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

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.

Assessing and Quantifying Air Added to the Voice by Means of Laryngostroboscopic Imaging, EGG, and Acoustics in Vocally Trained Subjects

OBJECTIVE

To assess and quantify singers' strategies for adding air to phonation to sound "breathy" in a healthy manner STUDY DESIGN: Case-control study with 20 professional singers.

METHODS

Twenty singers were recorded performing sustained vowels in the Complete Vocal Technique Neutral vocal mode with and without audible air added to the voice by means of laryngostroboscopic imaging using a videonasoendoscopic camera system, electroglottography, long-term average spectrum, as well as acoustic signals and audio perception. Singers completed Voice Handicap Index and Reflux Symptom Index questionnaires prior to examination.

RESULTS

Air added to the voice resulted in an expected glottal gap along the length of the vocal folds, with little to no further difference in the supraglottic area, as compared with the Neutral phonation. Air added resulted in lowered Qx, mean Sound Pressure Level, and Cepstral Peak Prominence, but higher Harmonics-to-Noise Ratio, Jitter, and Shimmer, with decreased energy at the fundamental frequency. Adding audible air to the phonation did not exhibit similar effects on acoustics for males and females. Also, for females, H1-H2 difference decreased with air added, while it increased for males.

CONCLUSION

Singers produce an audible airy phonation similar yet significantly different to the breathy phonation reported for both healthy and pathological speakers.

Curbing-The Metallic Mode In-between: An empirical study qualifying and categorizing restrained sounds known as Curbing based on audio perception, laryngostroboscopic imaging, acoustics, LTAS, and EGG

OBJECTIVES

This study aims to study the categorization Curbing from the pedagogical method Complete Vocal Technique as a reduced metallic mode compared with the full metallic modes Overdrive and Edge by means of audio perception, laryngostroboscopic imaging, acoustics, long-term average spectrum (LTAS), and electroglottography (EGG).

METHODS

Twenty singers were recorded singing sustained vowels in a restrained character known as Curbing. Two studies were performed: (1) laryngostroboscopic examination using a videonasoendoscopic camera system and the Laryngostrobe program; and (2) simultaneous recording of EGG and acoustic signals using Speech Studio. Images were analyzed based on consensus agreement. Statistical analysis of acoustic, LTAS, and EGG parameters was undertaken using Student paired t tests.

RESULTS

The reduced metallic singing mode Curbing has an identifiable laryngeal gesture. Curbing has a more open setting than Overdrive and Edge, with high visibility of the vocal folds, and the false folds giving a rectangular appearance. LTAS showed statistically significant differences between Curbing and the full metallic modes, with less energy across all spectra, yielding a high second and a low third harmonic. Statistically significant differences were identified on Max Qx, Average Qx, Shimmer+, Shimmer-, Shimmer dB, normalized noise energy, cepstral peak prominence, harmonics-to-noise ratio, and mean sound pressure level (P ≤ 0.05).

CONCLUSION

Curbing as a voice production strategy is statistically significantly different from Overdrive and Edge, and can be categorized based on audio perception. This study demonstrates consistently different laryngeal gestures between Curbing and Overdrive and Edge, with high corresponding differences in LTAS, EGG and acoustic measures.

The Pharyngoesophageal Segment After Total Laryngectomy

Objective:

The aim of the present study was to characterize the pharyngoesophageal segment in laryngectomees who rated themselves as functional tracheoesophageal speakers.

Methods:

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.

Results:

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.

Conclusions:

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.

Assessment of voice, speech, and related quality of life in advanced head and neck cancer patients 10-years+ after chemoradiotherapy

OBJECTIVES

Assessment of long-term objective and subjective voice, speech, articulation, and quality of life in patients with head and neck cancer (HNC) treated with concurrent chemoradiotherapy (CRT) for advanced, stage IV disease.

MATERIALS AND METHODS

Twenty-two disease-free survivors, treated with cisplatin-based CRT for inoperable HNC (1999-2004), were evaluated at 10-years post-treatment. A standard Dutch text was recorded. Perceptual analysis of voice, speech, and articulation was conducted by two expert listeners (SLPs). Also an experimental expert system based on automatic speech recognition was used. Patients' perception of voice and speech and related quality of life was assessed with the Voice Handicap Index (VHI) and Speech Handicap Index (SHI) questionnaires.

RESULTS

At a median follow-up of 11-years, perceptual evaluation showed abnormal scores in up to 64% of cases, depending on the outcome parameter analyzed. Automatic assessment of voice and speech parameters correlated moderate to strong with perceptual outcome scores. Patient-reported problems with voice (VHI>15) and speech (SHI>6) in daily life were present in 68% and 77% of patients, respectively. Patients treated with IMRT showed significantly less impairment compared to those treated with conventional radiotherapy.

CONCLUSION

More than 10-years after organ-preservation treatment, voice and speech problems are common in this patient cohort, as assessed with perceptual evaluation, automatic speech recognition, and with validated structured questionnaires. There were fewer complaints in patients treated with IMRT than with conventional radiotherapy.