Tracheoesophageal Speakers Research Articles

Electrophysiological activity of the pharyngoesophageal transition of total laryngectomees

To determine the association of the electrophysiological activity of the pharyngoesophageal transition with tracheoesophageal speech proficiency in total laryngectomees. An observational (nonexperimental) study of the correlation type with a descriptive approach. Thirty-four individuals (26 males), average age 62.5 years, total laryngectomees rehabilitated with the use of a tracheoesophageal prosthesis, were assessed for tracheoesophageal speech proficiency using an adapted protocol and classified as good, moderate, or poor speakers. Next they were submitted to electromyography of the muscles of the pharyngoesophageal transition with a needle electrode. The area to be examined was located by videofluoroscopy. Electromyographic analysis was characterized as normal, neurogenic injury (moderate to severe, severe, severe to total), myopathic injury, or inconclusive. The Fisher exact test was used to determine the association between the speech proficiency variables and electromyography. in the final rating of tracheoesophageal speech proficiency, most laryngectomees were categorized as moderate (n = 24) and a few as good (n = 3). Electromyography revealed neurogenic injury in all laryngectomees, which was severe in most cases (n = 20), followed by severe to total (n = 10), and moderate to severe injury (n = 4). There was no significant association between he electromyographic analyses of neurogenic injuries and tracheoesophageal speech proficiency. Whether or not the musculature of the pharyngoesophageal transition of tracheoesophageal speakers had a preserved motor unit, did not prevent voice acquisition and was not associated with tracheoesophageal speech proficiency. However, further studies are needed in this area. 4. Laryngoscope, 127:1369-1375, 2017.

The Effect of Noise on Relationships Between Speech Intelligibility and Self-Reported Communication Measures in Tracheoesophageal Speakers.

The purpose of this study was to examine how sentence intelligibility relates to self-reported communication in tracheoesophageal speakers when speech intelligibility is measured in quiet and noise. Twenty-four tracheoesophageal speakers who were at least 1 year postlaryngectomy provided audio recordings of 5 sentences from the Sentence Intelligibility Test. Speakers also completed self-reported measures of communication-the Voice Handicap Index-10 and the Communicative Participation Item Bank short form. Speech recordings were presented to 2 groups of inexperienced listeners who heard sentences in quiet or noise. Listeners transcribed the sentences to yield speech intelligibility scores. Very weak relationships were found between intelligibility in quiet and measures of voice handicap and communicative participation. Slightly stronger, but still weak and nonsignificant, relationships were observed between measures of intelligibility in noise and both self-reported measures. However, 12 speakers who were more than 65% intelligible in noise showed strong and statistically significant relationships with both self-reported measures (R2 = .76-.79). Speech intelligibility in quiet is a weak predictor of self-reported communication measures in tracheoesophageal speakers. Speech intelligibility in noise may be a better metric of self-reported communicative function for speakers who demonstrate higher speech intelligibility in noise.

Analysis of Polish Vowels of Tracheoesophageal Speakers

The aim of this study was to determine the acoustical differences between normal and tracheoesophageal Polish speakers during Polish vowel production. Formant frequencies, namely, the first (F1) and second (F2) formant frequencies for 6 Polish vowels produced by 11 normal and 11 tracheoesophageal speakers, were analyzed using statistical analysis of variance and discriminant analysis. Spectral analysis showed that the F1 and F2 values of Polish vowels produced by tracheoesophageal speakers were significantly higher than those produced by normal speakers, with the exception of the F2 value of /i/ produced by tracheoesophageal speakers. Analysis of variance showed significant differences between speeches based on the F1 and F2 formant frequencies. Discriminant analysis based on the formant frequencies for F1 and F2 exhibited 73.33% of the mean classification score for tracheoesophageal speakers and 96.36% for normal speakers. Tracheoesophageal speakers exhibit higher F1 and F2 formant frequencies, with the exception of the F2 value for the vowel /i/ than normal speakers. Discriminant analysis showed that the classification process for TE speech exhibits lower accuracy due to the poorer classification of the vowels /i/, /u/, and /y/.

The Pharyngoesophageal Segment in Laryngectomees with Non-Functional Voice: Is It All about Spasm?

Objective: The aim of the present study was to characterize the pharyngoesophageal segment in non functional tracheoesophageal speakers and to confirm that the patients responded to treatment with decreased pressures, better voice and increased neoglottis vibration. Methods: Voice perceptual assessment, high-resolution videomanometry of swallowing and phonation and high-speed camera recording during phonation provided information about anatomy and function of the pharyngoesophageal segment before and 1 month after treatment with balloon dilatation and/or botulinum toxin. Results: High resolution videomanometry revealed 12 patients with phonation pressure higher than 20 mm Hg before treatment: 2 patients with pressure between 20-45 mm Hg, 5 patients with pressure between 45-66 mmHg and 5 patients with pressure higher than 66 mm Hg. Eight of twelve patients reported clinical improvement after treatment. Their phonation index (defined as the ratio between phonation pressure at pharyngoesophageal segment and distal oesophagus), phonation pressure and residual pressure at the pharyngoesophageal segment decreased after treatment. There was no significant difference between voice variables values before and after treatment. High-speed camera recordings revealed a wide variation in the anatomical and functional characteristics of the neoglottis. Conclusions: Normal pressure of the PES during phonation is an important factor for successful sound emission in TE speakers. Others aspects as fibrosis at pharyngoesophageal segment and oesophageal peristalsis should be considered.

The relationship between communicative participation and postlaryngectomy speech outcomes.

The purpose of this study was to examine relationships between communicative participation and postlaryngectomy speech outcomes, including listener-rated speech intelligibility and acceptability, and patient-rated speech acceptability and voice handicap. Thirty-six laryngectomized individuals completed the Communicative Participation Item Bank (CPIB) short form and the Voice Handicap Index-10 (VHI-10). They provided recordings from the Sentence Intelligibility Test (SIT) and a reading passage, and rated their own speech acceptability. Forty-eight inexperienced listeners transcribed the SIT sentences to derive intelligibility scores. Eighteen additional listeners judged the speech acceptability using the rating scales. Listeners judged tracheoesophageal speakers as significantly more intelligible and acceptable than electrolaryngeal speakers (p < .05). Speech acceptability was significantly more acceptable to speakers than listeners (p < .05). Weak, nonsignificant relationships were found between communicative participation and listener-rated outcomes. Stronger, significant relationships were found between communicative participation and self-rated speech acceptability and voice handicap (p < .05). Patient-reported communication outcomes are complementary to listener-rated outcomes. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1955-E1961, 2016.

Computing scores of voice quality and speech intelligibility in tracheoesophageal speech for speech stimuli of varying lengths

In this paper, automatic assessment models are developed for two perceptual variables: speech intelligibility and voice quality. The models are developed and tested on a corpus of Dutch tracheoesophageal (TE) speakers. In this corpus, each speaker read a text passage of approximately 300 syllables and two speech therapists provided consensus scores for the two perceptual variables. Model accuracy and stability are investigated as a function of the amount of speech that is made available for speaker assessment (clinical setting). Five sets of automatically generated acoustic-phonetic speaker features are employed as model inputs. In Part I, models taking complete feature sets as inputs are compared to models taking only the features which are expected to have sufficient support in the speech available for assessment. In Part II, the impact of phonetic content and stimulus length on the computer-generated scores is investigated. Our general finding is that a text encompassing circa 100 syllables is long enough to achieve close to asymptotic accuracy.

Voice quality and surgical detail in post-laryngectomy tracheoesophageal speakers

The objective of this study is to assess surgical parameters correlating with voice quality after total laryngectomy (TL) by relating voice and speech outcomes of TL speakers to surgical details. Seventy-six tracheoesophageal patients' voice recordings of running speech and sustained vowel were assessed in terms of voice characteristics. Measurements were related to data retrieved from surgical reports and patient records. In standard TL (sTL), harmonics-to-noise ratio was more favorable after primary TL+postoperative RT than after salvage TL. Pause/breathing time increased when RT preceded TL, after extensive base of tongue resection, and after neck dissections. Fundamental frequency (f0) measures were better after neurectomy. Females showed higher minimum f0 and higher second formants. While voice quality differed widely after sTL, gastric pull-ups and non-circumferential pharyngeal reconstructions using (myo-)cutaneous flaps scored worst in voice and speech measures and the two tubed free flaps best. Formant/resonance measures in/a/indicated differences in pharyngeal lumen properties and cranio-caudal place of the neoglottic bar between pharyngeal reconstructions, and indicate that narrower pharynges and/or more superiorly located neoglottic bars bring with them favorable voice quality. Ranges in functional outcome after TL in the present data, and the effects of treatment and surgical variables such as radiotherapy, neurectomy, neck dissection, and differences between partial or circumferential reconstructions on different aspects of voice and speech underline the importance of these variables for voice quality. Using running speech, next to sustained/a/, renders more reliable results. More balanced data, and better detail in surgical reporting will improve our knowledge on voice quality after TL.

The Relationship Between Acoustic Signal Typing and Perceptual Evaluation of Tracheoesophageal Voice Quality for Sustained Vowels

To investigate the relationship between acoustic signal typing and perceptual evaluation of sustained vowels produced by tracheoesophageal (TE) speakers and the use of signal typing in the clinical setting. Two evaluators independently categorized 1.75-second segments of narrow-band spectrograms according to acoustic signal typing and independently evaluated the recording of the same segments on a visual analog scale according to overall perceptual acoustic voice quality. The relationship between acoustic signal typing and overall voice quality (as a continuous scale and as a four-point ordinal scale) was investigated and the proportion of inter-rater agreement as well as the reliability between the two measures is reported. The agreement between signal type (I-IV) and ordinal voice quality (four-point scale) was low but significant, and there was a significant linear relationship between the variables. Signal type correctly predicted less than half of the voice quality data. There was a significant main effect of signal type on continuous voice quality scores with significant differences in median quality scores between signal types I-IV, I-III, and I-II. Signal typing can be used as an adjunct to perceptual and acoustic evaluation of the same stimuli for TE speech as part of a multidimensional evaluation protocol. Signal typing in its current form provides limited predictive information on voice quality, and there is significant overlap between signal types II and III and perceptual categories. Future work should consider whether the current four signal types could be refined.

Tracheoesophageal speech: A dedicated objective acoustic assessment

After total laryngectomy, the placement of a tracheoesophageal (TE) prosthesis offers the possibility to recover a new voice. However, the quality of the resulting TE speech is known to be degraded. To assess a patient's voice, current approaches rely either on quality-of-life questionnaires or on a perceptual evaluation carried out by speech therapists. These two methods exhibit the disadvantage of being both subjective and time-consuming. In this paper, we propose a dedicated scale, called A4S, for the objective Automatic Acoustic Assessment of Alaryngeal Speech. For this purpose, we first identify the artefacts existing in TE speech. These are linked to the periodicity, regularity, high-frequency noise and gargling noise/creakiness of the signal, as well as to the speaking rate. Specific acoustic features are proposed for the characterization of each artefact. A statistical study shows that TE speakers have a significantly worse voice compared to the control group, except for the speaking rate. Based on these advances, the A4S scale is proposed. This scale is made of five normalized dimensions, related to the five identified artefacts. A given patient's phonation can then be represented by a pentagon in a radar chart, which allows a fast and intuitive visualization of the strengths and flaws of the voice. A4S can then be seen as a useful tool for speech therapists to design tailored exercises specific to the patient's voice. In addition, we show the applicability of A4S for the follow-up of patients, as well as to study the impact of the type of surgery (open neck, robot and flap reconstruction) used for total laryngectomy and of a pre-surgical radiotherapy on various aspects of the TE 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.

A new proposal for evaluation of the pharyngoesophageal segment and its relation with the narrow-band spectrogram in tracheoesophageal speakers

The primary purpose of this study was to assess the relationship between pharyngoesophageal segment (PES) configuration and narrow-band spectrogram of tracheoesophageal voices. This study included 30 total laryngectomees tracheoesophageal speakers. Patients were assessed by videofluoroscopy (VF), during deglutition and voicing, and the vowel /a/ was recorded for spectrographic analysis. The evaluation of VF recording consisted of visual perceptual rating of degree of contact between the prominence of PES and its anterior wall, defined as absent/mild (hypo contact), moderate (normo contact) and intense (hyper contact); and quantitative measures of PES: anteroposterior distance (APD) and length of the PES (lenPES); PES surface area in swallowing (areaSw), and phonation (areaPh), and the area of the air reservoir (areaAir). Visual inspection of a narrow-band spectrogram was made and four different acoustic signal typing were defined as Type I, II, III or IV. Type I-II is correlated with moderate contact; Type III, with intense and Type IV, with absent/mild contact. Type I-II has bigger APD and PES with lower length than Type IV. There is a correlation between bigger APD and shorter PES. The group with I-II signal typing has PES with normo contact; Type III with hyper contact and Type IV has PES with hypo contact. The best tracheoesophageal voices are achieved by PES with moderate contact of the prominence and with shorter and larger anteroposterior PES distances. What differentiates the PES with hyper contact from PES with normal one is only the degree of contact between the prominence of the PES and its anterior wall.

Boerhaave’s syndrome in a tracheoesophageal speaker: report of a case

Boerhaave's syndrome is still associated with a high mortality rate and remains a therapeutic challenge. Pharyngo-laryngo-esophagectomy is performed as the standard treatment for advanced hypopharyngeal cancer and tracheoesophageal speech is an option for esophageal speech rehabilitation. We report what, to our knowledge, is the first case of Boerhaave's syndrome developing in a tracheoesophageal speaker.

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.

Pitch Control in Esophageal and Tracheoesophageal Speech of Cantonese

Objective: Previous studies of English-speaking esophageal (SE) and tracheoesophageal (TE) speakers revealed a significantly lower voice fundamental frequency (F0) than normal laryngeal (NL) speakers. Studies of SE and TE speakers of a tone language, however, indicated discrepant findings. Tonal SE and TE speakers could produce comparable or even higher F0 than NL speakers. The present study examined the F0 characteristics associated with speech and nonspeech tasks produced by Cantonese SE and TE speakers. Subjects and Methods: Speech produced by 15 superior SE, 15 superior TE and 15 NL speakers was recorded while each was reading a short passage and performing a pitch scaling task. F0 values were calculated from the speech samples. Results: SE speakers had higher average F0 in reading tasks than TE and NL speakers, while the NL speakers exhibited the highest average F0 values followed by SE and TE speakers during pitch scaling. In addition, pitch scaling (nonspeech) tasks were associated with higher average F0 than passage reading tasks regardless of speaker type. Conclusion: The findings point to the fact that, despite the use of the new sound source, SE and TE speakers were still able to change F0 for specific speech tasks.

Listener effort for highly intelligible tracheoesophageal speech

The purpose of this study was to determine whether: (a) inexperienced listeners can reliably judge listener effort and (b) whether listener effort provides unique information beyond speech intelligibility or acceptability in tracheoesophageal speech. Twenty inexperienced listeners made judgments of speech acceptability and amount of effort required to listen to 14 male tracheoesophageal speakers using a paired comparison paradigm. Intelligibility was controlled to limit the analysis to the relationship between ratings of listener effort and speech acceptability. Results showed that as a group, inexperienced listeners reliably rated both speech acceptability and listener effort. In addition, ratings of speech acceptability and listener effort were strongly correlated (r>.99); however, there was evidence that some individual listeners assigned different ratings for each dimension for the same speech samples. Results have important implications for communication success for tracheoesophageal speakers.Learning outcomes: Readers will be able to describe: (a) the measurement of listener burden in speech and (b) the differences and relationships among listener effort, speech acceptability and speech intelligibility.

Chest Wall Kinematics during Speech Breathing in Tracheoesophageal Speakers

The purpose of the present study was to determine how tracheoesophageal (TE) speakers manipulate the chest wall (rib cage and abdomen) to speak and how respiratory compromise (chronic obstructive pulmonary disease; COPD) and task variables influence those behaviors. The chest wall movements of 11 male TE speakers (5 with COPD and 6 without COPD) were measured during tidal breathing, spontaneous speech, and reading. Repeated-measures multivariate analyses were used to compare breathing behaviors across speech tasks and by respiratory health. Additional repeated-measures multivariate analyses and 1-way analyses of variance were conducted on temporal, aerodynamic, and linguistic measures. There was a significant main effect of task and a significant interaction effect of COPD and task on chest wall movements. Rib cage movements varied by task, whereas abdominal movements were as predicted. There was a significant difference in utterance length by task. There were no main effects of COPD on the chest wall and no significant group differences in utterance length, aerodynamic measures, or intelligibility. The TE speakers were generally accurate in inspiring at appropriate linguistic boundaries. The results suggest that there is robust control for speech breathing following laryngectomy, but that there is also increased effort within the chest wall. Implications for future research considerations are discussed.

Lung Volumes Used during Speech Breathing in Tracheoesophageal Speakers

The purpose of this study was to determine how tracheoesophageal (TE) speakers manipulate lung volumes to meet speech demands and how respiratory compromise (chronic obstructive pulmonary disease [COPD]) and task variables influence these behaviors. The lung volumes of 9 male TE speakers (4 with COPD, 5 without) during tidal breathing, spontaneous speech, and reading were investigated. Repeated-measures multivariate analyses of variance were used to compare lung volumes and utterance length across speech tasks and by respiratory health. A one-way analysis of variance was used to compare aerodynamic measures and intelligibility by COPD diagnosis. There was a significant main effect of task and a significant interaction effect of COPD and task on lung volumes at initiation and termination of speech. The TE speakers terminated speech exclusively below the resting expiratory level (REL) in both speech tasks because of elevated RELs, which are often present after laryngectomy. There were no main effects of COPD on any lung volume measures and no significant group differences in utterance length, aerodynamic measures, or intelligibility. Intelligibility and aerodynamic measures were not influenced by lung volumes and were comparable to findings of previous research. Speaking past the REL might be a compensation to optimize expiratory control for speech in a compromised system and a marker for the increased effort often anecdotally described by TE speakers.

Aerodynamic characteristics associated with oesophageal and tracheoesophageal speech of Cantonese

The present study investigated the aerodynamic differences between standard oesophageal (SE) and tracheoesophageal (TE) speech. Airflow and air pressure values below the pharyngoesophageal segment were obtained from 10 SE and 12 TE superior speakers of Cantonese. Airflow data were directly measured from sustained vowels, and sub-pharyngoesophageal segment pressure was estimated from /iphiphi/ syllables produced by the alaryngeal speakers. Results indicated that SE speech was associated with a lower rate of airflow and a higher pressure below the pharyngoesophageal segment than TE speech. SE and TE speakers exhibited an average airflow and sub-pharyngoesophageal segment pressure values of 70.50 mL/s and 134.15 mL/s, and 25.13 cm H2O and 22.61 cm H2O, respectively. Using the airflow and sub-pharyngoesophageal segment pressure, neoglottal resistance values were derived. The estimated neoglottal resistance was greater in SE speakers than in TE speakers. It is speculated that such difference in neoglottal resistance may be related to the use of different air reservoir mechanisms between SE and TE speakers. Such information will help speech-language pathologists design better speech therapy regimes for SE and TE speakers by understanding more about the difference between SE and TE phonation.

Objective eye-gaze behaviour during face-to-face communication with proficient alaryngeal speakers: a preliminary study

There is a large body of research demonstrating the impact of visual information on speaker intelligibility in both normal and disordered speaker populations. However, there is minimal information on which specific visual features listeners find salient during conversational discourse. To investigate listeners' eye-gaze behaviour during face-to-face conversation with normal, laryngeal and proficient alaryngeal speakers. Sixty participants individually participated in a 10-min conversation with one of four speakers (typical laryngeal, tracheoesophageal, oesophageal, electrolaryngeal; 15 participants randomly assigned to one mode of speech). All speakers were > 85% intelligible and were judged to be 'proficient' by two certified speech-language pathologists. Participants were fitted with a head-mounted eye-gaze tracking device (Mobile Eye, ASL) that calculated the region of interest and mean duration of eye-gaze. Self-reported gaze behaviour was also obtained following the conversation using a 10 cm visual analogue scale. While listening, participants viewed the lower facial region of the oesophageal speaker more than the normal or tracheoesophageal speaker. Results of non-hierarchical cluster analyses showed that while listening, the pattern of eye-gaze was predominantly directed at the lower face of the oesophageal and electrolaryngeal speaker and more evenly dispersed among the background, lower face, and eyes of the normal and tracheoesophageal speakers. Finally, results show a low correlation between self-reported eye-gaze behaviour and objective regions of interest data. Overall, results suggest similar eye-gaze behaviour when healthy controls converse with normal and tracheoesophageal speakers and that participants had significantly different eye-gaze patterns when conversing with an oesophageal speaker. Results are discussed in terms of existing eye-gaze data and its potential implications on auditory-visual speech perception.

Speech and Voice after Laryngectomy: Perceptual and Acoustical Analyses of Tracheoesophageal Speech Related to Voice Handicap Index

Objective: To perform perceptual and acoustical analyses of tracheoesophageal (TE) speech and relate these analyses to self-reported voice handicap. Methods: Recordings of 35 TE speakers were perceptually assessed by 5 speech-language pathologists. Acoustical analyses were made of voice aspects and temporal speech aspects. Self-assessments of voice were made with the Voice Handicap Index (VHI). Results: Perceptual assessment of TE speech showed significant correlations between overall degree of deviation and low speaking rate, deviant articulation, monotonous intonation, roughness and low pitch. The overall degree of deviation correlated significantly with acoustical measurements of speaking rate, articulation rate, and phrase length. Significant correlations were also found between assessed pitch and measured fundamental frequency, between assessed speaking rate and measured number of words per minute, and between assessed phrase length and measured number of syllables per breath. Self-assessments of VHI were significantly correlated with voice intensity and temporal speech aspects such as total reading time, phrase length, and percent pause time. No significant correlations were found between perceptual assessment and VHI degree. Conclusion: The listeners’ ratings of overall degree of deviation in TE speech showed relations to both voice quality and temporal aspects in speech. The TE speakers’ voice handicap degree were mainly related to changes in temporal aspects of speech.