Speech evaluation and swallowing ability after intra-oral cancer

Effects of high-frequency speech therapy on speech-related quality of life and objective speech intelligibility of oral cancer patients

To analyze objective and subjective progression of speech intelligibility in oral cancer patients undergoing high-frequency speech therapy during early rehabilitation. Oral cancer patients in the Department of Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany, participated in the study from March 2016 to November 2017. Speech intelligibility was analyzed preoperatively (t1), post radiation (t2), and post speech therapy (t3). Objective measures were the Munich Intelligibility Profile (Online) and the Frenchay Dysarthria Assessment-2 (FDA-2). Subjective measures were the Speech Handicap Index (SHI), the speech subscale of the EORTC QLQ-C30&HN35, and the WHO-5 Index II. For nine patients with complete data, progression analyses showed a non-existent-to-low intelligibility impairment at t1 (means/SDs: e.g. FDA-2: 8.96/0.11, SHI: 17.5/15.15), increasing towards t2 (means/SDs/p-values for difference from t1: e.g. FDA-2: 7.40/0.80/0.000, SHI: 21.7/14.24/0.213), and then decreasing towards t3, without ever reaching the initial level (means/SDs/p-values for difference from t1: e.g. FDA-2: 8.22/0.60/0.005, SHI: 23.5/15.85/0.481). The objective changes in intelligibility were significant; the subjective changes were not. Overall, the ability to speak intelligibly after oral cancer treatment follows a typical pattern. Therefore, high-frequency speech therapy in the early rehabilitation phase might be recommendable. It might help patients to adapt to their situation after surgery, and facilitates compensating for possible functional deficits.

Tongue movement during articulation in magnetic resonance imaging: Findings in 20 healthy volunteers and a patient with anterior floor of the mouth squamous cell carcinoma

PURPOSE

Combined ablative and reconstructive oral maxillofacial surgery involves a multitude of anatomical and functional structures for speech and swallowing. Although there are a few methods to objectively examine swallowing function, this is not true for speech. We describe the development of an objective visualization and measurement tool for magnetic resonance imaging (MRI) to evaluate speech and its first application in a patient.

MATERIAL AND METHODS

A total of 20 healthy patients and one patient with squamous cell carcinoma localized in the anterior floor of the mouth were included in the study. Examination included an MRI examination of a paced, defined set of fictive words representing all sounds of the German language. The patient underwent MRI preoperatively and 1, 3, 6 and 12 months postoperatively. MRI findings were correlated with speech intelligibility.

RESULTS

In sagittal planes, the correct identification of vowels and consonants was feasible and showed a high accordance between two independent observers and repetitions. Measurements for the patient showed significant deviations 1 month postoperatively but gradually decreased over time. Aberrant values were persistent for sound /s/. Findings correlated with clinical findings of speech intelligibility.

CONCLUSION

The presented tool seems to be promising for evaluating articulation in (tumor) patients.

Speech Outcome in Oral Cancer Patients - Pre- and Post-operative Evaluation: A Cross-sectional Study

AIM

The tongue plays a major role in articulation. Speech outcome depends on the site of lesion, extent of resection, and flexibility of the remaining structures. The aim of this study is to evaluate the speech outcome measures such as sounds that are misarticulated and speech intelligibility and its connection to tumor site before and after surgery.

METHODOLOGY

Totally, 24 (12 pre- and 12 post-operative patients) patients who had buccal and tongue cancer underwent speech intelligibility rating and articulation screening.

RESULT

The results show that the speech outcome is worse in postoperative patients when compared to preoperative patients. The articulation errors produced by tongue cancer patients were more than the errors produced in buccal cancer patients. The type of reconstruction also affects the speech outcome.

CONCLUSION

The perceptual analysis of oral cancer patients showed specific articulation issues and reduced intelligibility of speech in regards to site of lesion and type of reconstruction surgery. To reduce the speech errors, effective rehabilitation is recommended. A comprehensive speech evaluation and analysis of error patterns would help us in planning the rehabilitative measures of speech which is the most important factor in re-establishing interpersonal communication and well-being of the individual.

Cancers of the tongue and floor of mouth: five-year file audit within the acute phase

PURPOSE

The impact of patient, surgical, and rehabilitation factors on speech and swallowing in the acute phase for patients following tongue and/or floor of mouth cancer surgery has not been reported to date. This study reviewed functional outcomes over a 5-year period at an Australian tertiary hospital.

METHOD

Patient medical files from July 2006 through 2011 were audited. Patient demographics, tumor and treatment, along with speech-language pathology (SLP) intervention details were examined.

RESULTS

Speech and swallow function were significantly different between those with primary closure and those requiring reconstruction, with significantly higher referral rate to SLP following reconstruction. The clinical speech and swallow function at SLP assessment following reconstruction was a predictor for the number of SLP intervention sessions provided. The number of intervention sessions provided to these patients significantly correlated with upgrade in fluids during hospitalization.

CONCLUSION

This is the first published study to report a relationship between function and dosage of clinical SLP intervention with this population. It is also the first known study to audit comprehensive functional outcomes in the acute phase of recovery with an Australian cohort. The findings contribute to establishing evidence-based SLP practice with this population.

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.

Speech Aerodynamics and Nasalance in Oral Cancer Patients Treated with Microvascular Transfers

The purpose of the current study was to assess speech aerodynamics and nasal acoustic energy during a follow-up period of 12 months in patients having undergone microvascular free flap reconstruction after tumor ablation from the oral cavity or oropharynx, usually followed by radiotherapy. Velopharyngeal function was assessed in terms of velopharyngeal orifice size by a pressure-flow measurement technique as well as by determining the instrumental correlate of perceived nasality (i.e., nasalance) during speech production. Velopharyngeal closure and nasalance were estimated to be adequate before operation both in oral cavity and oropharyngeal cancer patients. After the operation, at the group level, the oral cavity patients showed adequate velopharyngeal closure and nasalance. In contrast, the postoperative velopharynx orifice size was significantly bigger in the oropharyngeal cancer patients as compared with the oral cavity patients 6 months after operation. However, based on average aerodynamic as well as the nasalance data, the impairment of velopharyngeal function was not regarded clinically significant at the group level in either group of patients. The present treatment protocol served to maintain the prerequisites for normal or close to normal speech physiology.