Tracheoesophageal Speakers 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.

Temporal and Spectral Models as Correlates to Auditory-Perceptual Judgments of Overall Severity and Listener Comfort in Tracheoesophageal Voice.

This study pursued two objectives: (1) to determine the potential association between listener (n = 51) judgments of 20 male tracheoesophageal speaker samples for two auditory-perceptual dimensions of voice, overall severity (OS) and listener comfort (LC); and (2) to assess the temporal and spectral acoustic correlates for these auditory-perceptual dimensions. Three separate correlation analyses were performed to evaluate the association between OS and LC. First, scores of OS and LC from all listeners were pooled together, and then the correlation between OS and LC was computed. Second, scores of OS and LC were averaged over all listeners to derive a single estimate of OS and LC for each TE speaker sample; the correlation between the average OS and LC was then computed. Third, listener-to-listener variability in the association between OS and LC was evaluated by computing the correlation between OS and LC scores from each listener across all TE samples. Finally, two stepwise multiple regression models were created to relate the average LC score to spectral and temporal variation in the acoustic signal. While the pooled OS and LC scores had a moderate positive correlation (r = 0.66, p < 0.00001), the averaged OS and LC exhibited a near perfect positive correlation (r = 0.99, p < 0.00001). The significant differences between the pooled and averaged scores were explained by significant listener-to-listener variability in the association between OS and LC. OS and LC scores from 5 listeners had non-significant correlations, 10 had moderate correlations (r < 0.7), 35 listeners had high correlations (0.7 < r < 0.9), and 1 listener had a very high correlation (r < 0.9 < 1). Finally, the acoustic models created based on the spectral and temporal variations in the signal were able to account for 87.7% and 61.8% of variation in the average LC score. The strong correlations between OS and LC suggest that LC may, in fact, provide a more comprehensive auditory-perceptual surrogate for the voice quality of TE speakers. Although OS and LC are distinct conceptual dimensions, LC appears to have the advantage of assessing the social impact and potential communication disability that may exist in interactions between TE speakers and listeners.

The process of reacquiring new vocalization in total laryngectomy patients with head and neck cancer: A qualitative study

ObjectiveSpeech rehabilitation significantly contributes to the enhanced quality of life for patients who have undergone laryngectomy due to head and neck cancer. The initiation of tracheoesophageal speech early in the rehabilitation process has been associated with improved speech quality. Despite this, voice changes can carry a stigma due to communication challenges, even after successful voice restoration, potentially limiting the overall improvement in quality of life. Thus, our aim was to gain a profound understanding of the transition process from the selection to the adaptation of tracheoesophageal speech in patients with head and neck cancer. MethodsParticipants, who had undergone laryngectomy for head and neck cancer, were recruited from peer support groups in Japan, resulting in the identification of thirteen tracheoesophageal speakers. The data were analyzed using grounded theory methodology, incorporating open, axial, and selective coding. Semi-structured interviews delved into tracheoesophageal speakers' perceptions of their voices and the adaptive strategies employed for their preferred alternative communication methods. ResultsDuring the adaptation process, participants underscored the importance of communicating with their own voices. However, they also experienced anxiety about losing their natural voice, confronted the reality of living without a voice, and coped with their new voice. Eventually, participants came to recognize the changed voice as their own. ConclusionsThe personal conviction associated with the notion of “communicating with one's own voice” is integral to the adaptation process for patients with head and neck cancer who undergo laryngectomies and utilize tracheoesophageal speech. Some aspects of tracheoesophageal speech can evoke feelings of hopelessness, emphasizing the importance of comprehensive support for professional speech rehabilitation.

Perceptions and practices of people with a total laryngectomy during COVID-19 pandemic: A mixed methods analysis

PurposePeople with a total laryngectomy (PTL) confront safety threats related to altered airway anatomy and risk of adverse events is amplified during healthcare crises, as exemplified by COVID-19 pandemic. Understanding these challenges, how they are navigated by PTL, and what resources can be deployed to alleviate risk can improve interprofessional care by speech-language pathologists (SLPs), otolaryngologists, and other professionals. Materials and methodsAn online survey was disseminated to PTL in the United States during the COVID-19 pandemic, querying participants about safety concerns and sources of information accessed to address care. Descriptive statistics and Chi-square were used to analyze information sources consumed by tracheoesophageal, esophageal, and electrolaryngeal speakers. Content analysis was completed to identify themes and quantify responses by subtheme. ResultsAmong 173 respondent PTL, tracheoesophageal speakers preferentially sought otolaryngologist input, whereas esophageal and electrolaryngeal speakers more often chose SLPs (p < .01). Overall, tracheoesophageal speakers had more SLP or otolaryngologist contact. Many PTL reported stringent handwashing, neck cleaning, and hygienic risk mitigation strategies. Six themes emerged in content analysis involving risk of infection/transmission, heightened vigilance, changes to alaryngeal communication, modified tracheostoma coverage, diagnostic testing, and risk from comorbid conditions. Limited provider contact suggested pandemic barriers to healthcare access. ConclusionsPTL have a range of laryngectomy-specific needs and concerns, and type of alaryngeal communication was associated with source of information sought. Collaborations among healthcare professionals need to be optimized to improve patient navigation and overall access to specialized care.

The Influence of Stimulus Composition and Scoring Method on Objective Listener Assessments of Tracheoesophageal Speech Accuracy

Introduction: This study investigated the influence of stimulus composition for three speech intelligibility word lists and two scoring methods on the speech accuracy judgments of five tracheoesophageal (TE) speakers. This was achieved through phonemic comparisons across TE speakers’ productions of stimuli from the three intelligibility word lists, including the (1) Consonant Rhyme Test, (2) Northwestern Intelligibility Test, and (3) the Weiss and Basili list. Methodology: Fifteen normal-hearing young adults served as listeners; all listeners were trained in phonetic transcription (IPA), but none had previous exposure to any mode of postlaryngectomy alaryngeal speech. Speaker stimuli were presented to all listeners through headphones, and all stimuli were transcribed phonetically using an open-set response paradigm. Data were analyzed for individual speakers by stimulus list. Phonemic scoring was compared to a whole-word scoring method, and the types of errors observed were quantified by word list. Results: Individual speaker variability was noted, and its effect on the assessment of speech accuracy was identified. The phonemic scoring method was found to be a more sensitive measure of TE speech accuracy. The W&amp;B list yielded the lowest accuracy scores of the three lists. This finding may indicate its increased sensitivity and potential clinical value. Conclusions: Overall, this study supports the use of open-set, phonemic scoring methods when evaluating TE speaker intelligibility. Future research should aim to assess the specificity of assessment tools on a larger sample of TE speakers who vary in their speech proficiency.

An acoustic study of Cantonese alaryngeal speech in different speaking conditions.

Esophageal (ES) speech, tracheoesophageal (TE) speech, and the electrolarynx (EL) are common methods of communication following the removal of the larynx. Our recent study demonstrated that intelligibility may increase for Cantonese alaryngeal speakers using clear speech (CS) compared to their everyday "habitual speech" (HS), but the reasoning is still unclear [Hui, Cox, Huang, Chen, and Ng (2022). Folia Phoniatr. Logop. 74, 103-111]. The purpose of this study was to assess the acoustic characteristics of vowels and tones produced by Cantonese alaryngeal speakers using HS and CS. Thirty-one alaryngeal speakers (9 EL, 10 ES, and 12 TE speakers) read The North Wind and the Sun passage in HS and CS. Vowel formants, vowel space area (VSA), speaking rate, pitch, and intensity were examined, and their relationship to intelligibility were evaluated. Statistical models suggest that larger VSAs significantly improved intelligibility, but slower speaking rate did not. Vowel and tonal contrasts did not differ between HS and CS for all three groups, but the amount of information encoded in fundamental frequency and intensity differences between high and low tones positively correlated with intelligibility for TE and ES groups, respectively. Continued research is needed to understand the effects of different speaking conditions toward improving acoustic and perceptual characteristics of Cantonese alaryngeal speech.

Approaches to tracheoesophageal voice rehabilitation: a survey of the UK and Irish speech and language therapists' current practice and beliefs.

After total laryngectomy, surgical voice restoration is used to establish communication via tracheoesophageal voice prosthesis. Once voice is established, there is a paucity of information on what speech and language therapists (SLTs) should do to improve tracheoesophageal voice quality to ensure functional communication. No existing surveys or studies investigate this specific question. There is also a disconnect between guidelines, knowledge and clinical practice, whereby clinical guidelines stipulate the requirement for SLT intervention, but do not detail what this entails in the rehabilitation context. (1) To advance understanding of current clinical practice beyond voice prosthesis management and care. (2) To explore what approaches are implemented in clinical practice across the UK and Republic of Ireland to rehabilitate tracheoesophageal voice. (3) To investigate the barriers and facilitators to provision of tracheoesophageal voice therapy. A self-administered 10-min online survey was developed using Qualtrics software and piloted before dissemination. Survey development was informed by the Behaviour Change Wheel to identify barriers, facilitators and additional factors contributing to SLTs' provision of voice therapy to tracheoesophageal speakers. The survey was disseminated via social media and professional networks. Eligibility criteria included SLTs with at least one year post-registration experience and with experience of working with laryngectomy in the past 5 years. Descriptive statistics were used to analyse closed answer questions. Open question responses were analysed using content analysis. The survey received 147 responses. Participants were representative of the head and neck cancer SLT workforce. SLTs believe that tracheoesophageal voice therapy is an important aspect of laryngectomy rehabilitation; however, there was a lack of knowledge about therapy approaches and insufficient resources for implementing therapy. SLTs expressed a desire for more training, specific guidelines and a stronger evidence base to inform clinical practice. Some SLTs expressed feelings of frustration and lack of acknowledgement for the specialist skills required to undertake laryngectomy rehabilitation and tracheoesophageal work in general. The survey identifies the need for a robust training approach and detailed clinical guidelines to promote consistent practice across the profession. The evidence base within this clinical area is emergent, hence there is a need for increased research and clinical audit to inform practice. Under-resourcing was highlighted, which should be considered in service planning to ensure that adequate staff, access to expert practitioners or time ring-fenced for therapy are available for tracheoesophageal speakers to receive the support they require. What is already known on this subject Total laryngectomy results in life-altering changes to communication. Clinical guidelines advocate for speech and language therapy intervention; however, there is no clear information on what SLTs should do to optimize tracheoesophageal voice and the evidence base to support practice is lacking. What this study adds to existing knowledge This survey identifies what interventions SLTs provide in clinical practice to rehabilitate tracheoesophageal voice; and it explores the barriers and facilitators that influence the provision of tracheoesophageal voice therapy. What are the potential or actual clinical implications of this work? Specific training, clinical guidelines, increased research and audit are required to support clinical practice in laryngectomy rehabilitation. Service planning should address the under-resourcing of staff, expert practitioners and therapy allocated time.

Communication competence and disability secondary to laryngectomy and tracheoesophageal puncture voice restoration.

There is a large body of research showing the negative impact of a total laryngectomy on the resultant voice signal across multiple outcomes (e.g., speech intelligibility/acceptability, listener comprehension, voice quality). However, there is limited information on the effects of laryngectomy on broader communication acts, particularly in the area of pragmatics, commonly referred to as the social use of language. Considering that individuals with a laryngectomy (IWL) frequently report reduced quality of life as well as reduced communicative competency, expanding the current research to include pragmatics is warranted. To explore the pragmatic changes in communication experienced by tracheoesophageal speakers. The current study adapted an existing 17-item measure to assess verbal, non-verbal, paralinguistic and receptive communication competence via self-report. This adapted measure was then distributed to 65 tracheoesophageal speakers (52 males, 13 females, mean age = 63.4±8.5 years). Both negative and positive pragmatic changes to communication were reported by participants secondary to laryngectomy. This included changes in verbal (negative -37.5%, positive -15.15%); non-verbal (negative -9.54%, positive -35.45%; and paralinguistic acts (negative -29.55%, positive -34.09%). Changes to receptive communication were also noted (negative -14.78%, positive -43.19%). The overall results suggest that communication changes post-laryngectomy exist well beyond the paralinguistic areas (e.g., intelligibility, voice quality) and that males and females may approach or respond to changes in communication differently. Results are discussed specific to clinical intervention and the importance of including assessment of pragmatic function post-laryngectomy. What is already known on this subject While there is a large body of research on the changes to the speaker and listener following laryngectomy, there is minimal information on how the use of alaryngeal speech affects overall communication, specifically in the area of pragmatics or the social use of language. What this paper adds to existing knowledge This study used an adapted version of the widely used Pragmatic Protocol to delineate changes in pragmatic components of communication for tracheoesophageal speakers. What are the potential or actual clinical implications of this work? Clinically, this information can be used by healthcare professionals to educate and prepare IWL on potential changes in the underrecognized area of pragmatics.

An acoustic study of vowels produced by Cantonese alaryngeal speakers using clear speech

Alaryngeal speech is an alternative method of verbal communication following the removal of the larynx. Common alaryngeal speaking methods include esophageal (ES) speech, tracheoesophageal (TE) speech, and speech produced using an electrolarynx (EL). A recent study [Hui et al., in press, Folia Phoniatr Logop] demonstrated better intelligibility in Cantonese alaryngeal speakers while using clear speech (CS) compared to their everyday ‘habitual speech’ (HS). Yet the correlated change in the acoustics associated with CS is still not clear. The purpose of this study was to assess the acoustic characteristics of vowels produced by Cantonese alaryngeal speakers during HS and CS conditions. Thirty-one alaryngeal speakers (9 EL users, 10 ES speakers, and 12 TE speakers) produced sentences from the Cantonese Sentence Intelligibility Test in HS and CS. Acoustic analyses considered formants (measured by reassigned spectrogram), vowel space area (VSA) and vowel duration across alaryngeal speaking methods and styles. We also examined these acoustic differences in relation to duration of alaryngeal speech use and intelligibility. Results suggest that EL users had larger VSAs and larger increases in vowel duration while using CS compared to ES and TE speakers. Future research will examine the effects of refined CS protocols on improving acoustic and perceptual characteristics of Cantonese alaryngeal speech.

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.

Intelligibility of stop-plosive and fricative consonants produced by tracheoesophageal speakers in quiet and noise.

Despite functional levels of postlaryngectomy communication, individuals who undergo total laryngectomy and tracheoesophageal (TE) puncture voice restoration continue to experience significant communication difficulties in noisy environments. In order to identify and further characterize TE speakers' intelligibility in noise, the current auditory-perceptual study investigated stop-plosive and fricative intelligibility of TE speech in quiet and in the presence of multi-talker noise. Eighteen listeners evaluated monosyllabic consonant-vowel-consonant (CVC) words produced by 14 TE speakers using an open-response paradigm. The findings indicate that overall speaker intelligibility was significantly lower in noise. However, further examination of these data revealed a differential effect of noise on intelligibility according to manner and phoneme position. While overall error patterns remained consistent across conditions, the voicing distinction was affected differentially by manner class and articulatory position. The present investigation provides valuable insights into the influence of non-normal and degraded voice signals and differential perceptual patterns when comparing TE speech intelligibility in quiet and noise.

Speech Intelligibility and Communication-related Quality of Life in Tracheoesophageal Speakers

Speech Intelligibility and Communication-related Quality of Life in Tracheoesophageal Speakers

The Lombard effect associated with Chinese male alaryngeal speech

Objective: Alaryngeal speech shows marked reduction in vocal intensity, resulting in reduced intelligibility. Lombard effect, speaking with background noise has been found to boost speakers’ intensity. The study investigated oesophageal (ES), tracheoesophageal (TE) and electrolaryngeal (EL) speech production under quiet and noisy background conditions to determine if the Lombard effect is still present after laryngectomy.Method: Fifteen laryngeal and thirty-seven alaryngeal speakers who were native speakers of Cantonese were recruited and instructed to read aloud a Cantonese passage under two background conditions: quiet and 100 dB background noise conditions.Result: Significant increase in vocal intensity was found in all speaker types under the noise condition. In addition, perceived intelligibility ratings provided by naïve Cantonese listeners revealed that the overall intelligibility under noise was improved for TE and laryngeal speakers, but not for ES and EL speakers, when compared with quiet condition.Discussion and conclusion: Results confirmed that the Lombard effect is still present after total laryngectomy. However, intelligibility may not always be improved with increased vocal loudness. Improved intelligibility was only observed for TE and laryngeal speakers, but not ES and EL speakers. Clinical implications for the use of the Lombard effect in post-laryngectomy speech rehabilitation are discussed.

Articulatory Contact Pressure during Bilabial Plosive Production in Esophageal and Tracheoesophageal Speech

Objectives: The present study investigated the articulatory contact pressure during the production of bilabial plosives by esophageal (ES), tracheoesophageal (TE), and laryngeal speakers. Methods: The peak contact pressure (PCP) during bilabial plosive production of /CVCVCVCVCV/ syllable strings of /p/ and /p^h/ was obtained from 10 ES, 10 TE, and 10 laryngeal speakers of Cantonese. PCP values were obtained by using a pressure transduction system (Iowa Oral Performance Instrument) during speech production. Results: The results showed that ES speakers exhibited a significantly greater PCP value than TE and laryngeal speakers, as revealed by cheek muscle compression force. In addition, the unaspirated bilabial plosive /p/ was associated with a greater PCP than its aspirated counterpart /p^h/. Conclusion: The current findings might support the hypothesis of over-exaggerated speech for better intelligibility among alaryngeal speakers. In addition, the increased oral muscular effort could be associated with a compensatory strategy for maintaining a high intraoral pressure or the unique air intake by ES speakers.

Esophageal Dysmotility in Patients following Total Laryngectomy.

Objectives Dysphagia is common in total laryngectomees, with some symptoms suggesting esophageal dysmotility. Tracheoesophageal (TE) phonation requires effective esophagopharyngeal air passage. Hence, esophageal dysmotility may affect deglutition or TE phonation. This study aimed to determine (1) the characteristics of esophageal dysmotility in laryngectomees, (2) whether clinical history is sensitive in detecting esophageal dysmotility, and (3) the relationship between esophageal dysmotility and TE prosthesis dysfunction. Study Design Multidisciplinary cross-sectional study. Setting Tertiary academic hospital. Subjects and Methods For 31 participants undergone total laryngectomy 1 to 12 years prior, clinical histories were taken by a gastroenterologist and a speech pathologist experienced in managing dysphagia. Esophageal high-resolution manometry was performed and analyzed using Chicago Classification v3.0. Results Interpretable manometric studies were obtained in 23 (1 normal manometry). Esophageal dysmotility patterns included achalasia, esophagogastric junction outflow obstruction, diffuse esophageal spasm, and other major (30%) and minor (50%) peristaltic disorders. The sensitivity of predicting any esophageal dysmotility was 28%, but it is noteworthy that patients with achalasia and diffuse esophageal spasm (DES) were predicted. Two of 4 participants with TE puncture leakage had poor esophageal clearance. Of 20 TE speakers, 12 had voice problems, no correlation between poor voice, and any dysmotility pattern. Conclusions Peristaltic and lower esophageal sphincter dysfunction are common in laryngectomees. Clinical history, while not predictive of minor motor abnormalities, predicted correctly cases with treatable spastic motor disorders. Dysmotility was not associated with poor phonation, although TE puncture leakage might be linked to poor esophageal clearance. Esophageal dysmotility should be considered in the laryngectomees with persisting dysphagia or leaking TE puncture.

Evaluation of Direct and Indirect Methods of Sub-Neoglottic Pressure Measurement in Tracheoesophageal Speakers: A Systematic Review and Meta-Analysis

Objective: Tracheoesophageal (TE) prosthetic voice is one of the voice restoration options for individuals who have undergone a total laryngectomy. Aerodynamic analysis of the TE voice provides insight into the physiological changes that occur at the level of the neoglottis with voice prosthesis in situ. The present study is a systematic review and meta-analysis of sub-neoglottic pressure (SNP) measurement in TE speakers by direct and indirect methods. Patients and Methods: The screening of abstracts and titles was carried out for inclusion of articles using 10 electronic databases spanning the period from 1979 to 2016. Ten articles which met the inclusion criteria were considered for meta-analysis with a pooled age range of 40–83 years. Results: The pooled mean SNP obtained from the direct measurement method was 53.80 cm H₂O with a 95% confidence interval of 21.14–86.46 cm H₂O, while for the indirect measurement method, the mean SNP was 23.55 cm H₂O with a 95% confidence interval of 19.23–27.87 cm H₂O. Conclusion: Based on the literature review, the various procedures followed for direct and indirect measurements of SNP contributed to a range of differences in outcome measures. The meta-analysis revealed that the “interpolation method” for indirect estimation of SNP was the most acceptable and valid method in TE speakers.

Whispering by Individuals Using Tracheoesophageal Speech

This study compared whispering attempts by adults using tracheoesophageal (TE) speech with those by adults with a larynx. Comparisons were based on listener judgments, visual-perceptual assessment of spectrograms, and measures of the acoustic signal. This was a prospective, cross-sectional study. Seventeen TE and 10 laryngeal speakers produced sentences in a whisper and in their spoken voice. Listeners judged sentences as whispered or spoken. Judges signal-typed the spectrograms based on presence-absence of a "voicing bar." Speaking rate, articulation rate, percent pause, and dB sound pressure level were measured. Twenty-nine percent of TE speakers were perceived to be whispering on whisper attempts; most others were perceived to be using spoken voice while attempting to whisper. Spectrograms of TE whispering were most often categorized as "mostly voiced." Speaking and articulation rates were slower for TE speakers. There was a significantly greater reduction in speaking rate from spoken to whisper for the TE group. Percent pause did not differ significantly between groups and speaking mode. TE speakers had a significantly smaller difference in dB sound pressure level between spoken and whisper modes. Some individuals using TE speech can whisper based on auditory-perceptual judgment, but most were perceived to be speaking during these attempts. The fact that some TE participants could whisper indicates the behavior is possible and might be considered a therapeutic target if it is of importance to an individual. The percentage of TE speakers who can learn to whisper, and the optimal training approach, are yet to be determined.

An optimized lumped model for tracheoesophageal speakers

Since the advent of the first lumped model of the phonatory system by Flanagan and Landgraf (1968), many improvements have been made in order to capture more realistic features of the human phonation in glottal speakers. Although lumped models are quite limited when it comes to representing realistic structural and fluid dynamic aspects, they are very important to understand fundamental features of human phonation. Nevertheless, only a few lumped models have been proposed in order to investigate the dynamics of the pharyngoesophageal segment in tracheoesophageal speakers. This work presents some improvements on a lumped model of the pharyngoesophageal segment, firstly proposed by Schwarz et al. (2011). The improvements have been achieved by conducting an optimization process that involves the glottal volume flow as the optimization function, using as reference the experimental data obtained from tracheoesophageal speakers. The results suggest that the lumped model of the esophageal region can be extended to capture important features, such as the pressure threshold for the onset of self-sustained oscillation.

Measuring the “glottal waveform” in laringectomized patients

There are several noninvasive and well-devised techniques for measuring the glottal waveform of human subjects, most of which rely on source-filter separation by digital inverse filtering. A more direct and simple approach relies on the use of the Sondhi tube technique to record the subjects’ voice, from which the glottal waveform is extracted, assuming that the effect of the vocal tract is negligible on the recorded sound. Although these techniques can capture the characteristics of the source waveform from normal speakers with reasonable accuracy, they have limitations when used to capture the source waveform of tracheoesophageal and esophageal speakers. This is due to the fact that these types of speech are highly aperiodic, which may compromise the accuracy of inverse filtering techniques. Moreover, the acoustic coupling between the vocal tract and the source in tracheoesophageal and esophageal speech is not well understood yet, and the assumptions implied by the Sondhi tube techniques cannot be taken. This work proposes a new experimental technique to capture the source waveform of tracheoesophageal and esophageal speakers based on the layer-peeling technique using a open-closed tube with two microphones and a sound source. Results for the source waveform of both normal and tracheoesophageal speakers are captured with the new technique and compared with traditional methods based on both inverse filtering and the Sondhi tube.

The Pharyngoesophageal Segment After Total Laryngectomy.

The aim of the present study was to characterize the pharyngoesophageal segment in laryngectomees who rated themselves as functional tracheoesophageal speakers. Voice perceptual assessment, high-resolution videomanometry of swallowing and phonation, and high-speed camera recording during phonation provided information about the anatomy and function of the pharyngoesophageal segment. Fourteen patients were included in the study. The voice assessments presented high intra/inter-listener reliability. We found a significant correlation between roughness and poor voice quality, hyperfunction and poor intelligibility, and poor voice quality, long time since the operation, and old age. High-resolution videomanometry during phonation revealed decreasing mean pressures from the distal esophagus to the pharynx and confirmed low resting pressures at the pharyngoesophageal segment and low esophageal peristaltic contraction pressures after laryngectomy in comparison to normal subjects. The neoglottis shape was mainly circular and presented a strong mucosal wave in most of the patients on the high-speed camera recording. Perceptual voice assessment and high-speed camera recordings provided baseline information about voice characteristics and vibration regularity of the neoglottis. Additionally, the quantitative measures obtained with high-resolution videomanometry may have clinical applicability as reference data in voice rehabilitation after total laryngectomy.