Understandability Of Speech Research Articles

Effects of suspension pharyngeal flap on speech in Filipino individuals with velopharyngeal insufficiency.

This study investigated the effects of suspension pharyngeal flap surgery for velopharyngeal insufficiency (VPI) due to cleft palate. Ten Filipino individuals (mean age = 20.63 years, range = 8.4 to 34.9 years) with a cleft palate who underwent suspension pharyngeal flap surgery for VPI were included in this study. Perceptual and instrumental speech assessments were conducted at two different time points: before surgery (data point 1) and after surgery (data point 2, range = 4 to 26 weeks post-operatively). Speech intelligibility in different contexts and satisfaction with speech were assessed by the participants themselves using a self-report questionnaire. Additionally, the risk for obstructive sleep apnea was assessed using the The Berlin Questionnaire. Velopharyngeal gap size significantly decreased after the surgery. Additionally, significant improvements in speech understandability and acceptability were observed following the suspension pharyngeal flap procedure. Besides, a significant reduction in hypernasality, nasal emission, and the occurrence of passive articulation errors was seen. No difference in the occurrence of active articulation errors was observed when comparing data pre- and post-surgery. The ten individuals reported to be significantly more intelligible in different contexts after surgery. Improved speech was observed in individuals who received the suspension pharyngeal flap procedure. This procedure also positively influences an individual's intelligibility in different contexts in daily life. In individuals with persisting active articulation errors, post-surgery speech therapy will still be necessary.

Do Adult Naïve Listeners Perceive Differences in Speech Before and After Therapy for Cleft Palate Speech Disorders? A Reliability Study of Perceptual Speech Ratings.

This study compared the interrater reliability of adult naïve listeners' perceptual assessments of different speech variables in children with a cleft palate with or without a cleft lip (CP ± L). In addition, the study investigated whether the listeners were able to perceive differences in these speech variables before and after speech therapy for cleft palate speech disorders. Thirty-four speech samples of 14 children with a CP ± L (14 samples collected immediately before 10 hr of speech intervention, 14 samples collected immediately after speech intervention, and six randomly selected samples that were duplicated to assess intrarater reliability) were perceptually assessed by 26 adult naïve listeners. The listening panel consisted of nine men and 17 women (age range: 18-51 years). The speech variables included speech understandability, speech acceptability, hypernasality, hyponasality, nasal airflow, and articulation, which were assessed on a visual analog scale. Furthermore, the need for speech therapy was assessed. Good to very good interrater reliability was observed for the naïve listeners' ratings of all speech variables. A significant time effect was found for the pre- and postevolution of the speech variables "speech understandability," "speech acceptability," "nasal airflow," and "articulation." This time effect indicates an improvement of these variables postintervention. According to the naïve listeners, children were less in need of additional speech therapy after the 10-hr intervention period compared to assessments before this intervention period. Adult naïve listeners perceptually identified an improvement in different speech variables after 10 hr of cleft palate speech therapy. These findings confirm previous assessments of expert speech-language pathologists and suggest that speech improvements after cleft palate speech therapy can also be perceived by communication partners outside the therapy room. Perceptual ratings of naïve listeners can, thus, be used to add life-situation significance to the assessments of experts. Future research could include both expert raters and caregivers or relatives of children with a CP ± L in listening panels, as previous knowledge on craniofacial anomalies may lead to different results.

Perceptual and Acoustical assessment of voice in children with cleft lip and palate

BACKGROUND: The speech of individuals with cleft lip and palate is primarily characterized by nasality of oral speech because of cleft and or velopharyngeal dysfunction. OBJECTIVES: The aim of the present study is to investigate the acoustical assessment and perceptual rating measurements in cleft lip and palate children. METHODS: The study participants included 30 children with cleft lip and palate in the age range of 4 to 12 years. Prior parental consent was obtained for the inclusion of their children in the study. Speech samples of all the l the participants were recorded. Prerecorded speech samples of the individuals of the CLP groups were mixed and randomized and played,using headphone conditions in a quiet room. The SLPs speech language pathologists rated the nasality of the participant. Samples given for perceptual evaluation are 15 phonation samples of /ă/, /ɪ/ and /ŭ/ vowels vowel, 15 conversation samples and 30 subjects (3 oral sentences each so total 90 sentences). RESULTS: For the Phonation sample, SLP must evaluate the presence of hypernasality by Wilcoksons nasality scale. Acoustic analysis was done using PRAAT software. The spectral and temporal parameters were measured. The Kappa coefficient was 0.88 for inter-rater reliability for nasality rating scale, 0.82 for speech intelligibility,1.02 for speech understandability,1.00 for speech acceptability, which suggests substantial agreement between the raters for four different rating scales. CONCLUSION: Thus, to conclude in children with cleft lip and palate both acoustical and perceptual evaluation plays an important role while assessing the speech domain by using different kinds of speech stimuli.

Neurotization of the radial forearm free flap improves swallowing outcomes in hemiglossectomy defects.

We examined the effect of free tissue neurotization on speech and swallowing outcomes for patients undergoing reconstruction of hemiglossectomy defects with a radial forearm free flap (RFFF). A retrospective study was performed in patients with oral cavity squamous cell carcinoma undergoing a hemiglossectomy and reconstruction with a RFFF. Functional outcomes including nutritional mode, range of liquids and solids, and speech understandability were analyzed 1-year post-treatment. Eighty-four patients were included in this analysis, 41 of whom had neurotized flaps (49%). No significant differences in demographic or clinical variables were seen between the neurotized and non-neurotized groups. On multivariate analysis controlling for BMI, flap area, and N-classification, patients with neurotized flaps were significantly more likely to have normal range of liquids and solids and less likely to have a G-tube. Neurotization of RFFF reconstructing hemiglossectomy defects results in decreased G-tube dependence and improved range of liquids and solids.

Better speech outcomes after very early palatal repair?—A longitudinal case-control study in Ugandan children with cleft palate

IntroductionChildren born with cleft palate with or without cleft lip (CP±L) tend to use less oral pressure consonants and more glottal sounds in their babbling. The purpose of very early palatal repair (i.e., one-stage palatal closure prior to 6 months of age) is to make the palate functional before the onset of speech acquisition to reduce the anchoring of wrong patterns in the child's developing phonological system. As a result, less compensatory articulation errors are expected to be present. Currently, no detailed longitudinal speech outcomes after very early palatal closure are available. This study aimed to provide longitudinal speech outcomes in Ugandan children with CP±L who received palatal closure prior to the age of 6 months. MethodsTen children with CP±L were assessed at a mean age of 5 and 10 years old. Speech understandability, speech acceptability, resonance, nasal airflow and articulation were perceptually rated by two experienced speech-language pathologists. Velopharyngeal function was estimated using the velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary (speech) surgery was collected. The outcomes were compared with the longitudinal outcomes of an age- and gender-matched control group of 10 Ugandan children without CP±L. ResultsSpeech understandability and acceptability improved significantly over time in the group with CP±L (all p's ≤ 0.05, all Z's > −2.43). At both test dates, significantly worse judgments were found for the group with CP±L compared to the control group for these variables and variables related to passive speech errors (all p's ≤ 0.05, all Z's > 2.49). A statistically significant difference with the control group was found for the presence of compensatory articulation errors at the age of 5 years but not at the age of 10 years, indicating a catch up by the children with CP±L. ConclusionWhether a one-stage palatal closure prior to the age of 6 months is more favorable for speech outcomes compared to one-stage palatal closure at 12 months is still not clear. Speech of the children with CP±L improved over time, but significantly differed from the control group at the age of 5 and 10 years old. Limited access to health care facilities and possible influence of malnutrition on wound healing need to be considered when interpreting the results. Whether palatal closure prior to the age of 6 months is transferable to other countries is subject for further research, including both longitudinal and prospective designs with larger samples.

Longitudinal functional outcomes and late effects of radiation following treatment of nasopharyngeal carcinoma: secondary analysis of a prospective cohort study

BackgroundThe study objectives were: provide longitudinal data on upper aerodigestive tract function and late complications following IMRT for nasopharyngeal carcinoma, and elucidate factors that might predict a worse outcome. The hypotheses were: (1) Despite advances such as IMRT, radiation will cause significant functional decline and late complications that often progress or arise years after treatment. (2) Larger radiation volume will be associated with poorer outcomes.MethodsLongitudinal, observational cohort study of nasopharyngeal carcinoma patients with retrospective analysis of prospectively collected, population-based data. Late sequelae and validated measures of overall performance, speech, and swallowing were documented pre-treatment and 3,6,12, 24, 36 and ≥ 60-months post-treatment.ResultsForty-two patients treated curatively with radiation (N = 9) or chemoradiation (N = 33) were followed for a median 74 months. Functional outcomes showed an initial nadir at 3 months associated with acute effects of treatment, followed by initial recovery. There was subsequent functional decline years post-treatment with advancing dysphagia/aspiration, trismus, muscle spasm, and hypoglossal nerve palsy. Univariable regression analysis revealed that increasing high-dose radiation volumes (PTV 70 Gy) were associated with increased likelihood of less than solid diet (Performance Status Scale (PSS)—Normalcy of Diet score < 50; p = 0.04), and reduced PSS—Understandability of Speech (p = 0.005). The probability of poor outcome increased with time. Eleven percent of patients were tube feed dependent at ≥ 5 years.ConclusionsDespite improvements in radiation delivery, late effects of radiation remain common. Higher radiation volumes are associated with poorer outcomes that worsen over time.Graphical

Selected functional outcomes in advanced oral cancer: Comparison of surgery alone versus surgery with postoperative radiotherapy.

Study objectives were to determine whether the addition of postoperative radiation (PORT) resulted in a decline in oral function relative to surgery alone and to describe the longitudinal course of oral function following treatment of advanced oral cancer. This was a 36-month retrospectively analyzed observational cohort study of patients with stage III-IV oral cancer. Prospectively collected, oral functional outcomes were acquired pretreatment and 3, 6, 12, 24, and 36 months post-treatment. One hundred and eighteen patients were included. Forty-three patients treated with surgery alone were compared to 75 who received surgery with PORT. Mixed model analysis demonstrated the acute effect of PORT was associated with patient-rated xerostomia (p < 0.001) and the late or persistent effect was associated with decreased clinician-rated eating in public (p=0.008), understandability of speech (p=0.02), and normalcy of diet (p=0.005) compared with surgery alone. There were no differences between surgery alone and PORT groups in clinician-rated feeding tube dependence or patient-rated speech handicap. The use of PORT was associated with a demonstrable decline in oral function in four of six outcomes measures relative to surgery alone.

Dutch listeners’ responses to Dutch, British and American English accents in three contexts.

The aim of this study was to assess Dutch listeners’ responses to native-accented Englishes compared with Dutch-accented English in terms of speech understandability and speech evaluations in three professional communication contexts. In a matched-guise experiment Dutch listeners (N=392) responded to a Dutch English, a standard British and American accent in terms of speech understandability (intelligibility, comprehensibility, interpretability) and speaker evaluations (status, affect, dynamism). Dutch listeners evaluated these accents in three communication contexts: Lecture, Audio Tour, Job Pitch. Only context affected speech understandability: comprehensibility and interpretability were higher for the Lecture compared to the Audio Tour and the Job Pitch. Accent only negatively affected status evaluations for Dutch-accented English. Context only evoked more affect in the Audio Tour and the Lecture than in the Job Pitch. Our main conclusion is that Dutch-accented English negatively impacts status, but not understanding, affect and dynamism. Context impacts understanding and affect.

Speech and Swallowing Outcomes Following Surgical Resection with Immediate Free Tissue Transfer Reconstruction for Advanced Osteoradionecrosis of the Mandible Following Radiation Treatment for Head and Neck Cancer

Despite recent advances in the radiation techniques used for the treatment of head and neck cancer (HNC) including intensity-modulated radiotherapy (IMRT), mandibular osteoradionecrosis (ORN) remains a significant complication. Advanced stage ORN is managed surgically with resection and immediate free tissue transfer reconstruction. An evaluation of the functional speech and swallowing outcomes was undertaken for patients undergoing surgical management of advanced ORN. We retrospectively reviewed consecutive patients, at a single, tertiary cancer centre, who underwent surgical resection for advanced Notani grade III ORN. Outcomes investigated included use and duration of tracheostomy and swallowing and speech status using Performance Status Scale for Head and Neck Cancer Normalcy of Diet (PSS-NOD) and Understandability of Speech (PSS-Speech) at baseline and 3 months following surgery. Ten patients underwent surgical resection with free tissue transfer reconstruction between January 2014 and December 2019. Two patients required supplemental nutrition via a gastrostomy at three months post surgery. As per the PSS-NOD data half of the patients’ (n = 5) diet remained stable (n = 2) or improved (n = 3) and half of the participants experienced a decline in diet (n = 5). The majority of patients had no speech difficulties at baseline (n = 8). The majority of patients’ speech remained stable (n = 8) with two patients experiencing a deterioration in speech clarity following surgery. Well-designed studies with robust, sensitive multidimensional dysphagia and communication assessments are required to fully understand the impact of surgical management of advanced ORN using resection with free tissue transfer reconstruction.

Preliminary Functional Outcomes and Quality of Life after Tongue Reconstruction with the Vastus Lateralis Myofascial Free Flap.

The aim of the present study is to report our preliminary experience with the vastus lateralis myofascial free flap (VLMFF) for tongue reconstruction according to tongue and donor site functional outcomes. Twelve consecutive patients (F: 5; median age: 54.0 years, interquartile range or IQR 42.75-69.0) were included. The validated European Organization for Research and Treatment of Cancer of the Head and Neck 35 Quality of Life Questionnaire (EORTC QLQ-H&N35) and the performance status scale for head and neck cancer (PSS-HN) questionnaires were used to assess the health-related quality of life (HRQOL). The lower extremity functional scale (LEFS) was used to self-report the donor area function. All patients were successfully treated, and no VLMFF failure was detected during a median follow-up period of 10.5 months (IQR: 6.5-33.0). The HRQOL showed a median EORTC QLQ-H&N35 score of 56.0 (IQR: 50.0-72.5). The median PSS-HN score was 80.0 (IQR: 45.0-95.0), 75.0 (IQR: 62.5-100.0), 75.0 (IQR: 62.5-100.0) for "Normalcy of Diet," "Public Eating," and "Understandability of Speech," respectively. The self-reported function of the lower extremities (donor area) showed a median LEFS of 59.0 (IQR: 32.5-74.0). This study reports optimistic data regarding the functional and quality of life outcomes after tongue reconstruction using VLMFF. Prospective controlled studies are needed to demonstrate advantages and disadvantages when compared with other reconstructive techniques.

Furlow Palatoplasty: Should We Also Focus on the Size of the Nasopharynx?

(1) To determine the incidence rate of velopharyngeal dysfunction (VPD) according to 7 speech criteria post-Furlow palatoplasty. (2) To find an anatomical measurement of the cleft palate (or combination of measurements) associated with the occurrence of VPD. Retrospective cohort study. Fifty-six patients with cleft palate ± cleft lip underwent palatoplasty with the Furlow technique at the age of 10 months. Pre-and post-palatoplasty cleft palate measurements were collected during the procedure. Three blinded speech-language pathologists (SLPs) retrospectively scored the patients from the chart data at age 4. Student t test and receiver operating characteristic curve analysis were used to evaluate the association and predictive capacity between cleft measurements and parameters (M&P) with all VPD criteria. The SLPs found an incidence of VPD according to 7 criteria: hypernasality (11%), audible nasal emission (4%), nasal rustle (14%), compensatory errors (4%), impairment of speech understandability (7%), and impairment of speech acceptability (16%). The SLPs recommended a secondary surgical procedure in 5 patients (9%). A statistically significant association was found between, respectively, 17 and 5 M&P and the occurrence of compensatory errors and audible nasal emission. Our data suggest that the length of the cleft, the cleft area, and the postoperative transversal size of the nasopharynx are the best indicators of the future positivity of VPD criteria. The size of the postoperative transverse nasopharyngeal area during the primary cleft palate procedure may become the focus of the next generation of cleft surgeons to reduce the incidence of VPD.

Perceptual Speech Outcomes After Early Primary Palatal Repair in Ugandan Patients With Cleft Palate.

To provide speech outcomes of English-speaking Ugandan patients with a cleft palate with or without cleft lip (CP±L). Prospective case-control study. Referral hospital for patients with cleft lip and palate in Uganda. Twenty-four English-speaking Ugandan children with a CP±L (15 boys, 9 girls, mean 8.4 years) who received palatal closure prior to 6 months of age and an age- and gender-matched control group of Ugandan children without cleft palate. Comparison of speech outcomes of the patient and control group. Perceptual speech outcomes including articulation, resonance, speech understandability and acceptability, and velopharyngeal composite score (VPC-sum). Information regarding speech therapy, fistula rate, and secondary surgery. Normal speech understandability was observed in 42% of the patients, and 38% were judged with normal speech acceptability. Only 16% showed compensatory articulation. Acceptable resonance was found in 71%, and 75% of the patients were judged perceptually to present with competent velopharyngeal function based on the VPC-sum. Additional speech intervention was recommended in 25% of the patients. Statistically significant differences for all these variables were still observed with the control children (P < .05). Overall, acceptable speech outcomes were found after early primary palatal closure. Comparable or even better results were found in comparison with international benchmarks, especially regarding the presence of compensatory articulation. Whether this approach is transferable to Western countries is the subject for further research.

Comparison of Parkinsonian speech ratings by individuals with Parkinson disease, communication partners, and a trained rater

ABSTRACT A majority of individuals with Parkinson disease (PD) experience speech and voice changes as initial signs of the condition, sometimes months or years before the clinical diagnosis of PD. Accurate perception of these changes is, therefore, important for early referral and clinical decision making. Limited studies have examined the general perception abilities of individuals with PD for their speech and neurologically typical speech based on multiple speech dimensions. Therefore, the current study examined self- perception abilities of individuals with PD for their live speech (immediate perception) and recorded neurologically typical speech (playback perception) based on seven speech dimensions (including pitch, pitch variability, loudness, rate, pauses, understandability, and speaker’s physical effort). The current study included 20 participants with PD, 20 communication partners, and a single trained rater as listeners. Results indicated that participants with PD provided significantly higher self-loudness ratings when compared to the trained rater. In addition, participants with PD showed significant differences in ratings for loudness, rate, and understandability for the two neurologically typical speakers when compared to corresponding ratings by their communication partners. Finally, perceptual ratings for speakers’ physical effort had a significant relationship with ratings for speech rate and understandability, thereby suggesting its role in creating listener impressions for parkinsonian speech. Overall, the current study provided evidence for general speech perception deficits among individuals with PD based on live and recorded listening tasks. Further, the study provided evidence for aging and habituation- related factors among communication partners when listening to family members with PD.

Where does a 'foreign' accent matter? German, Spanish and Singaporean listeners' reactions to Dutch-accented English, and standard British and American English accents.

How well L2 English is understood and how L2 English speakers perceive one another within varying communication contexts has been studied relatively rarely, even though most speakers of English in the world are L2 speakers. In this matched-guise experiment (N = 1699) the effects of L1 and L2 English accents and communication context were tested on speech understandability (intelligibility, comprehensibility, interpretability) and speaker evaluations (status, affect, dynamism). German (N = 617), Spanish (N = 540), and Singaporean listeners (N = 542) were asked to evaluate three accents (Dutch-accented English, standard British English, standard American English) in three communication contexts (Lecture, Audio Tour, Job Pitch). The main finding is that the Dutch-accented English accent was understood as well as the two L1 English accents. Furthermore, Dutch-accented English evoked equally positive evaluations to the two L1 English accents in German listeners, and more positive evaluations than the two L1 English accents in Spanish and Singaporean listeners. These results suggest that accent training aimed at achieving an L1 English accent may not always be necessary for (Dutch) English language learners, especially when they are expected to mostly interact with other L2 speakers of English. More generally, our results indicate that L2 English speakers’ understanding and their evaluation of L1 and L2 Englishes would not seem to reflect traditional language norms. Instead, they seem to reflect the socio-cultural embedding of a language norm in a Lingua Franca English speech community that does not view accent varieties as a hindrance to successful communication.

Assessment of Functional Recovery and Subjective Donor-Site Morbidity Following Radial Forearm Flap Reconstruction in Small- to Moderate-Sized Palatal Defects.

Palatal defects are encountered following tumor extirpation, trauma, or congenitally. Among the known alternatives, radial artery free forearm flap (RAFF) is a versatile flap that confers good results in head and neck reconstruction, but donor-site morbidity has been an issue of discontent among the plastic surgeons. This limitation needs to be studied further and addressed considering the unmatched quality of this tissue. This study aims to weigh the impact of the functional edge of this flap against the unpopular donor-site morbidity on a group of patients. This is a retrospective analysis of recuperation of palatal function and patient concerns with the donor-site function and cosmesis on 7 consecutive patients with small-to-moderate palatal defects reconstructed with RAFF. Postoperative recovery of speech, palatal movement, and restoration of oromaxillary interface was assessed using objective tests, such as speech intelligibility testing and articulation studies. Simultaneously, subjective donor-site function and cosmesis were assessed using Patient Scar Assessment Scale (PSAS), Upper Extremity Functional Index (UEFI), and donor limb sensory testing. Mean PSAS score was 8.28/60, and UEFI score reported was 77/80, which reflect high patient satisfaction with the donor site. Nasoendoscopy shows remarkable restoration of palate anatomy. Intelligibility testing depicts near-normal speech understandability, whereas articulation studies revealed distortions post-palatal reconstruction with RAFF. Radial artery free forearm flap should be considered as the forerunner of reconstruction in palatal defects involving less than 50%.

RETRACTED ARTICLE: Preserving learnability and intelligibility at the point of care with assimilation of different speech recognition techniques

The neoteric introduction of 5G technology in mobile internet is transforming Internet of mobile Things (IoMT) massively by addressing low latency, support for a large number of IoMT devices, and less power consumption, thereby delivering cost-effective solutions to low-end devices. This transformational technology enables a ubiquitous connected critical communication network between the healthcare system and IoT, as they largely depend on low-end devices for gathering data at the point of care. Gathering and interpolation of data from things are moved over to the cloud, making the extraction of knowledge and decision-making capabilities more robust. Vocal signals form the basis of communication between human beings with the transfer of complex data with variations in thrust, pitch, and tones. The representation and recognition of these analog signals by digital systems prove to be quite exciting and challenging. The spoken language models are converted to digital signals to be identifiable based on different cues like phonetic, prosodic, phonotactic, and lexical features. Voice patterns tend to be specific for every individual with a slight orientation towards the language spoken by the individual of a particular region. While speech patterns tend to alter the meaning of words with tones, high and low pitches in the utterance of the words, NLP tends to learn specific associations of words through vectors. The focus on learned networks in solving the problem of speech synthesis to text with minimal loss and high predictability of syllable of word, sentence, and paraphrase is needed. The creation of a knowledge base corpus of learned variable prosody of features helps in the learnability of interestingness directly without any perturbations. The learning algorithms to realize the degree of understandability of speech with the word, sentence identified, and transcription with substantial noise interference. The transfer of the acoustic features learned by algorithms proves to be quiet challenging as they are distorted by sudden environmental changes. Syllable extracted from the speech translation may or may not represent the Sentiment of the word, with different phonetical modulation. Utilization of the MobileNets and DistillBERT to transfer the language extraction and the edge reducing the time of processing and reducing the corpus of the size, reducing the adversial learning of the voice features and the patterns, reducing the Transfer of learned corpus and patterns.

Outcomes following TORS for HPV-positive oropharyngeal carcinoma: PEGs, tracheostomies, and beyond.

To review swallowing, airway and speech outcomes following transoral robotic surgery (TORS) ± adjuvant therapy for human papillomavirus associated oropharyngeal squamous cell carcinoma (HPV[+]OPSCC). Patients underwent TORS ± standard adjuvant therapy from 5/1/2007-5/31/2015. Clinical data were recorded and descriptive analysis was performed. 267 patients met criteria. All patients underwent surgery at Mayo, however, only 41/81 and 71/119 patients received RT and CRT at a Mayo Clinic site. A PEG was placed in 77 patients (3 prior to any treatment, 74 reactively during adjuvant therapy), with 3 PEG dependent and 3 partially PEG reliant at last follow-up. Tracheostomy was performed in 30 (11%) patients; 28 were decannulated. Swallow evaluations were completed for 20/81 undergoing RT and 50/119 undergoing CRT at a median of 3.8 and 7.6 months post-treatment, respectively. An unrestricted oral diet was reported by 5% following RT and 12% following CRT on the Functional Oral Intake Scale. HN-PSS normalcy of diet scores indicated a diet beyond soft chewable foods for 27% following RT and 46% following CRT. No restriction of place, food, or companion was reported for the HN-PSS for public eating in 13% after RT and 33% after CRT. Aspiration of thin liquid was present in 17% and 28% following RT and CRT, respectively. HN-PSS understandability of speech was "always understandable" in 60% and 63%, following RT and CRT, respectively. Hoarseness was reported in 56% and 45% following RT and CRT respectively. Long-term PEG and tracheostomy dependence in this cohort is low. However, these outcomes under-represent the decrement in patient speech and swallowing following TORS ± standard adjuvant therapy for HPV(+)OPSCC.

Effect of speech segment samples selection in stutter block detection and remediation

Speech remediation by identifying those segments which take away from the substance of the speech content can be performed by identifying portions of speech which may be deleted without diminishing from the speech quality, but rather improving the speech. Speech remediation is important when the speech is disfluent as in the case of stuttered speech. We describe two stuttered speech remediation approaches based on the identification of those segments of speech which, when removed, would enhance speech understandability in terms of both, speech content and speech flow. We adopted two approaches, in the first approach we identify and extract speech segments that have weak semantic significance due to their low relative intensity; we subsequently trained several classifiers using a large set of inherent and derived features which provided a second layer filtering stage. The first approach was effective but required a two step process. In order to streamline the detection and remediation process, we introduced an enhancement which expands the realm of disfluency detection to include a broader range of speech anomalies by eliminating the need for a domain-dependent pre-qualification stage. The results of the new approach offer improved accuracy with enhanced simplicity, flexibility and extensibility.

The relationship between health-related quality of life and speech in patients with cleft palate

IntroductionIn health-care, current efforts focus on providing patient-centered care. Specifically for patients with velopharyngeal insufficiency, and by extent patients with cleft palate, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire (Skirko et al., 2012; 2013) allows the clinician to map the impact of speech and swallowing difficulties on the patient's health-related quality of life (HRQoL). The current study evaluated the hypothesized association between this speech-related HRQoL measure and perceptually and instrumentally assessed speech variables, to provide evidence for the construct validity of the Dutch version of the VELO questionnaire. Materials and methodsThirty participants, twenty-five patients with cleft palate and five controls, were enrolled. Perceptual speech assessment was conducted following the recently developed Belgian Dutch outcome tool for perceptual speech assessment in patients with cleft palate. In addition, nasalance values and the Nasality Severity Index (NSI) 2.0 were determined. The relationship between these speech outcomes and the scores on the VELO parent report was determined using Spearman rank-order correlation coefficients. ResultsModerate to strong correlations were found between the total score on the VELO parent report and five speech variables: the VPC-SUM score (rs = −0.476), speech understandability (rs = −0.657), passive CSC's (rs = −0.654), speech acceptability (rs = −0.591) and the need for C(L)P-related speech therapy (rs = −0.711). Furthermore, these variables were associated with at least one subscale of the VELO questionnaire. Discussion and conclusionCorrelations between speech outcomes and the Dutch version of the VELO questionnaire provide evidence for the construct validity of this version of the instrument. Furthermore, insights in these associations may lead the way to efficient therapy approaches, targeting speech features with the greatest impact on the patient's health-related quality of life.

Salvage laryngectomy and laryngopharyngectomy: Multicenter review of outcomes associated with a reconstructive approach.

Surgeons have developed various reconstructive techniques to minimize the rate of pharyngocutaneous fistula and optimize functional outcome after salvage laryngectomy or laryngopharyngectomy. Multicenter retrospective review at 33 institutions of 486 patients with a history of squamous cell carcinoma (SCC) of the larynx or hypopharynx previously treated with primary chemoradiotherapy (CRT) who required salvage surgery. Outcomes evaluated were overall fistula rate, fistula requiring reoperation, and 12-month speech and swallowing function. Primary closure of the hypopharynx was associated with a statistically higher overall fistula rate and fistula requiring reoperation compared to reconstruction with vascularized tissue augmentation. Vascularized tissue augmentation with muscle led to worse 12-month "understandability of speech" and "nutritional mode" scores compared to vascularized tissue augmentation without muscle. Vascularized tissue augmentation reduces the overall fistula rate and fistula requiring reoperation but vascularized tissue augmentation with muscle may impair speech and swallowing outcomes.