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Bachmann AS, Höche S, Peters B, Wiltfang J, Hertrampf K. Effects of high-frequency speech therapy on speech-related quality of life and objective speech intelligibility of oral cancer patients. J Craniomaxillofac Surg 2021; 49:1072-1080. [PMID: 34193379 DOI: 10.1016/j.jcms.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/11/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022] Open
Abstract
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.
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Affiliation(s)
- Anne Susann Bachmann
- Institute of Psychology, Christian-Albrechts-University Kiel, Olshausenstr. 62, 24118, Kiel, Germany
| | - Svea Höche
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Building B, D-24105, Kiel, Germany
| | - Benno Peters
- Institute for Scandinavian Studies, Frisian Studies and General Linguistic Christian-Albrechts-University Kiel, Leibnizstr. 10, 24118, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Building B, D-24105, Kiel, Germany
| | - Katrin Hertrampf
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Building B, D-24105, Kiel, Germany.
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Fu SW, Li PC, Lai YH, Yang CC, Hsieh LC, Tsao Y. Joint Dictionary Learning-Based Non-Negative Matrix Factorization for Voice Conversion to Improve Speech Intelligibility After Oral Surgery. IEEE Trans Biomed Eng 2017; 64:2584-2594. [DOI: 10.1109/tbme.2016.2644258] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kansy K, Hoffmann J, Bendszus M, Heiland S, Krisam J, Wohlfarth M, Mistele N, Geschwinder A, Gradl J. 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. J Craniomaxillofac Surg 2017; 45:2046-2053. [PMID: 29037920 DOI: 10.1016/j.jcms.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/27/2017] [Accepted: 09/11/2017] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Katinka Kansy
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry and Informatics, Department Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Matthias Wohlfarth
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Nicole Mistele
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne Geschwinder
- Department of Otorhinolaryngology and Phoniatrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Johann Gradl
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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Saravanan G, Ranganathan V, Gandhi A, Jaya V. Speech Outcome in Oral Cancer Patients - Pre- and Post-operative Evaluation: A Cross-sectional Study. Indian J Palliat Care 2016; 22:499-503. [PMID: 27803574 PMCID: PMC5072244 DOI: 10.4103/0973-1075.191858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Gomathi Saravanan
- Department of Speech Language Pathology, Institute of Speech and Hearing, Madras Medical College, Chennai, Tamil, India
| | - Venkatesan Ranganathan
- Department of Speech Language Pathology, Institute of Speech and Hearing, Madras Medical College, Chennai, Tamil, India
| | - Anitha Gandhi
- Department of Surgical Oncology, Government Royapettah Hospital, Chennai, Tamil Nadu, India
| | - V Jaya
- Department of Speech Language Pathology, Institute of Speech and Hearing, Madras Medical College, Chennai, Tamil, India
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Blyth KM, McCabe P, Heard R, Clark J, Madill C, Ballard KJ. Cancers of the tongue and floor of mouth: five-year file audit within the acute phase. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 23:668-678. [PMID: 25089517 DOI: 10.1044/2014_ajslp-14-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 07/23/2014] [Indexed: 06/03/2023]
Abstract
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.
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Schuster M, Stelzle F. Outcome measurements after oral cancer treatment: speech and speech-related aspects--an overview. Oral Maxillofac Surg 2012; 16:291-8. [PMID: 22864645 DOI: 10.1007/s10006-012-0340-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/16/2012] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- M Schuster
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Stelzle F, Maier A, Nöth E, Bocklet T, Knipfer C, Schuster M, Neukam FW, Nkenke E. Automatic Quantification of Speech Intelligibility in Patients After Treatment for Oral Squamous Cell Carcinoma. J Oral Maxillofac Surg 2011; 69:1493-500. [DOI: 10.1016/j.joms.2010.05.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 02/28/2010] [Accepted: 05/17/2010] [Indexed: 10/18/2022]
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Dwivedi RC, Kazi RA, Agrawal N, Nutting CM, Clarke PM, Kerawala CJ, Rhys-Evans PH, Harrington KJ. Evaluation of speech outcomes following treatment of oral and oropharyngeal cancers. Cancer Treat Rev 2009; 35:417-24. [DOI: 10.1016/j.ctrv.2009.04.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022]
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Windrich M, Maier A, Kohler R, Nöth E, Nkenke E, Eysholdt U, Schuster M. Automatic Quantification of Speech Intelligibility of Adults with Oral Squamous Cell Carcinoma. Folia Phoniatr Logop 2008; 60:151-6. [DOI: 10.1159/000121004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Markkanen-Leppänen M, Isotalo E, Mäkitie AA, Suominen E, Asko-Seljavaara S, Haapanen ML. Speech Aerodynamics and Nasalance in Oral Cancer Patients Treated with Microvascular Transfers. J Craniofac Surg 2005; 16:990-5; discussion 996. [PMID: 16327545 DOI: 10.1097/01.scs.0000179753.14037.7a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Mari Markkanen-Leppänen
- Department of Otolaryngology-Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland.
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