Voice outcomes post total laryngectomy

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.

Perceptual Evaluation of the Tracheoesophageal Voice: Italian Validation of the Sunderland Tracheoesophageal Perceptual Scale

OBJECTIVES

This study aimed to validate the Sunderland Tracheoesophageal Perceptual Scale (SToPS) in the Italian language by checking the inter- and intra-rater reliability.

STUDY DESIGN

Scale validation METHODS: The validation of the tool involved the following steps: (1) translation and adaptation of the SToPS into Italian language; (2) recruitment of participants (60 laryngectomized patients with a voice prosthesis and 12 health professionals-six speech and language therapists (SLTs) and six ear, nose, and throat surgeons-classified into experienced (Exp) or not at assessing voice; (3) recording of patients' speech samples; (4) perceptual evaluation of recorded speech samples (test and retest) performed by the 12 health professionals; and (5) statistical analysis (quadratic weighted Cohen kappa and weighted kappa of Light coefficients).

RESULTS

When all raters were considered as one group, an agreement ≥0.50 was reached for all parameters. The "ExpSLTs" group rated more reliably than the other groups, achieving a "good" intrarater agreement for 9/10 parameters. Despite the interrater coefficients were lower than the intrarater ones for all rater groups, "ExpSLTs" obtained the best levels of interrater agreement, achieving a level of agreement ≥0.50 for all parameters. Finally, considering intrarater+interrater agreement ("good + good" or "good + moderate"), the "ExpSLTs" group showed the greatest agreement, attaining all parameters that met the criteria for "good" or "moderate" agreement levels.

CONCLUSIONS

The Italian version of SToPS can be considered a reliable tool. As in the original version, expert SLTs are the better judges for tracheoesophageal voice assessment.

(I)INFVo scale for perceptive evaluation of substitutional voices - validation of the Polish version

<br><b<Aim:</b> The aim of this study was to evaluate the relevance and reliability of the (I)INFVo scale - a clinical tool for the perceptual assessment of substitutional voice in patients after total laryngectomy. The process involved translating the scale into Polish and verifying the relevance and reliability of the tool in 33 native Polish-speaking patients using tracheo-esophageal or esophageal substitutional voice.</br> <br><b>Methods:</b> Voice recordings were rated using the perceptual-auditory (I)INFVo scale by two experts with 10 years of experience in phoniatrics and speech therapy and a clinical speech therapy graduate. One of the specialists listened to and assessed the voice recordings twice at a one-week interval. Objective measures - speech rate, diadochokinesis (DDK), and maximum phonation time (MPT) were calculated from the aforementioned recordings. The results of the Polish version of Voice Handicap Index (VHI-POL) self-assessment questionnaire including three subscales (functional, physical, and emotional) as obtained from the medical records of the study subjects were also used in the analysis. All values obtained in the study were submitted to correlation analysis.</br> <br><b>Results:</b> Very strong statistical relationships were obtained for inter- and intra-rater reliability. A statistically significant correlation was found between the parameters of the (I)INFVo scale and the objective measures (speech rate, DDK, MPT), the total VHI-POL scores, and the scores within the physical and functional subscales of the VHI-POL questionnaire, confirming the reliability of ratings provided by the experts using the validated scale.</br> <br><b<Conclusion:</b> The perceptual (I)INFVo scale appears to be a reliable and adequate tool for the diagnostics of patients using tracheo-esophageal and esophageal substitutional voice after total laryngectomy.</br>.

Adaptation and Validation of the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) Questionnaire into Bahasa Malaysia

BACKGROUND

Communication adjustment from patients' perspective is paramount to ensure optimization of voice rehabilitation post laryngectomy. Very few specific self-rating tools exist with the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) having the most evidence regarding validity, reliability and clinical utility.

OBJECTIVES

This study aimed to translate and validate a Bahasa Malaysia version of SECEL (mSECEL) using a validated framework of transcultural adaptation.

METHODS

This cross-sectional study was conducted in the Otorhinolaryngology, Department of Universiti Kebangsaan Malaysia Medical Centre from February 2019 to May 2020. The mSECEL was produced following a rigorous forward and backward translation. Eighty-three laryngectomees (78 male, five female) using various methods of alaryngeal communication (47 voice prosthesis, 29 electrolarynx, three esophageal speech and four pen and paper), completed the mSECEL and mVHI-10 before head and neck and flexible laryngoscopic examinations. The mSECEL was repeated in 2 weeks via telephone interview or clinic visit. Its reliability was assessed using intraclass correlation. The Pearson product-moment correlation test was used to analyze correlation between the mSECEL and mVHI-10.

RESULTS

The mSECEL questionnaire showed strong internal consistency with the Cronbach alpha of >0.90 for total score, Environmental and Attitude subscale. The test-retest reliability for total mSECEL score was high with the intraclass correlation of 0.97. There was a highly significant positive correlation between the mSECEL total score and mVHI-10 (P < 0.001). Items in the General subscale showed poorer internal consistency with Cronbach alpha ranging 0.55-0.46 and poor correlation with mVHI-10.

CONCLUSIONS

The Bahasa Malaysia version of the SECEL measure is a valid and reliable instrument to evaluate communication perception after laryngectomy. Future studies should consider subscale validation and further abbreviation of its items to make this measure clinically relevant.

Pareto-Optimized Non-Negative Matrix Factorization Approach to the Cleaning of Alaryngeal Speech Signals

The problem of cleaning impaired speech is crucial for various applications such as speech recognition, telecommunication, and assistive technologies. In this paper, we propose a novel approach that combines Pareto-optimized deep learning with non-negative matrix factorization (NMF) to effectively reduce noise in impaired speech signals while preserving the quality of the desired speech. Our method begins by calculating the spectrogram of a noisy voice clip and extracting frequency statistics. A threshold is then determined based on the desired noise sensitivity, and a noise-to-signal mask is computed. This mask is smoothed to avoid abrupt transitions in noise levels, and the modified spectrogram is obtained by applying the smoothed mask to the signal spectrogram. We then employ a Pareto-optimized NMF to decompose the modified spectrogram into basis functions and corresponding weights, which are used to reconstruct the clean speech spectrogram. The final noise-reduced waveform is obtained by inverting the clean speech spectrogram. Our proposed method achieves a balance between various objectives, such as noise suppression, speech quality preservation, and computational efficiency, by leveraging Pareto optimization in the deep learning model. The experimental results demonstrate the effectiveness of our approach in cleaning alaryngeal speech signals, making it a promising solution for various real-world applications.

Validation and Cross-Cultural Adaptation of Croatian Self-Evaluation of Communication Experiences after Laryngectomy Questionnaire

INTRODUCTION

The Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) is a 35-item patient-reported questionnaire developed to address the communication needs of patients with laryngectomies. The aim was to translate, cross-culturally adapt, and validate the Croatian version.

METHODS

The SECEL was translated from English by two independent translators and back-translated by a native speaker, after which it was approved by an expert committee. The Croatian version of the Self-Evaluation of Communication Experiences after Laryngectomy questionnaire (SECEL:HR) was filled in by 50 laryngectomised patients who had completed their oncological treatment a year prior to inclusion in the study. Patients also filled in the Voice Handicap Index (VHI) and the Short Form Health Survey (SF-36) on the same day. All patients completed the SECEL:HR twice, the second time being 2 weeks after the initial test. Maximum phonation time and diadochokinesis of articulation organs were used for objective assessment.

RESULTS

Among the Croatian patients, the questionnaire was well-accepted and demonstrated good test-retest reliability and internal consistency for two out of three subscales. The correlations between VHI, SF-36, and SECEL:HR were moderate to strong. There were no significant differences between patients who are using oesophageal speech, tracheoesophageal speech, or the electrolarynx based on the SECEL:HR.

CONCLUSION

Preliminary findings of the research indicate that the Croatian version of the SECEL has sufficient psychometric qualities, high reliability, and good internal consistency, with a Cronbach's alpha of 0.89 for the total score. The Croatian version of SECEL can be recommended as a reliable and clinically valid measure for the assessment of substitution voices in Croatian-speaking patients.

Substitution voicing index: towards improved speech assessment in patients who have undergone laryngeal oncosurgery

This study aimed to develop a multidimensional model for the evaluation of substitution voicing (SV) after laryngeal oncosurgery. The study group consisted of 121 adult male individuals: 59 patients with SV after laryngeal oncosurgery (endolaryngeal cordectomy, partial laryngectomy, total laryngectomy with tracheoesophageal prosthesis) and 62 healthy controls. A multidimensional protocol for the assessment of SV included, 1) self-reported speech evaluation with a short version of the Speech Handicap Index, 2) auditory-perceptual assessment, and 3) acoustic speech analysis using AMPEX® (Auditory Model Based Pitch Extractor) software. Moderate correlations were observed between parameters from self-reported auditory-perceptual and acoustic speech analysis domains. The multidimensional Substitution Voicing Index (SVI), including markers from these domains, was elaborated by using linear stepwise regression to determine the optimal set of parameters for categorising SV patients. The lowest mean SVI score was revealed in the control subgroup corresponding to the normal speech, followed by cordectomy subgroup and partial laryngectomy subgroup. The highest mean SVI score was revealed in the total laryngectomy subgroup, reflecting the most severely deteriorated quality of SV. One-way analysis of variance identified statistically significant differences between the mean SVI scores in separate subgroups. The results demonstrated the potential benefits of the SVI for a multidimensional evaluation of SV in patients after laryngeal oncosurgery.

Characteristics associated with communicative participation after total laryngectomy

PURPOSE

The purpose of this study was to identify individual characteristics that are associated with communicative participation after total laryngectomy (TL).

METHODS

This study was a single-institution investigation of individuals who had undergone TL. Data were collected at a single timepoint via patient self-report and medical record review. Thirty-five participants completed a questionnaire containing a communication survey as well as several published, validated instruments. Independent variables included characteristics related to demographics, health and medical history, social network composition, and communication. The dependent variable was communicative participation, which was assessed using the Communicative Participation Item Bank (CPIB). Correlations between the independent variables and CPIB scores were calculated to assess the influence of these characteristics on communicative participation. The study participants were subdivided into three distinct groups based on whether their primary method of communication was spoken or non-spoken and the frequency of using alternate methods of communication. Outcomes across the three groups were then compared. A follow-up survey was also conducted to examine the impact of "stay at home" orders during the COVID-19 pandemic of 2020-21.

RESULTS

There were significant correlations between communicative participation and some non-communication-related characteristics. Reduced communicative participation was associated with younger age, less time since TL, a history of reconstructive surgery, poorer self-rated health, more depressive symptoms, worse quality of life, and a weaker social network of friends. Several communication-related characteristics were also associated with CPIB scores. Increased communicative participation was associated with using fewer non-spoken communication methods, higher levels of satisfaction with speech and communication, and better communicative effectiveness. There were significant differences between the three groups for communicative effectiveness and satisfaction with speech. The three groups did not differ significantly for satisfaction with communication or communicative participation. There were no significant differences in CPIB scores measured before and during the pandemic.

CONCLUSIONS

Communicative participation is a complex measure that may be affected by a variety of factors related to demographics, health, social network status, and communication. Despite poorer communicative effectiveness and lower levels of satisfaction, individuals who use non-spoken methods of communication after TL did not demonstrate worse communicative participation than those using spoken methods. Surprisingly, CPIB scores did not decline as a result of social distancing.

Functional Outcomes Following Total Laryngectomy and Pharyngolaryngectomy: A 20-Year Single Center Study

BACKGROUND

Laryngeal cancer accounts for 1% of all cancers in men and 0.3% of all cancers in women. Pharyngolaryngectomy (TPL) and total laryngectomy (TL) are central surgical techniques in the management of advanced laryngeal malignancies but are associated with significant morbidity. In addition, optimal reconstruction following TPL remains an area of active research.

METHODS

Here, we compared speech and swallowing outcomes following circumferential and partial pharyngeal resection alongside total laryngectomy in patients with laryngeal and hypolaryngeal tumors. We performed a systemic analysis of patient demographics, tumor characteristics, treatment modality, and pharyngeal reconstruction technique following TPL and TL, leveraging data collected over a 20-year period at a large tertiary referral center.

RESULTS

Analyzing 155 patients the results show circumferential pharyngeal defects and prior radiotherapy have a significant impact on surgical complications.

CONCLUSION

Pharyngeal resection carries a substantial risk of incurring impaired speech and swallowing in patients. Moreover, our results support poorer functional outcomes with more radical pharyngeal resections and show a clear trend toward worse swallowing outcomes in salvage surgery.

Multidimensional evaluation of voice outcomes following total laryngectomy: a prospective multicenter cohort study

Purpose

The purpose of this study is to assess the general course of acoustic, patient rated, and clinician-rated voice outcomes from pre- up to 12 months post total laryngectomy.

Methods

Patients admitted to a total laryngectomy in five participating hospitals in Australia and The Netherlands were included. Assessments took place at pre-, 3 months, 6 months, and 12 months post-surgery. Voice outcomes are evaluated with the Acoustic Voice Quality Index (AVQI), perceptual scales, and patient-reported outcome measures including VHI-10 and EQ-5D-5L. Statistical analyses include descriptive statistics, t tests (pre- to 6 months post-surgery), Linear Mixed Effect models.

Results

The study included 43 participants. A significant worsening of AVQI is seen from pre- to post-surgery evaluated with t test (p < 0.001). The Linear Mixed Effect model confirmed Time as a significant factor in predicting AVQI score (p ≤ 0.001), as well as perceptual rated voice quality by the clinician (p = 0.015) and patient-reported perceptual rated voice quality (p = 0.002). No statistical significance was found in VHI-10 scores over time.

Conclusion

Successful TE-speech was achieved in most participants, some had to rely on augmentative alternative communication methods. Patient-reported outcomes indicate acceptance of the condition and sufficient coping in the long term. However, acoustic rated voice quality is abnormal at all post-surgery time-points. AVQI proved to be a useful instrument to evaluate TE-speech. There is a need for validation and determination of cut-off values for VHI-10 and AVQI for use in TE-speech.

Cortical presentation of language functions in patients after total laryngectomy: a fMRI study

Purpose

The aim of this study is to use functional magnetic resonance (fMRI) to analyse the cortical presentation of selected language functions in patients after a total laryngectomy.

Methods

Eighteen patients after total laryngectomy treated with electrolarynx speech and 18 volunteers were included. The mean number of patients’ post-operative speech rehabilitation sessions was five (range of 3–8 sessions). Four paradigms were used, including noun generation, pseudoword reading, reading phrases with pseudowords, and nonliteral sign reproduction.

Results

In noun, the most significant difference between the groups was the stronger activation of both lingual gyri in the volunteers. Pseudoword reading resulted in stronger activations in patients than in volunteers in the lingual gyri, the right cerebellum, the right Broca’s area, and the right parietal operculum. Reading phrases with pseudowords involved different parts of the Brodmann area 40. During nonliteral sign reproduction, there was a stronger activation of the left Broca’s area in volunteers and a stronger activation of the left premotor cortex in patients.

Conclusion

This study provides evidence of altered cortical activation in response to language tasks in patients after a laryngectomy compared with healthy volunteers, which may be considered brain plasticity in response to a laryngectomy.

An Investigation of Reliability of the Sunderland Tracheosophageal Voice Perceptual Scale

BACKGROUND

The Sunderland Tracheosophageal Voice Perceptual scale (SToPS) is the only perceptual rating scale designed specifically for tracheosophageal voice [Hurren et al.: Clin Otolaryngol. 2009 Dec; 34(6): 533-8].

OBJECTIVE

To investigate the inter rater reliability of the SToPS when analyzing alaryngeal voice.

METHODS

Prospective evaluation of inter rater reliability of the SToPS based on audio recordings of 230 voice samples from 41 laryngectomy patients rated by 3 experts. Interval data were analyzed using intraclass correlation coefficients (ICC) while categorical data were analyzed using Kappa.

RESULTS

ICC of above 0.6 was observed between raters for each prosthesis on a majority of parameters demonstrating a good level of reliability. Reliability was fair (ICC of between 0.40 and 0.59) on Q11 (Articulatory precision) and Q12 (Paralinguistics). Reliability was also fair (0.21-0.40) or slight (0.00-0.20) for Q2 (Tonicity), which was analyzed using Kappa. Kappa above 0.61 signified a good level of reliability.

CONCLUSIONS

This study demonstrates good rater reliability for the majority of parameters on the SToPS scale, supporting the use of this tool within the clinical realm. However, further research is required to ascertain if any methods of increasing inter rater reliability on those parameters which did not reach good reliability can be identified.