Long-time spectral and intensity characteristics of esophageal speech

Clinical Experiences of People With a Laryngectomy During the SARS COVID-19 Pandemic

Purpose This study described the clinical experiences of patients with a total laryngectomy (TL) during the COVID-19 pandemic and identified changes in communication, tracheostoma care, and heat-moisture exchange (HME) use that were recommended or self-implemented. Method An online survey addressing the study aims was completed by 173 people with a TL who live in the United States. The survey was open from July 5 to August 10, 2020. Results In-person clinic visits, appointment cancellations, and contact from their speech-language pathologists (SLPs) were reported by 42%, 19%, and 54% of the TL respondents, respectively. At clinic visits, 78% were required to wear a mask over their nose/mouth, and 73% were required to wear a mask over their tracheostoma. Masks, gloves, and face shields worn by the SLP at these visits were reported by 84%, 82%, and 70% of the TL patients, respectively. Alaryngeal communication changes were recommended by the SLP for 7%-18% of TL patients, depending on their method of communication, whereas 43%-45% implemented changes on their own. Changes in tracheostoma care and HME use were recommended by the SLP for 27% and 21% of the TL respondents, respectively, whereas 54% and 47% made changes on their own. Conclusions Individuals with a TL will require in-person care even during a pandemic, as reflected in this study. Many had not been contacted by their SLP or otolaryngologist about TL guidelines that were becoming available. Notably, larger percentages of TL patients reported self-initiated changes to their communication, tracheostoma care, and HME use because of the pandemic than their SLP had advised. The types of communication changes varied in part, depending on the method of alaryngeal speech a respondent used. Supplemental Material https://doi.org/10.23641/asha.16807270.

The Lombard effect associated with Chinese male alaryngeal speech

Objective: Alaryngeal speech shows marked reduction in vocal intensity, resulting in reduced intelligibility. Lombard effect, speaking with background noise has been found to boost speakers' intensity. The study investigated oesophageal (ES), tracheoesophageal (TE) and electrolaryngeal (EL) speech production under quiet and noisy background conditions to determine if the Lombard effect is still present after laryngectomy.Method: Fifteen laryngeal and thirty-seven alaryngeal speakers who were native speakers of Cantonese were recruited and instructed to read aloud a Cantonese passage under two background conditions: quiet and 100 dB background noise conditions.Result: Significant increase in vocal intensity was found in all speaker types under the noise condition. In addition, perceived intelligibility ratings provided by naïve Cantonese listeners revealed that the overall intelligibility under noise was improved for TE and laryngeal speakers, but not for ES and EL speakers, when compared with quiet condition.Discussion and conclusion: Results confirmed that the Lombard effect is still present after total laryngectomy. However, intelligibility may not always be improved with increased vocal loudness. Improved intelligibility was only observed for TE and laryngeal speakers, but not ES and EL speakers. Clinical implications for the use of the Lombard effect in post-laryngectomy speech rehabilitation are discussed.

The use of the Lombard Effect in Improving Alaryngeal Speech

OBJECTIVE

The present study examined and compared the Lombard effect among laryngeal and alaryngeal speakers including esophageal, tracheoesophageal, pneumatic artificial laryngeal, electrolaryngeal speakers of Cantonese. The subsequent change in intelligibility was also examined.

METHODS

A total of 52 native Cantonese-speaking laryngeal and alaryngeal speakers (10 laryngeal , 8 laryngeal , 13 electrolaryngeal , 11 esophageal, and 10 tracheoesophageal) participated in a reading task involving three 10-syllable Cantonese sentences under 10 background conditions: quiet, 60 dB, 65 dB, 70 dB, 75 dB, 80 dB, 85 dB, 90 dB, 95 dB, and 100 dB white background noise. Speech intelligibility associated with speaking conditions were evaluated by five naïve Cantonese speakers.

RESULTS

Output intensity was significantly increased in all speaker types under all nine noisy background conditions when compared with the quiet condition. However, the amount of increase was different for different modes of phonation. In addition, significant difference in speech intelligibility between laryngeal and alaryngeal speakers was found at all conditions, but not among any alaryngeal speech.

DISCUSSION AND CONCLUSION

The Lombard reflex is still present after total laryngectomy. Yet, different alaryngeal speech was associated with different amount of loudness change, and subsequent improvement in intelligibility was not observed.

The multidimensional impact of total laryngectomy on women

Based on society's expectations of what defines the norms for what is deemed "masculine" and "feminine", and a propensity for society's members to adhere to these expectations, women may face a unique set of circumstances and pressures following surgical treatment for laryngeal cancer. This is primarily due to the changes that occur to women's physical, psychological, and social functioning when dealing with cancer diagnosis and treatment outcomes. Because of concerns related to physical disfigurement, acoustic and perceptual changes to one's voice, and threat of the psychological sequelae associated with total laryngectomy (TL) (or, the surgical removal of one's voicebox and surrounding structures), there is an increased potential for violation of social expectations that cross these areas of functioning. As such, efforts that seek to better understand the potentially differential impact of TL on women and identify the specific needs they may have leading up to and after such treatment pursuant to contemporary societal expectations are warranted. Thus, this paper provides an examination of the potentially differential impact of TL on women. In addressing this position, this paper examines the unique challenges women may face postlaryngectomy through the framework of the International Classification of Functioning, Disability, and Health (ICF). Through the use of the ICF, this paper will provide an expanded perspective related to the interactions between body functioning, active participation in daily activities, and contextual factors that may act as facilitators or barriers to women's societal reintegration secondary to TL.

LEARNING OUTCOMES

Readers will be able to describe the multiple factors that may contribute to the differential impact of total laryngectomy (TL) on women. More specifically, readers will gain an understanding about women's physical, psychological, and social functioning secondary to TL. This paper also provides readers with exposure to the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) framework. This framework provides readers with an expanded perspective related to the interactions between body functioning, active participation in daily activities, and contextual factors that may act as either facilitators or barriers to the societal reintegration of women secondary to TL.

Long-term average spectral characteristics of Cantonese alaryngeal speech

OBJECTIVE

In Hong Kong, esophageal (SE), tracheoesophageal (TE), electrolaryngeal (EL), and pneumatic artificial laryngeal (PA) speech are commonly used by laryngectomees as a means to regain verbal communication after total laryngectomy. While SE and TE speech has been studied to some extent, little is known regarding the EL and PA sound quality. The present study examined the sound quality associated with SE, TE, EL, and PA speech, and compared with that associated with laryngeal (NL) speech by using long-term average speech spectra (LTAS).

METHODS

Continuous speech samples of reading a 136-word passage were obtained from NL, SE, TE, EL, and PA speakers of Cantonese. The alaryngeal speakers were all superior speakers selected from the New Voice Club of Hong Kong, which is a self-help organization for the laryngectomees in Hong Kong. TE speakers were fitted with Provox valve, and EL speakers used Servox-type electrolarynx. Speech samples were digitized at 20kHz and 16bits/sample by using Praat, based on which LTAS contours were developed. First spectral peak (FSP), mean spectral energy (MSE), and spectral tilt (ST) derived from the LTAS contours associated with different speaker groups were compared.

RESULTS

Data revealed all speakers generally exhibited similar LTA contours. However, PA speakers exhibited the lowest average FSP value and the greatest average MSE value. NL phonation was associated with a significantly greater ST value than alaryngeal speech of Cantonese.

CONCLUSION

The differences in FSP, MSE, and ST values in different speaker groups may be related to the different sound sources being used by the laryngectomees, and the difference in the way the sound source is coupled with the vocal tract system.

Age-Related Changes in Long-Term Average Spectra of Children's Voices

This paper forms part of a larger study into the nature of singing development in children. The focus here is on an investigation of age-related changes in long-term average spectra (LTAS). Three hundred and twenty children in age groups 4-11 years learned a song. Each child was then digitally recorded singing alone. LTAS curves were calculated from the recordings of each voice and perceived age was estimated by a panel of independent judges. Progressive statistically significant changes were observed in the LTAS as a function of increasing age of the children. These took the form of increases in spectral energy in all frequencies below 5.75 kHz, with concomitant reductions of energy in frequency regions above this point. Increases with age were also found in overall intensity levels of the vocal products. Four experienced listeners audited the voice samples and made estimates of the children's ages. The level of accuracy of age-estimates was remarkably high for children in the youngest age groups, but was reduced with voice samples from older children. Maturation and developing competence of the vocal system, both in growth of lung capacity and at a laryngeal level, are implicated in the generation of age-related spectral changes. Perceived child singer age appears to be less closely related to spectral characteristics (as defined within LTAS) with increasing age of children.

Acoustic characteristics of Mandarin esophageal speech

The present study attempted to investigate the acoustic characteristics of Mandarin laryngeal and esophageal speech. Eight normal laryngeal and seven esophageal speakers participated in the acoustic experiments. Results from acoustic analyses of syllables /ma/and /ba/ indicated that, F0, intensity, and signal-to-noise ratio of laryngeal speech were significantly higher than those of esophageal speech. However, opposite results were found for vowel duration, jitter, and shimmer. Mean F0, intensity, and word per minute in reading were greater but number of pauses was smaller in laryngeal speech than those in esophageal speech. Similar patterns of F0 contours and vowel duration as a function of tone were found between laryngeal and esophageal speakers. Long-time spectra analysis indicated that higher first and second formant frequencies were associated with esophageal speech than that with normal laryngeal speech.

The ICF: a proposed framework for comprehensive rehabilitation of individuals who use alaryngeal speech

The International Classification of Functioning, Disability and Health (ICF) provides a conceptual framework and common language for describing human functioning and disability (World Health Organization, 2001). The ICF provides direction for comprehensive rehabilitation by classifying individual functioning at the levels of (a) body functions and structures and (b) activities and participation. Consequently, the purpose of this article is (a) to summarize the ICF; (b) to apply a case example to the framework of the ICF, involving individuals who have undergone total laryngectomy; and (c) to examine implications for both research and clinical practice. This article demonstrates how speech-language pathologists may apply the ICF framework and endorses the adoption of the framework by the American Speech-Language-Hearing Association in the 2001 Scope of Practice in Speech-Language Pathology.

Characteristics of voicing source waveforms produced by esophageal and tracheoesophageal speakers

Voicing source waveforms produced by 10 laryngectomized esophageal speakers, 12 laryngectomized tracheoesophageal speakers, and 10 age-matched, normal male speakers were obtained by inversely filtering flow functions recorded with a circumferentially vented mask. The data from these speakers was used to evaluate differences in source signal properties on a group basis. In a second analysis source signals produced by a single laryngectomized individual, capable of producing esophageal and tracheoesophageal speech in a highly proficient manner, were analyzed and compared. The overall results of this project provide an initial and novel description of voicing source signals produced by esophageal and tracheoesophageal speakers. The characteristics of these signals appear to be highly variable, particularly in comparison with the homogeneous pattern of source waves produced by age-matched, normal speakers. This initial description of voicing source signals produced by alaryngeal speakers is generally supportive of the hypothesis of differences in source properties among normal, esophageal, and tracheoesophageal voices.

Fundamental frequency and intensity measurements in laryngeal and alaryngeal speakers

Fundamental frequency measurements and voice sound pressure levels were examined in 10 tracheoesophageal, 10 esophageal, and 10 laryngeal speakers during three phonation tasks. The results indicated that tracheoesophageal speakers had a fundamental frequency approximately 25 Hz higher than esophageal speakers. Intensity levels for laryngeal and tracheoesophageal speakers were similar. Discussion includes support for this new voice restoration technique.

Overpressure and breathiness in spastic dysphonia. An acoustic (LTAS) and perceptual study

Pre- and postsurgical speech segments spoken by patients with spastic dysphonia were submitted to long-time-average-spectrum (LTAS) analysis and for perceptual assessment of breathiness and overpressure. Breathy phonation corresponded to a steep fall in the LTAS, while overpressured phonation produced higher spectral levels and a less steep fall. Mixed breathy-overpressured phonation produced a somewhat elevated spectrum. Post-surgical changes in overpressure are demonstrated by spectral shifts. Perceptual scores correlated well with the objective acoustic spectral measures.

Acoustic characteristics: tracheoesophageal speech

This study examined differences among five tracheoesophageal, four esophageal, and five laryngeal speakers on the acoustic parameters of intensity and duration. Each subject repeated 14 prerecorded model sentences and prolonged phonation of three vowels. Analogue prints of the voice samples were obtained, and measures were subjected to parametric statistical analysis. Differences among groups indicate that the tracheoesophageal speakers are more like normal speakers than are esophageal speakers, indicating that surgical procedures such as the tracheoesophageal puncture are a significant rehabilitative alternative for the laryngectomee.