. RT is an appropriate treatment method for early-stage HPC. However, because synchronous or metachronous malignancies occur at a relatively high frequency, careful follow-up and the early detection of such malignancies are critical.

Communication disorders in individuals with cleft lip and palate: An overview

ABSTRACTThe need for an interdisciplinary approach in the comprehensive management of individuals with cleft lip and palate is well recognized. This article provides an introduction to communication disorders in individuals with cleft lip and palate for members of cleft care teams. The speech pathologist is involved in identifying those infants who are at risk for communication disorders and also for initiating early intervention to prevent or mitigate communication disorders caused by the cleft. Even with early cleft repair, some children exhibit ‘cleft palate speech’ characterized by atypical consonant productions, abnormal nasal resonance, abnormal nasal airflow, altered laryngeal voice quality, and nasal or facial grimaces. These manifestations are evaluated to identify those that (a) are developmental, (b) can be corrected through speech therapy alone, and, (c) those that may require both surgery and speech therapy. Speech is evaluated perceptually using several types of stimuli. It is important to identify compensatory and obligatory errors in articulation. When velopharyngeal dysfunction is suspected, the assessment should include at least one direct measure such as nasoendoscopy or videofluoroscopy. This provides information about the adequacy of the velopharyngeal valve for speech production, and is useful for planning further management of velopharyngeal dysfunction. The basic principle of speech therapy in cleft lip and palate is to establish the correct placement of the articulators and appropriate air flow. Appropriate feedback is important during therapy for establishing the correct patterns of speech.

Analysis of the human phonation with different vocal fold geometries by applying a two-dimensional fully coupled fluid-solid-acoustic finite element scheme.

A numerical two-dimensional model is presented simulating the human laryngeal voice production. Air flowing through the larynx interacts with the structural mechanics of the vocal folds forcing them to vibrate and induce sound. In turn, the vibrations of the vocal folds cause the airflow to pulsate which acts as a further sound source inside the larynx. This coupled field problem is modeled by utilizing an enhanced finite element method. The presented approach takes all three involved physical fields consisting of fluid mechanics, solid mechanics, acoustics, and their interactions fully into account. The results of these simulations clearly demonstrate the impact of different vocal fold geometries on the fluid field, e.g., changing the occurrence of the Coanda effect. In addition, influences on the produced sound signal resulting in modified main acoustic frequencies are observed. An additional eigenfrequency analysis on the vocal fold model was performed showing that the first eigenmode and the vibrational frequency in the transient case are identical. The first eigenmode was in the range of about 100 Hz depending on the vocal fold geometry.

Surgical treatment for well-differentiated thyroid carcinoma invading the larynx,trachea,esophagus and hypopharynx

Objective:To explore the surgical treatment for well-differentiated thyroid carcinoma(WDTC) invading the larynx,trachea,esophagus and hypopharynx. Methods: Primary tumor resection was performed in 17 patients with advanced WDTC.All the 17 cases had laryngotracheal involvement and received different kinds of surgical treatment: including 14 receiving local shaving-off,wedge tracheal resection with direct suture,window tracheal resection with sternocleidomastoid myoperiosteous flap reconstruction,sleeve tracheal resection with tracheal anastomosis or tracheal reconstruction by forearm free skin flap,and 3 receiving total laryngectomy or near-total laryngectomy. Eleven cases with esophagus and hypopharynx involvement received muscular layer resection or esophageal and hypopharynx partial resection with pectoralis major myocutaneous flap reconstruction. For 12 cases with recurrent laryngeal nerve involvement,9 were treated by nerve decompression,nerve resection combined with one-stage arytenoid within-shift and/or recurrent laryngeal nerve transposition,3 by simple laryngectomy. Results: The patients were followed up for 1 to 12 years. Sixteen patients survived and one died of tumor metastasis. The 5-year survival rate was 93.3%; the post-operation complication rate was 23.5%.Tumor relapses were found in 2 cases who had undergone local shaving-off or partial cervical trachea resection. The voice quality of the 9 patients receiving recurrent laryngeal nerve decompression or voice rehabilitation was greatly improved,and 5 of them had normal voice. Conclusion: The curative rate and quality of life of WDTC patients with extrathyroidal extension can be improved by one-stage resection and reconstruction. Operation modes should be chosen according to the location, involvement of tumor, the invasion of recurrent laryngeal nerve and the disease course. Operation is invasive and reconstruction is a complicated process, with many complications.

Reply to Dr. Agarwal’s letter to the Editor “Recurrent laryngeal nerve, phonation and voice preservation—energy devices in thyroid surgery—A note of caution”

Sir, Dr. Brij B. Agarwal’s comments to my letter provide many hints for meditation on the overwhelming aggression of new technologies in general surgery [1]. Moreover, it is a clear invitation for the new generation general surgeons to be judicious and prudent before accepting to use any new technological device so smartly offered by the industry. Otherwise, we all know how difficult it is to propose to a patient to enter a prospective randomized control trial which proposes a new surgical procedure, or any related innovation. Surgery is not medicine, and any procedure “is not like an aspirin”. Nevertheless, the new devices proliferate, and many of them have been recently favorably received by the surgical community. The purpose of my letter to the Editor has been to focus the attention to the fact that ultrasonic coagulating– dissectioning systems (HCDS) and electrothermal bipolar vessel sealing systems (EBVSS)—which are now so widely used in thyroid surgery, either traditional or videoscopic [1]— may be potentially more treacherous due to the restricted space in which possible and unrecognized electrical and thermal effects could damage delicate structures such as the recurrent laryngeal nerve (RLN) [2, 3]. I perfectly agree with Dr. Agarwal that in thyroid surgery a meticulous technique during the dissection is absolutely essential; however, if the well-trained surgeon feels confident in using HCDS or EBVSS, possible solutions to avoid lesions due to the involuntary spread of invisible energy from these devices at present are a standardized technique (distance between HCDS or EBVSS shears to the RLN more than 5mm) and to have an intraoperative neuromonitoring (NM) of the preserved function of RLN [1]. Invisible RLN insult from thermal spread by HCDS or EBVSS goes undetected by the surgeon eye and only intraoperative electromyography with NM can exclude such an insult [1, 4]. NM is a new functional dimension of RLN intraoperative management during modern thyroid surgery, superior to visual identification for intraoperative RLN injury [1, 4]. The intraoperative (and not postoperative) assessment of RLN function during thyroid surgery is important for different reasons: clarification of RLN anatomy; intraoperative prediction of postoperative function (prognosis); prevention of bilateral RLN injury (“stage thyroidectomy”); identification of where and how the RLN was injured; early differentiation between RLN related and unrelated voice changes [4, 5]. I do not mean to emphasize new technologies over sound common sense and I do recognize that at present standards for recurrent laryngeal nerve (RLN) management during thyroid surgery are yet extensive knowledge of RLN anatomy, routine visual identification of nerve, cervical exposure of RLN, experience, training, and preand postoperative laryngoscopy [5]. Specific training and caution with NM is essential for optimal use: this modern device requires a senior endocrine surgeon and anesthesiologist with a high level of experience and a standardized approach with routine preand postthyroid resection vagus stimulation [4, 5]. Langenbecks Arch Surg (2009) 394:913–914 DOI 10.1007/s00423-009-0512-x

Recurrent laryngeal nerve, phonation and voice preservation—energy devices in thyroid surgery—a note of caution

Reservations [1] about energized dissection (ED) in thyroidectomies (EDIT) and ED-induced iatrogenic catastrophes in laparoscopy exhort us to forsake adventurism, with technology un-benchmarked against standards of patient safety [2]. Surgeons embody Plato’s “techne iatrike”, Aristotle’s desire for dexterity, and artist’s sensibilities, remembering the technology as a double-edged sword, giving accolade and criticism equally [2]. The advocates of EDIT, reporting higher rate of insult to recurrent laryngeal nerve (RLN), confess to essentiality of meticulous surgical technique and await prospective randomized control trails (RCT), knowledge about thyroid specific heat dispersion and heat sink engineered ED. Even RCTs cannot negate the basics of surgical precision and hemostasis [3]. A few minutes gain should not be traded off against quadrupled complications. Redundancy of assistance is made a virtue violating the team-based “systems approach”, sounding contemptuous towards training. Surgeons train in heterogeneous fiscal atmospheres with universal concerns about ethics and safety. Time advantage remains unsupported by hepatectomy experiences where the collateral damageinduced biliary sealing is a virtue, but structures around thyroid cannot be bartered as collaterals for damage. “Patient-reported outcomes” are the proper “study end points” in this era of informed patients, and “technological toy”-wielding surgeon, as altered “phonation frequency range”, and vocal flitter reported in thyroidectomies with preserved RLN indicate invisible insult during dissection. Involuntary spread of invisible energy in ED insults the precision of cold sharp dissection, something regaining respect even in laparoscopic surgery [4]. History of thyroid surgery is a study of evolution of hemostasis. Advocacy of ED for hemostasis is contemptuous for pioneers whose names live on in the hemostats that we use, i.e., Schiebervorrichtung of Fricke, Kocher, Halsted, Mayo, Crile, and Lahey. Hemostatic techniques in thyroid surgeries are an index of surgical skills. It might surprise us that the hemostatic forceps were developed to replace cautery. Even Halsted castigated Cushing (co-inventor of Bovie) by saying “The only weapon with which the unconscious patient can immediately retaliate upon the incompetent surgeon is hemorrhage”. The benchmark in hemostasis evolved despite criticism from Berry calling thyroidectomy “worse than useless” and Gross “No honest and sensible surgeon, it seems to me, would engage in it”. Invisible RLN insult from thermal spread goes undetected because only laryngeal electromyography can exclude such an insult. There are more vulnerable structures, i.e., parathyroid vasculature and the nerve of Amalita Galli Curci. ED is an environmental compromise too [4]. To submit all patients to something that has a small benefit in a small group of patients and yet has complications that are measurable in the larger group seems madness [5]. Langenbecks Arch Surg (2009) 394:911–912 DOI 10.1007/s00423-009-0504-x

Communication disorders in individuals with cleft lip and palate: An overview.

The need for an interdisciplinary approach in the comprehensive management of individuals with cleft lip and palate is well recognized. This article provides an introduction to communication disorders in individuals with cleft lip and palate for members of cleft care teams. The speech pathologist is involved in identifying those infants who are at risk for communication disorders and also for initiating early intervention to prevent or mitigate communication disorders caused by the cleft. Even with early cleft repair, some children exhibit ‘cleft palate speech’ characterized by atypical consonant productions, abnormal nasal resonance, abnormal nasal airflow, altered laryngeal voice quality, and nasal or facial grimaces. These manifestations are evaluated to identify those that (a) are developmental, (b) can be corrected through speech therapy alone, and, (c) those that may require both surgery and speech therapy. Speech is evaluated perceptually using several types of stimuli. It is important to identify compensatory and obligatory errors in articulation. When velopharyngeal dysfunction is suspected, the assessment should include at least one direct measure such as nasoendoscopy or videofluoroscopy. This provides information about the adequacy of the velopharyngeal valve for speech production, and is useful for planning further management of velopharyngeal dysfunction. The basic principle of speech therapy in cleft lip and palate is to establish the correct placement of the articulators and appropriate air flow. Appropriate feedback is important during therapy for establishing the correct patterns of speech.

Umidificador de traqueostoma: influência na secreção e voz de laringectomizados

total laryngectomy has several consequences such as loss of the laryngeal voice and alterations in the respiratory system. to evaluate the influence of a tracheostoma humidifier (heat moisture exchanger - HME) on the control of lung secretion and esophageal and tracheoesophageal vocal quality in patients with total laryngectomy. nine male individuals, aged between 46 to 67 years, submitted to total laryngectomy. The patients answered a protocol containing subjective questions related to lung secretion in three different moments: T1 (pre-use assessment of the HME), T2 (pre-use assessment of the HME six weeks after the first assessment) and T3 (assessment six weeks after the use of the HME). Voice samples were recorded during these 3 different assessments and were evaluated by three speech-language pathologists, in a blind study format, according to a perceptual auditory vocal analysis protocol. The non-parametric test of Wilcoxon was used to compare results of both protocols. no significant differences were observed for tracheoesophageal and esophageal vocal quality in the three different moments of assessment: T1 (pre-use assessment of the HME), T2 (pre-use assessment of the HME six weeks after the first assessment) and T3 (assessment six weeks after the use of the HME). On the other hand, there were significant differences, after the period of the HME use, regarding occurrence of cough and forced expectoration during the day time. The use of the HME during the period of six weeks reduced cough and expectoration of patients with total laryngectomy. However, the use of the humidifier did not have any influence on the tracheoesophageal and esophageal vocal quality of these patients.

Larynx Transplantation: Laryngectomees’ Opinion Poll

In 1998, Strome et al. performed the first human larynx transplantation in a patient with larynx traumatism. L'Association Nationale des Mutilés de la Voix, a French association of laryngectomees, estimates that the number of laryngectomees in France has reached 20,000. The main goal of the study was to determine the potential number of patients ready to benefit from larynx transplantation in France. We carried out a public opinion poll among 420 total laryngectomees in Rhone-Alpes, in the southeast of France. The questionnaire could be divided into three parts: demographic data; incapacities and deficiencies of the patients; and acceptability of larynx transplantation according to short-, medium-, and long-term implications. We received 205 answers from 420 questionnaires (48.8%). Sixty-three patients (i.e., 30.7%) would accept larynx transplantation, especially the younger patients. The patients more willingly accepted the medical constraints (e.g., medical follow-up, rehabilitation) than they did vital (after the operation or because of the treatments) or functional (risk of permanent canula, no guarantee of laryngeal voice, no guarantee of swallowing) risks. Even though this opinion poll has intrinsic bias and acceptance rate is low, by interpolation, larynx transplantation would interest many patients in France. Larynx transplantation is an intervention that should be proposed to a certain number of patients in the future with the help of new immunosuppressor treatments.

Model-based quantification of pathological voice production

Hoarseness, the primary symptom of voice disorders, results from irregular vocal fold vibrations. The oncological therapy of laryngeal cancer may even result in a total loss of voice if an excision of the larynx, and thus, the vocal folds, is necessary. State-of-the-art voice rehabilitation technique in this case is the utilization of scarred tissue in the upper part of the esophagus for substitute voice production. The quality of laryngeal voice, as well as the substitute voice, primarily depends on the anatomy and the vibration patterns of the voice-producing element. Using endoscopic high-speed recordings, the voice generators are observed during voice production. In this work, a model-based approach feasible for the analysis and objective quantification of vocal fold vibrations, as well as the PE dynamics, is presented. By means of an automatic parameter optimization, the dynamic of a biomechanical model of the considered voice-producing element is fitted to the recorded vibration patterns. Thereby spatial and temporal properties of the vibrations are incorporated. The resulting values of the optimization parameters represent an objective quantification of the vibration patterns. In addition, the model parameters enable an approximation of physiological tissue parameters as stiffness and mass distribution.

Vocal efficiency in tracheoesophageal phonation

Objective Voice rehabilitation after total laryngectomy is challenging. In order to investigate and understand the function of the neoglottis sophisticated measurements need to be made. During voice production, aerodynamic energy is transformed into sound energy. In non-laryngectomized patients, the voice production efficiency is called the vocal efficiency. Vocal efficiency is an indication of how efficient the transformation of energy takes place. Vocal efficiency is calculated by dividing the output sound power by the aerodynamic power. Patients and methods In a group of eight laryngectomees with tracheoesophageal voice, we measured aerodynamic and acoustic quantities and calculated vocal efficiency. We used a computer setup with airflow transducers, pressure transducers, mikrotip transducers and sound intensity measurement to allow calculation of the needed parameters. Results The tables show the results of the power used and produced in various phonatory tasks. Relatively high levels of aerodynamic power are interpreted as increased effort to speak. Conclusion The aerodynamic power is an indication of the effort needed for voice generation. The efficiency of TE-voice production is lower compared to laryngeal voice production but does show an increase when sound intensity increases, a known phenomenon in healthy laryngeal voice production.

Multidisciplinary Management of Laryngeal Carcinoma

The management of head and neck cancer has evolved into a multidisciplinary approach in which patients are evaluated before treatment and decisions depend on prospective multi-institutional trials, as well as retrospective outcome studies. The choice of one or more modalities to use in a given case varies with the tumor site and extent, as exemplified in the treatment of laryngeal squamous cell carcinomas. The goals of treatment include cure, laryngeal voice preservation, voice quality, optimal swallowing, and minimal xerostomia. Treatment options include transoral laser excision, radiotherapy (both definitive and postoperative), open partial laryngectomy, total laryngectomy, and neck dissection. The likelihood of local control and preservation of laryngeal function is related to tumor volume. Patients who have a relatively high risk of local recurrence undergo follow-up computed tomography scans every 3-4 months for the first 2 years after radiotherapy. Patients with suspicious findings on computed tomography might benefit from fluorodeoxyglucose positron emission tomography to differentiate post-radiotherapy changes from tumor.

Automatic evaluation of prosodic features of tracheoesophageal substitute voice

In comparison with laryngeal voice, substitute voice after laryngectomy is characterized by restricted aero-acoustic properties. Until now, an objective means of prosodic differences between substitute and normal voices does not exist. In a pilot study, we applied an automatic prosody analysis module to 18 speech samples of laryngectomees (age: 64.2 +/- 8.3 years) and 18 recordings of normal speakers of the same age (65.4 +/- 7.6 years). Ninety-five different features per word based upon the speech energy, fundamental frequency F(0) and duration measures on words, pauses and voiced/voiceless sections were measured. These reflect aspects of loudness, pitch and articulation rate. Subjective evaluation of the 18 patients' voices was performed by a panel of five experts on the criteria "noise", "speech effort", "roughness", "intelligibility", "match of breath and sense units" and "overall quality". These ratings were compared to the automatically computed features. Several of them could be identified being twice as high for the laryngectomees compared to the normal speakers, and vice versa. Comparing the evaluation data of the human experts and the automatic rating, correlation coefficients of up to 0.84 were measured. The automatic analysis serves as a good means to objectify and quantify the global speech outcome of laryngectomees. Even better results are expected when both the computation of the features and the comparison method to the human ratings will have been revised and adapted to the special properties of the substitute voices.