Automatic Quantification of Speech Intelligibility in Patients After Treatment for Oral Squamous Cell Carcinoma

Speech assessment following microsurgical soft palate repair

The aim of this study was to analyze speech intelligibility of children, who had undergone microsurgical soft palate repair according to Sommerlad. Cleft palate patients were treated by closure of the soft palate according to Sommerlad at about 6 months of age. At the age of 11, their speech was evaluated through automatic speech recognition. Word recognition rate (WR) was used as the outcome parameter of automatic speech recognition. To validate automatic speech results, an institute for speech therapy evaluated the speech samples for perceptual intelligibility. The results of this study group were compared to an age-matched control group. A total of 61 children were evaluated in this study, 29 in the study group and 32 in the control group. Study group patients had a lower word recognition rate (mean 43.03, SD 12.31) compared to the control group (mean 49.98, SD 12.54, p = 0.033). The magnitude of the difference was considered small (95% CI of the difference 0.6-13.3). The study group patients received significantly lower scores in the perceptual evaluation (mean 1.82, SD 0.58) compared to the control group mean (mean 1.51, SD 0.48, p = 0.028). Again, the magnitude of the difference was small (95% CI of the difference 0.03-0.57). Within the limitations of the study it seems that microsurgical soft palate repair according to Sommerlad at the age of 6 months might be a relevant alternative to other well established surgical techniques.

Hospital Based Quality of Life in Oral Cancer Surgery

The diagnosis of cancer and its treatment have an incomparable impact on a patient's life. In the early postoperative stages after the surgical treatment of oral squamous cell carcinoma (OSCC), functions and well-being are limited, which leads to a fundamental decline of the quality of life (QoL). To date, no studies have been performed that focus on the development of special aspects during the time of the in-patient stay of OSCC patients. With the results of this cross-sectional study, we are able to identify those patients who tend to require special support. This cross-sectional study determined the postoperative QoL with a questionnaire (QU) that was handed out twice to OSCC patients after surgery during their inpatient stay. The questions were based on the European Organisation for Research and Treatment of Cancer (EORTC)'s Quality of Life Questionnaire (QLQ)-C30 and QLQ-H&N35. In our study, we found that for postoperative OSCC patients, eating, swallowing and speech were influenced the most. After decannulation, tracheotomy showed no impact on functions. Social contact was impaired at both timepoints. Especially female patients consider themselves to be more impaired on the scale of social contact. QoL should be checked with a standardized QU as an established tool during hospitalization in every oncology department. Only this procedure can pinpoint those patients who have struggles with their surgical outcome and need more assistance.

Speech intelligibility in patients with oral cancer: An objective baseline evaluation of pretreatment function and impairment

BACKGROUND

This study seeks to identify those factors that influence the pre-therapeutic speech intelligibility in patients with oral squamous cell carcinoma (OSCC).

METHOD

A group of 172 patients (125 males, 47 females, mean age = 61 ± 11 a) with different OSCC stages ranging from T1 to T4 and N0 to N2 was examined for their speech intelligibility using a computerized measuring tool, and compared to a healthy reference group (30 males, 10 females, mean age = 59 ± 12 a).

RESULTS

It was found that the pre-therapeutic speech intelligibility in patients with OSCC is decreased when compared to a healthy collective. Two demographic factors that influence speech intelligibility could be identified: sex and age. It was determined that the only disease-related factor that influences speech intelligibility before therapy is the location of the tumor.

CONCLUSION

The results of this study reveal that a preoperative speech intelligibility impairment in patients suffering from OSCC occurs independent of tumor stage, size of the tumor and infiltration status.

Speech-Language Pathologists' Use of Intelligibility Measures in Adults With Dysarthria

PURPOSE

Speech-language pathologists (SLPs) who work with adults with dysarthria were surveyed to investigate trends of clinical practice for assessing speech intelligibility.

METHOD

Two hundred ninety-six SLPs responded to an online survey October 22-November 30, 2015.

RESULTS

Findings showed that 35% of SLPs lacked access to any standardized assessments of intelligibility, with 66% of these implicating cost as the main reason. Work settings played a role, as all SLPs working in Veterans Affairs hospitals and 97% of SLPs working in university or research clinics reported access to at least one formal assessment. Even with access to formal tools to measure intelligibility, most SLPs preferred less formal measures. It is surprising to note that many SLPs reported using physical examinations (e.g., of cranial nerves and oral mechanisms) to measure speech intelligibility.

CONCLUSIONS

Results indicate the need to increase SLP familiarity with, and access to, currently available standardized assessments, as well as to improve education regarding the fundamental need to rate speech to assess intelligibility. Clinicians may also benefit from new standardized methods to objectively assess intelligibility that are accessible, practical, and efficient.

Speaking legibly: Qualitative perceptions of altered voice among oral tongue cancer survivors

OBJECTIVE

Treatment for oral tongue cancer poses unique challenges to restoring and maintaining personally acceptable, intelligible speech.

METHODS

We report how oral tongue cancer survivors describe their speech after treatment in a qualitative descriptive approach using constant comparative technique to complete a focal analysis of interview data from a larger grounded theory study of oral tongue cancer survivorship. Interviews were completed with 16 tongue cancer survivors 3 months to 12 years postdiagnosis with stage I-IV disease and treated with surgery alone, surgery and radiotherapy, or chemo-radiation. All interview data from the main study were analyzed for themes describing perceptions of speech as oral tongue cancer survivors.

RESULTS

Actual speech impairments varied among survivors. None experienced severe impairments that inhibited their daily lives. However, all expressed some level of concern about speech. Concerns about altered speech began when survivors heard their treatment plans and continued through to survivorship without being fully resolved. The overarching theme, maintaining a pattern and character of speech acceptable to the survivor, was termed "speaking legibly" using one survivor's vivid in vivo statement. Speaking legibly integrate the sub-themes of "fears of sounding unusual", "learning to talk again", "problems and adjustments", and "social impact".

CONCLUSIONS

Clinical and scientific efforts to further understand and address concerns about speech, personal presentation, and identity among those diagnosed with oral tongue are important to improving care processes and patient-centered experience.

Preservation of organ function in head and neck cancer

Preservation of function is a crucial aspect for the evaluation of therapies applied in the field of head and neck cancer. However, preservation of anatomic structures cannot automatically be equated with preservation of function. Functional outcome becomes increasingly important particularly for the evaluation of alternative treatment options with equivalent oncological outcomes.AS A RESULT, PRESENT STUDIES TAKE INTO ACCOUNT THREE TOPIC AREAS WITH VARYING EMPHASIS: (1) the effects of cancer therapy on essential physiological functions, (2) additional therapy-induced side-effects and complications, and (3) health-related quality of life. The present article summarizes vital aspects of clinical research from recent years. Functional outcomes after surgical and non-surgical treatment approaches are presented according to tumor localization and staging criteria. Additional methodological aspects relating to data gathering and documentation as well as challenges in implementing the results in clinical practice are also discussed.

Outcome measurements after oral cancer treatment: speech and speech-related aspects--an overview

INTRODUCTION

Oral cancer and its surgical treatment impair speech quality by an alteration of the vocal tract. Local size and stage of the tumour as well as surgical and adjuvant treatment modalities have an impact on the functional outcome of patients' speech rehabilitation. It was the aim of this overview to specifiy speech and speech-related aspects as well as to delineate measurement methods of speech outcome in patients with oral cancer by a review of the literature.

METHODS

The review is based on a Medline Search on "speech", "cancer", "oral cancer", "malignoma mouth", "intelligibility", "formant", "ultrasound".

DISCUSSION

In particular, speech intelligibility is inevitable for the social interaction of patients which is highly correlated with the patient's quality of life. However, speech outcome measurement shows a variety of methods without an international standardisation. Additionally, several co-aspects of speech production have to be considered: tongue mobility, voice production, velopharyngeal closure and neural coordination are important influencing factors. Speech assessment is traditionally performed by perceptual methods on a subjective or semi-subjective base. More objective, technical-based methods of speech evaluation are in development and under research.

PURPOSE

It was the aim of this overview to specify speech and speech-related aspects as well as to delineate measurement methods of speech outcome in patients with oral cancer by a review of the current literature.