Objective Evaluation Of Speech Research Articles

The Role of Computer-Aided Diagnosis in Speech Restoration in Patients with Cancer of the Oral Cavity and Oropharynx after Hemiglosectomy: a Prospective Comparative Study

INTRODUCTION. Oral cavity and oropharyngeal cancers usually require extensive surgeries accompanied by damages to anatomical structures and impaired speech function.
 AIM. To compare the effectiveness and terms of speech rehabilitation in patients with cancer of the oral cavity and oropharynx using various speech restoration techniques.
 MATERIALS AND METHODS. We studied the effectiveness and length of speech rehabilitation in 140 patients with stages II–IV oral cavity and oropharyngeal cancer. The age of the patients ranged from 24 to 70 years. All the patients underwent hemiglosectomy. Combined modality treatment and postoperative speech rehabilitation were performed according to the technique developed in the Department of Head and Neck Tumors of the Oncology Research Institute. Speech rehabilitation effectiveness was studied on the basis of subjective and objective evaluation of speech using the computer-software complex (OnkoSpeech v 1.0).
 RESULTS AND DISCUSSION. Impaired speech function of patients was observed before starting combined modality treatment and manifested as a change in the prosodic system of speech and subjective communication difficulties associated with the presence of a tumor. After surgery, all the patients demonstrated impaired speech function, ranging from distorted pronunciation to the complete absence of verbal communication. Speech rehabilitation started 8 to 29 days after surgery: in the study group I, Me = 9.6, in the study group II, Me = 9.8, values did not have statistically significant differences (p 0.05). At the beginning of speech rehabilitation, to restore activity and coordinate the work of articulatory apparatus muscles and speech expiration, special complexes of articulation and breathing exercises followed by sound pronunciation correction were performed. Postoperative speech rehabilitation resulted in the improvement of speech function in 100 % of cases. In group II, where the correction of sound pronunciation was performed on the basis of speech diagnosis data using the OnkoSpeech v 1.0 computer-software complex, it was possible to achieve a better result of sound pronunciation correction of all the studied sounds, except for hissing (lingual-frontal) [sh], [zh], [shch], [ch].
 CONCLUSION. The use of the OnkoSpeech v1. ± software package for speech computer-aided diagnosis made it possible to objectively evaluate and quantify the effectiveness of the correction of the sound pronunciation of six phonemes of the Russian language, improve the results of the correction of sound pronunciation and reduce the time of speech therapy.

Detailed speech evaluation including formant 3 analysis and voice visualization in maxillofacial rehabilitation: A clinical report

Objective speech evaluation such as analysis of formants 1 and 2 and nasality measurement have been used in maxillofacial rehabilitation for outcome assessment. However, in some patients, those evaluations are insufficient to assess a specific or unique problem. This report describes the use of a new speech evaluation including formant 3 analysis and voice visualization in a patient with a maxillofacial defect. The patient was a 67-year-old man who had a maxillary defect that opened to the maxillary sinus and who had an unnatural voice even when wearing an obturator. Nasality was low and the frequency of formants 1 and 2 were normal even without the obturator. However, a low frequency of formant 3 and a shifted center of voice were observed. These results indicated that the unnatural voice was related to increased resonant volume in the pharynx rather than hypernasality. This patient demonstrates that advanced speech analysis can be useful for detecting the cause of speech disorder and planning maxillofacial rehabilitation.

Subjective and Objective Evaluation of Speech in Adult Patients With Repaired Cleft Palate.

To explore the speech outcomes of adult patients with repaired cleft palate through subjective perception evaluation and objective acoustic analysis, and to compare the differences in pronunciation characteristics between speakers with complete velopharyngeal closure (VPC) and velopharyngeal insufficiency (VPI) patients. Subjective evaluation indicators included speech intelligibility, nasality and consonant missing rate, for objective acoustic analysis, we used speech sample normalization and objective acoustic parameters included normalized vowel formants, voice onset time and the analysis of 3-dimensional spectrogram and spectrum, were carried out on speech samples produced by 3 groups of speakers: (a) speakers with velopharyngeal competence after palatorrhaphy (n=38); (b) speakers with velopharyngeal incompetence after palatorrhaphy (n=70), (c) adult patients with cleft palate (n=65) and (d) typical speakers (n=30). There was a highly negative correlation between VPC grade and speech intelligibility (ρ=-0.933), and a highly positive correlation between VPC and nasality (ρ=0.813). In subjective evaluation, the speech level of VPI patients was significantly lower than that of VPC patients and normal adults. Although the nasality and consonant loss rate of VPC patients were significantly higher than that of normal adults, the speech intelligibility of VPC patients was not significantly different from that of normal adults. In acoustic analysis, patients with VPI still performed poorly compared with patients with VPC. The speech function of adult cleft palate patients is affected by abnormal palatal structure and bad pronunciation habits. In subjective evaluation, there was no significant difference in speech level between VPC patients and normal adults, whereas there was significant difference between VPI patients and normal adults. The acoustic parameters were different between the 2 groups after cleft palate repair. The condition of palatopharyngeal closure after cleft palate can affect the patient's speech.

Subjective and Objective Evaluation of Speech in Adult Patients with Unrepaired Cleft Palate.

To explore the speech outcomes of adult patients through subjective perception evaluation and objective acoustic analysis, and to compare the differences in pronunciation characteristics between speakers with adult patients with unrepaired cleft palate and their non-cleft peers. Subjective evaluation indicators included speech intelligibility, nasality, and consonant missing rate, whereas objective acoustic parameters included normalized vowel formants, voice onset time, and the analysis of three-dimensional spectrogram and spectrum, were carried out on speech samples produced by 2 groups of speakers: (a) speakers with unrepaired cleft palate ( n = 65, mean age = 25.1 years) and (b) typical speakers ( n = 30, mean age = 23.7 years). Compared with typical speakers, individuals with unrepaired cleft palate exhibited a lower speech intelligibility with higher nasality and consonant missing rate, the missing rate is highest for the 6 consonants syllables The acoustic parameters are mainly manifested as differences in vowel formants and voice onset time. The results revealed important acoustical differences between adult patients with unrepaired cleft palate and typical speakers. The trend of spectral deviation may have contributed to the difficulty in producing pressure vowels and aspirated consonants in individuals with speech disorders related to cleft palate.

Treatment of velopharyngeal insufficiency in a patient with a submucous cleft palate using a speech aid: the more treatment options, the better the treatment results

BackgroundThe submucous cleft palate (SMCP) is a type of cleft palate that may result in velopharyngeal insufficiency (VPI). Palate muscles completely separate oral and nasal cavities by closing off the velopharynx during functional processes such as speech or swallow. Also, hypernasality may arise from anatomical or neurological abnormalities in these functions. Treatments of this issue involve a combination of surgical intervention, speech aid, and speech therapy. This case report demonstrates successfully treated VPI resulted from SMCP without any surgical intervention but solely with speech aid appliance and speech therapy.Case presentationA 13-year-old female patient with a speech disorder from velopharyngeal insufficiency that was caused by a submucous cleft palate visited to our OMFS clinic. In the intraoral examination, the patient had a short soft palate and bifid uvula. And the muscles in the palate did not contract properly during oral speech. She had no surgical history such as primary palatoplasty or pharyngoplasty except for tonsillectomy. And there were no other medical histories. Objective speech assessment using nasometer was performed. We diagnosed that the patient had a SMCP. The patient has shown a decrease in speech intelligibility, which resulted from hypernasality. We decided to treat the patient with speech aid (palatal lift) along with speech therapy. During the 7-month treatment, hypernasality measured by a nasometer decreased and speech intelligibility became normal.ConclusionsSurgery remains the first treatment option for patients with velopharyngeal insufficiencies from submucous cleft palates. However, there were few reports about objective speech evaluation pre- or post-operation. Moreover, there has been no report of non-surgical treatment in the recent studies. From this perspective, this report of objective improvement of speech intelligibility of VPI patient with SMCP by non-surgical treatment has a significant meaning. Speech aid can be considered as one of treatment options for management of SMCP.

What's New in Cleft Palate and Velopharyngeal Dysfunction Management?

After studying this article, the participant should be able to: 1. Have a clear understanding of the evolution of concepts of velopharyngeal dysfunction, especially as it relates to patients with a cleft palate. 2. Explain the subjective and objective evaluation of speech in children with velopharyngeal dysfunction. 3. On the basis of these diagnostic findings, be able to classify types of velopharyngeal dysfunction. 4. Develop a safe, evidence-based, patient-customized treatment plan for velopharyngeal dysfunction founded on objective considerations. Velopharyngeal dysfunction is improper function of the dynamic structures that work to control the velopharyngeal sphincter. Approximately 30 percent of patients having undergone cleft palate repair require secondary surgery for velopharyngeal dysfunction. A multidisciplinary team using multimodal instruments to evaluate velopharyngeal function and speech should manage these patients. Instruments may include perceptual speech analysis, video nasopharyngeal endoscopy, multiview speech videofluoroscopy, nasometry, pressure-flow, and magnetic resonance imaging. Velopharyngeal dysfunction may be amenable to surgical or nonsurgical treatment methods or a combination of each. Nonsurgical management may include speech therapy or prosthetic devices. Surgical interventions could include palatal re-repair with repositioning of levator veli palatini muscles, posterior pharyngeal flap, sphincter pharyngoplasty, or soft palate or posterior wall augmentation. Treatment interventions should be based on objective assessment and rating of the movement of lateral and posterior pharyngeal walls and the palate to optimize speech outcomes. Treatment should be tailored to specific anatomical and physiologic findings and the overall needs of the patient.

Oral squamous cell carcinoma of the tongue: Prospective and objective speech evaluation of patients undergoing surgical therapy.

Prospective speech intelligibility assessments lack objectivity in patients undergoing surgery for oral squamous cell carcinoma (OSCC) of the tongue. Speech intelligibility was measured based on word recognition by means of an automatic and objective speech recognition system preoperatively, and 14 to 20 days, and 3 months, 6 months, and 12 months postoperatively. The study comprised 25 patients with OSCC of the tongue and a healthy control group (n = 40). Patients yielded significant speech impairments compared to the healthy control group both before surgery and after 12 months (p ≤ .002). The speech intelligibility of the patients decreased significantly 14 to 20 days after surgery (p < .001) but realigned to preoperative values after 12 months (p = .159). Preservation of the tip of the tongue resulted in significantly higher word recognition after 12 months (p = .007; Δword recognition = 16.29). Having OSSC of the tongue results in a significant impairment of speech intelligibility. The preservation of the tip of the tongue seems to be a central factor concerning the recovery of speech. © 2015 Wiley Periodicals, Inc. Head Neck 38: 993-1001, 2016.

Cleft palate repair and velopharyngeal dysfunction.

After studying this article, the participant should be able to: (1) Describe the technical details common to all cleft palate repairs that optimize outcomes and minimize complications. (2) Explain the subjective and objective evaluation of speech in children with cleft palate. (3) Practice with an increased awareness of the management of complications associated with cleft palate repair. (4) Design a treatment plan for velopharyngeal dysfunction. Goals of a successful cleft palate repair include separation of the oral and nasal components without fistula, achieving sufficient velar length, and creating functional transverse orientation of the levator muscle sling. A number of techniques have been described to achieve these goals, but they all have the following technical details in common: elevation of oral mucosal flaps based on the greater palatine arteries, tension free nasal lining mobilization, and functional intervelar muscle dissection. After palate repair, speech evaluation needs to be performed by an objective interdisciplinary team following a standardized protocol. Identification of velopharyngeal insufficiency secondary to an incompetent nasopharyngeal port will necessitate secondary speech surgery. These secondary techniques include pharyngeal flaps, soft palate lengthening, or pharyngeal sphincters, which should be tailored to optimize speech, while minimizing the risk of obstructive sleep apnea.

Measurement of Voice Onset Time in Maxillectomy Patients

Objective speech evaluation using acoustic measurement is needed for the proper rehabilitation of maxillectomy patients. For digital evaluation of consonants, measurement of voice onset time is one option. However, voice onset time has not been measured in maxillectomy patients as their consonant sound spectra exhibit unique characteristics that make the measurement of voice onset time challenging. In this study, we established criteria for measuring voice onset time in maxillectomy patients for objective speech evaluation. We examined voice onset time for /ka/ and /ta/ in 13 maxillectomy patients by calculating the number of valid measurements of voice onset time out of three trials for each syllable. Wilcoxon's signed rank test showed that voice onset time measurements were more successful for /ka/ and /ta/ when a prosthesis was used (Z = −2.232, P = 0.026 and Z = −2.401, P = 0.016, resp.) than when a prosthesis was not used. These results indicate a prosthesis affected voice onset measurement in these patients. Although more research in this area is needed, measurement of voice onset time has the potential to be used to evaluate consonant production in maxillectomy patients wearing a prosthesis.

Relationship between subjective and objective evaluation of noise-reduced speech with various widths of temporal windows

It is necessary to enhance adverse speech signals for building useful speech interfaces. Speech enhancement is essential under noisy and reverberant acoustic environments. Therefore, quality assessment of the enhanced speech signals should be also an important issue in noise reduction and dereverberation. Subjective evaluation is given by carrying out listening tests, and objective evaluation is provided by speech distortion measures. However, there is the discrepancy between subjective and objective evaluation of speech distortion. The author has investigated the relationship between subjective and objective evaluation of noise-reduced speech signals. The objective speech distortion was calculated in each short-term frame, of which length was fixed, and the statistical characteristics of the short-term speech distortion were investigated using higher-order statistics such as skewness and kurtosis. The preliminary result suggested that skewness of the short-term speech distortion could give an explanation for the discrepancy between subjective and objective evaluation. Further investigation of the relationship between subjective and objective evaluation of noise-reduced speech signals is carried out with a variety of temporal window widths. [Work supported by NEDO, Japan.]

A new simple evaluation method of the monosyllable /sa/ using a psychoacoustic system in maxillectomy patients

An objective assessment of speech would benefit the prosthetic rehabilitation of maxillectomy patients. This study aimed to establish a simple, objective evaluation of monosyllable /sa/ utterances in maxillectomy patients by using a psychoacoustic system typically used in industry. This study comprised two experiments. Experiment 1 involved analysis of the psychoacoustic parameters (loudness, sharpness and roughness) in monosyllable /sa/ utterances by 18 healthy subjects (9 males, 9 females). The utterances were recorded in a sound-treated room. The coefficient of variation (CV) for each parameter was compared to identify the most suitable parameter for objective evaluation of speech. Experiment 2 involved analysis of /sa/ utterances by 18 maxillectomy patients (9 males, 9 females) with and without prosthesis, and comparisons of the psychoacoustic data between the healthy subjects and maxillectomy patients without prosthesis, between the maxillectomy patients with and without prosthesis, and between the healthy subjects and maxillectomy patients with prosthesis. The CV for sharpness was the lowest among the three psychoacoustic parameters in both the healthy males and females. There were significant differences in the sharpness of /sa/ between the healthy subjects and the maxillectomy patients without prosthesis (but not with prosthesis), and between the maxillectomy patients with and without prosthesis. We found that the psychoacoustic parameters typically adopted in industrial research could also be applied to evaluate the psychoacoustics of the monosyllable /sa/ utterance, and distinguished the monosyllable /sa/ in maxillectomy patients with an obturator from that without an obturator using the system.

Late laryngeal findings in sulfur mustard poisoning

Introduction. Sulfur mustard is an alkylating warfare agent and its inhalation results in early and late toxic effects. This agent was used widely against both military and civilian population by Iraqi forces in the Iran–Iraq war (1983–88). The purpose of the study was to describe abnormal laryngeal findings in a group of chemical war injury patients (soldiers) 20 years after an acute exposure to sulfur mustard. Methods. In this observational case series study, 50 male patients who were suffering from chronic respiratory symptoms and because of exacerbation of these problems, were consecutively selected and clinically examined for dysphonia by a speech-language pathologist, and then underwent fiberoptic laryngobronchoscopy to describe anatomical and functional pathologic findings of the larynx. Results. In objective speech evaluation, different degrees of dysphonia including harshness and hoarseness were observed in 46% of patients. Inflammation was present in supraglottic and subglottic regions of 9 (18%) and 3 (6%) patients, respectively. Hyperfunction of the false vocal cords was observed in 24 (48%) patients. Conclusion. Chronic laryngitis was seen in a considerable number of exposed victims nearly 20 years after exposure, in spite of different treatments received.

The impact of tonsillectomy with or without adenoidectomy on speech and voice

The aim of this study was to evaluate changes in acoustic features of speech and voice after tonsillectomy with or without adenoidectomy. Before and 1 month after surgery the following parameters were estimated: average of fundamental frequency (Fo), Jitter percent (Jitt), Shimmer, noise-to-harmonics ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), degree of voiceless (DUV), degree of voice breaks (DVB) and peak amplitude variation (vAm); as an evaluation of nasal resonance, speech articulation and voice handicap index (VHI). The results were statistically evaluated using the unpaired t-test. Probability values below 0.05 were regarded as significant. One month after surgery, our data showed significant (P<0.05) improvements of the acoustic and other parameters in the children submitted to adenotonsillectomy: Fo (176Hz vs. 206Hz, after sustained vowels: 206Hz vs. 192Hz; 148Hz vs. 168Hz; 171Hz vs. 161Hz after balanced sentences), Jitt (0.85% vs. 1.81% to 0.82% vs. 1.81%), Shimmer (3.41% vs. 5.81% to 4.89% vs. 5.73%), NHR (0.16 vs. 0.42 to 0.29 vs. 0.39), VTI (0.05 vs. 0.38 to 0.28 vs. 0.37), SPI (14.78 vs. 21.14-19.89 vs. 21.89), DUV (0% vs. 0.44% to 0% vs. 0.48%), DVB (0% vs. 0.42% to 0% vs. 0.42%) and vAm (8.93% vs. 23.89% to 8.89% vs. 24.25%). The results suggest the role of adenotonsillectomy in the improvement of voice and speech quality and of objective evaluation of speech and voice in the correct management of these children.

Effects of Tonsillectomy on Speech and Voice

The aim of this study was to evaluate changes in acoustic features of speech after tonsillectomy and to establish concepts of patient management and rational therapeutic approach. Before and 1 month after surgery, phonetically balanced sentences and sustained vowels a, e, i were carried out and digitalized with Multi-Dimensional Voice Program (Kay Elemetrics, Lincoln Park, NJ) in all the patients, as an evaluation of nasal resonance, speech articulation, and voice handicap index (VHI). These parameters were estimated: average of fundamental frequency, Jitter percent, Shimmer, noise-to-harmonics ratio, voice turbulence index, soft phonation index, degree of voiceless, degree of voice breaks, and peak amplitude variation. Our data showed that 1 month after tonsillectomy, improvements in all the acoustic parameters, a subjective decrease of hypernasality, and an improvement of speech articulation and VHI were achieved. These data suggest the reduction of the nasal resonance and highlight the role of tonsillectomy in the improvement of voice and speech quality. Furthermore, tonsillectomy should be performed before consideration of pharyngeal flap surgery. Our results highlight that objective evaluation of speech and voice helps the specialist to improve patient management and avoid unnecessary and dangerous surgical procedures.

P127 Development and validation of a new objective speech evaluation tool for glossectomy defects

P127 Development and validation of a new objective speech evaluation tool for glossectomy defects

Perceptual and Objective Evaluation of Speech Processed by Adaptive Differential PCM

An experiment has been performed to study the perceptual characteristics of speech processed by adaptive differential PCM. We created 18 three-bit and four-bit coders spanning a wide range of quantizer adaptation parameters. Subjects judged differences between coders and rated the quality of each coder individually. The difference data reveal three important perceptual characteristics: overall clarity, signal vs. background degradation, and rough vs. smooth impairment. These characteristics are strongly correlated with coder design parameters and objective performance measures. Overall subjective quality is well predicted by segmental signal-to-noise ratio and even better by a linear combination of measures of granular distortion and overload distortion.