Communication competence and disability secondary to laryngectomy and tracheoesophageal puncture voice restoration.

BACKGROUND: There is a large body of research showing the negative impact of a total laryngectomy on the resultant voice signal across multiple outcomes (e.g., speech intelligibility/acceptability, listener comprehension, voice quality). However, there is limited information on the effects of laryngectomy on broader communication acts, particularly in the area of pragmatics, commonly referred to as the social use of language. Considering that individuals with a laryngectomy (IWL) frequently report reduced quality of life as well as reduced communicative competency, expanding the current research to include pragmatics is warranted. AIM: To explore the pragmatic changes in communication experienced by tracheoesophageal speakers. METHODS & PROCEDURES: The current study adapted an existing 17-item measure to assess verbal, non-verbal, paralinguistic and receptive communication competence via self-report. This adapted measure was then distributed to 65 tracheoesophageal speakers (52 males, 13 females, mean age = 63.4 ± 8.5 years). OUTCOMES & RESULTS: Both negative and positive pragmatic changes to communication were reported by participants secondary to laryngectomy. This included changes in verbal (negative -37.5%, positive -15.15%); non-verbal (negative -9.54%, positive -35.45%; and paralinguistic acts (negative -29.55%, positive -34.09%). Changes to receptive communication were also noted (negative -14.78%, positive -43.19%). CONCLUSIONS & IMPLICATIONS: The overall results suggest that communication changes post-laryngectomy exist well beyond the paralinguistic areas (e.g., intelligibility, voice quality) and that males and females may approach or respond to changes in communication differently. Results are discussed specific to clinical intervention and the importance of including assessment of pragmatic function post-laryngectomy. WHAT THIS PAPER ADDS: What is already known on this subject While there is a large body of research on the changes to the speaker and listener following laryngectomy, there is minimal information on how the use of alaryngeal speech affects overall communication, specifically in the area of pragmatics or the social use of language. What this paper adds to existing knowledge This study used an adapted version of the widely used Pragmatic Protocol to delineate changes in pragmatic components of communication for tracheoesophageal speakers. What are the potential or actual clinical implications of this work? Clinically, this information can be used by healthcare professionals to educate and prepare IWL on potential changes in the underrecognized area of pragmatics.

Effects of Virtual Instruction on Educators' Voices During the COVID-19 Pandemic.

INTRODUCTION: Resulting from the COVID-19 pandemic, professionals in the United States were mandated to work virtually from home to protect the health needs of the population. The shift in setting and ergonomic factors posed a threat to the vocal health of workers, and more specifically, to those whose professions inflict significant vocal load, such as educators. This study compared the symptoms of vocal tract discomfort and self-perceived voice handicap in full-time educators between face-to-face and virtual settings. Additionally, this study sought to identify relationships between specific environmental factors and levels of discomfort. METHODS: A cross-sectional research study was conducted by distributing an online survey to 223 individuals who identified as full-time educators. This survey collected data on vocal tract symptoms during both face-to-face and virtual instruction, environmental factors of virtual work setting, personal vocal health habits, and self-perceived voice handicap in each setting. RESULTS: In this sample population, the shift to a virtual work setting did not result in a significant increase in the number of vocal discomfort symptoms or an increase in vocal handicap. However, environmental factors such as air quality and water intake had the strongest correlation with levels of vocal tract discomfort. CONCLUSION: It is beneficial to provide resources to full-time educators regarding the risk of voice disorders and the impact of environmental factors on vocal health.

Effects of Virtual Teaching on Swedish Teachers' Voices During the COVID-19 Pandemic.

PURPOSE: Since the beginning of 2020, teachers all over the world have had to switch over to virtual teaching because of the COVID-19 pandemic. This change of teaching mode has unknown consequences on the vocal health of teachers who already experience voice disorders at a rate nearly double that of the general population. Therefore, the purpose of this study is to investigate teachers' self-reported voice problems during virtual teaching compared to face-to-face teaching and how they are associated to perceived risk factors in the work environment. METHOD: Participants included 141 teachers (49 males, 92 females) in high schools and higher education in Sweden who responded to an internet-based survey. Information was collected about participants' self-reported voice handicap using a translated version of the Voice Handicap Index-10 (VHI-10). Information about self-reported VTD (Vocal Tract Discomfort) symptoms and dysphonia was collected in regard to both modes of teaching (virtual vs face-to- face). The survey also included questions on risk factors related to vocal health. RESULTS: Self-reported voice handicap and VTD symptoms were slightly lower during periods of virtual teaching compared to periods of face-to-face teaching. There was a lower frequency of dysphonia symptoms during virtual teaching compared to face-to- face teaching, however the difference was not statistically significant. In addition, 34% of teachers reported experiencing more voice problems when teaching face-to-face while 15% reported more voice problems when teaching virtually. The most reported VTD symptoms during both virtual and face-to-face teaching were having a dry and a tight throat. The dysphonia symptoms with the highest reported frequency were a tense voice and hoarseness in both modes of teaching. Risk factors associated with higher prevalence of voice symptoms and/or higher levels of voice handicap during virtual teaching were air quality and straining the voice while teaching face-to-face. In addition, those teachers who reported more voice problems while teaching virtually also reported feeling more stressed. CONCLUSION: The results showed a slight decrease in voice symptoms and voice handicap during virtual teaching compared to face-to-face teaching. Although multifactorial, results suggest that a potential positive effect may be attributed to better air quality in the work environment and more favorable acoustic conditions preventing teachers from straining their voice.

Effect of Dysphonia and Cognitive-Perceptual Listener Strategies on Speech Intelligibility.

There is a high prevalence of dysphonia among professional voice users and the impact of the disordered voice on the speaker is well documented. However, there is minimal research on the impact of the disordered voice on the listener. Considering that professional voice users include teachers and air-traffic controllers, among others, it is imperative to determine the impact of a disordered voice on the listener. To address this, the objectives of the current study included: (1) determine whether there are differences in speech intelligibility between individuals with healthy voices and those with dysphonia; (2) understand whether cognitive-perceptual strategies increase speech intelligibility for dysphonic speakers; and (3) determine the relationship between subjective voice quality ratings and speech intelligibility. Sentence stimuli were recorded from 12 speakers with dysphonia and four age- and gender-matched typical, healthy speakers and presented to 129 healthy listeners divided into one of three strategy groups (ie, control, acknowledgement, and listener strategies). Four expert raters also completed a perceptual voice assessment using the Consensus Assessment Perceptual Evaluation of Voice for each speaker. Results indicated that dysphonic voices were significantly less intelligible than healthy voices (P ≤ 0.001) and the use of cognitive-perceptual strategies provided to the listener did not significantly improve speech intelligibility scores (P = 0.602). Using the subjective voice quality ratings, regression analysis found that breathiness was able to predict 41% of the variance associated with number of errors (P = 0.008). Overall results of the study suggest that speakers with dysphonia demonstrate reduced speech intelligibility and that providing the listener with specific strategies may not result in improved intelligibility.

The Impact of Dysphonic Voices on Healthy Listeners: Listener Reaction Times, Speech Intelligibility, and Listener Comprehension.

Purpose: There is currently minimal information on the impact of dysphonia secondary to phonotrauma on listeners. Considering the high incidence of voice disorders with professional voice users, it is important to understand the impact of a dysphonic voice on their audiences. Methods: Ninety-one healthy listeners (39 men, 52 women; mean age = 23.62 years) were presented with speech stimuli from 5 healthy speakers and 5 speakers diagnosed with dysphonia secondary to phonotrauma. Dependent variables included processing speed (reaction time [RT] ratio), speech intelligibility, and listener comprehension. Voice quality ratings were also obtained for all speakers by 3 expert listeners. Results: Statistical results showed significant differences between RT ratio and number of speech intelligibility errors between healthy and dysphonic voices. There was not a significant difference in listener comprehension errors. Multiple regression analyses showed that voice quality ratings from the Consensus Assessment Perceptual Evaluation of Voice (Kempster, Gerratt, Verdolini Abbott, Barkmeier-Kraemer, & Hillman, 2009) were able to predict RT ratio and speech intelligibility but not listener comprehension. Conclusions: Results of the study suggest that although listeners require more time to process and have more intelligibility errors when presented with speech stimuli from speakers with dysphonia secondary to phonotrauma, listener comprehension may not be affected.

Current knowledge and impressions of speech-language pathologists of the swallow of persons who are obese.

PURPOSE: The overall goal of this study was to provide insight on the topic of dysphagia in the obese population. More specifically, the purpose of this study was to obtain preliminary descriptive data on the knowledge and impressions of speech-language pathologists (SLPs) working in the field of dysphagia on the swallow of persons who are obese. METHODS: One hundred seventy-seven SLPs responded to a web-based survey that was posted on two popular listserves that serve the dysphagia community. RESULTS: Descriptive results showed that nearly all SLPs have assessed and treated patients who are obese for dysphagia, that there is little consensus as to how the obese swallow compares to the normal swallow, and that there is a consensus that dysphagia observed in the obese population is most likely related to other concomitant disorders. CONCLUSIONS: Results provide preliminary insight into the knowledge and impressions of SLPs working with dysphagia and highlight the need for future research to determine (1) if there is an increased incidence of dysphagia in the obese population, and (2) if obesity itself constitutes a risk factor for dysphagia or if any dysphagia observed in this population is related to other comorbidities.

Tongue-palate contact pressure, oral air pressure, and acoustics of clear speech.

PURPOSE: The authors compared articulatory contact pressure (ACP), oral air pressure (Po), and speech acoustics for conversational versus clear speech. They also assessed the relationship of these measures to listener perception. METHOD: Twelve adults with normal speech produced monosyllables in a phrase using conversational and clear speech. Target phonemes were /t, d, s, z, l, n/. ACP was measured at a point of articulatory contact; Po was sensed by a catheter open in the posterior oral cavity. RESULTS: ACP was increased to a greater extent in clear speech for /t, d, z/. Po was increased to a greater extent for /t, d/. Acoustic changes also occurred in terms of segment durations, speaking rate, and CV dB ratio. Regression analysis indicated that segment duration was the strongest predictor of listener ratings of speech clarity, followed by an index of articulatory effort and speaking rate. CONCLUSION: Articulatory effort, as indexed by ACP, Po, and CV dB ratio, was increased to varying degrees depending on the consonant. Greatest changes occurred for /t, d/. Durational measures at both the segment and the phrase level were also important for predicting listener ratings of speech clarity.

Communication adjustment of patients with a laryngectomy in Turkey: analysis by type of surgery and mode of speech.

Previous studies have routinely shown that individuals with a laryngectomy (IWL) have a decreased quality of life (QoL). However, the questionnaires frequently used are not specifically designed for persons with laryngeal cancer and may not reflect the issues of most concern to IWL. The purpose of this study was to investigate (1) the overall communication adjustment of IWL in Turkey, (2) the differences in communication adjustment among types of surgery for the treatment of laryngeal cancer, and (3) the differences in communication adjustment among types of speech following treatment for laryngeal cancer. Fifty-two patients (50 males and two females) who underwent surgical treatment for laryngeal cancer (i.e. total, supraglottic, frontolateral, vertical, supracricoid) and were being seen for follow-up care were recruited from an ENT clinic in Bursa, Turkey. Patients were provided with a written translation of the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) which yielded information on three subscales (General, Environment, and Attitude) and a Total score. Kruskall-Wallis and Wilcoxon signed ranks nonparametric tests of significance showed that overall adjustment was within the well-adjusted range for all types of surgery and modes of speech with two exceptions: Mean scores for supracricoid laryngectomy with cricohyoidopexy (28.5) and esophageal speech (29.3) were both within the poorly adjusted range on the Environment subscale [lowest mean score = 8.7 (supraglottic)]. Total mean scores ranged from 19.8 (supraglottic) to 49.9 (esophageal speech). Mean scores of the General subscale ranged from 4.0 (electrolaryngeal speech) to 7.7 (tracheoesophageal speech). Mean scores of the Attitude subscale ranged from 6.2 (supraglottic) to 19 (electrolaryngeal). Results of the Kruskall-Wallis test also showed a significant difference between type of surgery for the Environment subscale (p = 0.003), the Attitude subscale (p = 0.039), and the Total score (p = 0.007). The results suggest that overall, IWL in Turkey are well-adjusted to their new voice. However, results also showed that certain conservation surgeries (i.e. supraglottic, frontolateral, vertical) yielded more favorable outcomes than either supracricoid laryngectomy or speech following total laryngectomy. This finding is most likely related to the amount of tissue preserved following conservation surgery, in particular the preservation of the vocal folds.

Effects of audio-visual information on the intelligibility of alaryngeal speech.

BACKGROUND: There is minimal research on the contribution of visual information on speech intelligibility for individuals with a laryngectomy (IWL). AIMS: The purpose of this project was to determine the effects of mode of presentation (audio-only, audio-visual) on alaryngeal speech intelligibility. METHOD: Twenty-three naïve listeners were randomly presented 176 phonemically balanced sentences produced by three alaryngeal (tracheoesophageal, esophageal, electrolaryngeal) and one typical, laryngeal speaker in both audio-only and audio-visual modes of presentation. RESULTS: Overall, results showed a small (3%) but statistically significant higher speech intelligibility score for audio-visual stimuli compared to audio-only stimuli as well as a significant interaction effect between mode of speech and mode of presentation. Within mode of speech, electrolaryngeal speech was the only mode that benefited significantly from the inclusion of visual information (10% increase). Overall intelligibility showed similar patterns both within audio-only and audio-visual modes of presentation: typical laryngeal and tracheoesophageal speech modes were significantly more intelligible than both esophageal and electrolaryngeal. CONCLUSIONS: Results suggest that listeners may benefit more from visual information from speakers with poor baseline speech intelligibility. Results also show similar intelligibility between typical, laryngeal and tracheoesophageal modes of speech. Results should be interpreted with caution, however, as only one speaker from each mode of speech was included. Further research is required to determine the nature of the increase. LEARNING OUTCOMES: Readers will (1) increase their understanding of the potential impact of visual information in the perception of alaryngeal speech; (2) identify potential factors that may augment or hinder speech perception; and (3) discuss how individual modes of alaryngeal speech may be affected by audio-visual information.

Effects of audio-visual information and mode of speech on listener perceptions of alaryngeal speakers.

There is minimal research on listener perceptions of an individual with a laryngectomy (IWL) based on audio-visual information. The aim of this research was to provide preliminary insight into whether listeners have different perceptions of an individual with a laryngectomy based on mode of presentation (audio-only vs. audio-visual) and mode of speech (tracheoesophageal, oesophageal, electrolaryngeal, normal). Thirty-four naïve listeners were randomly presented with a standard reading passage produced by one typical speaker from each mode of speech in both audio-only and audio-visual presentation mode. Listeners used a visual analogue scale (10 cm line) to indicate their perceptions of each speaker's personality. A significant effect for mode of speech was present. There was no significant difference in listener perceptions between mode of presentation using individual ratings. However, principal component analysis showed ratings were more favourable in the audio-visual mode. Results of this study suggest that visual information may only have a minor impact on listener perceptions of a speakers' personality and that mode of speech and degree of speech proficiency may only play a small role in listener perceptions. However, results should be interpreted with caution as results are based on only one speaker per mode of speech.

Listeners' perceptions of the personality of male alaryngeal speakers.

Currently, there is limited information on listeners' perceptions of an individual with a laryngectomy. The purpose of this study is to determine whether listeners have different impressions of a laryngectomized speaker's personality based on mode of alaryngeal speech. Fifty-one listeners were presented with a reading passage produced by three male, alaryngeal speakers. Listeners were instructed to rate each speaker's personality and overall speech on a seven-point scale. Results showed that listeners' perceptions of personality were not affected by mode of alaryngeal speech, although listener's perceptions of overall speech were shown to be significantly affected by mode. Results, however, should be interpreted with caution due to small sample size and limited speaker representation. A portion of this information was previously presented at the American Speech Language and Hearing Association (ASHA) Annual Convention, Chicago, IL, November 13-15, 2003.

Reaction times of normal listeners to laryngeal, alaryngeal, and synthetic speech.

The purpose of this study was to compare listener processing demands when decoding alaryngeal compared to laryngeal speech. Fifty-six listeners were presented with single words produced by 1 proficient speaker from 5 different modes of speech: normal, tracheosophageal (TE), esophageal (ES), electrolaryngeal (EL), and synthetic speech (SS). Cognitive processing load was indexed by listener reaction time (RT). To account for significant durational differences among the modes of speech, an RT ratio was calculated (stimulus duration divided by RT). Results indicated that the cognitive processing load was greater for ES and EL relative to normal speech. TE and normal speech did not differ in terms of RT ratio, suggesting fairly comparable cognitive demands placed on the listener. SS required greater cognitive processing load than normal and alaryngeal speech. The results are discussed relative to alaryngeal speech intelligibility and the role of the listener. Potential clinical applications and directions for future research are also presented.

Velopharyngeal aerodynamics of /m/ and /p/ in tracheoesophageal speech.

The purpose of this study was to compare oral pressure (P(o)), nasal airflow (V(n)), and velopharyngeal (VP) orifice area estimates from 12 tracheoesophageal (TE) and 12 laryngeal speakers as they produced /p/ and /m/ in syllable series. The findings were as follows: (1) TE speakers produced greater P(o) than the laryngeal speakers; (2) for /p/, TE speakers generated V(n), and VP orifice area estimates comparable with, or less than, the laryngeal speakers; and (3) for /m/, TE speakers had V(n) and VP orifice area estimates greater than the laryngeal speakers. The elevated P(o) could be the result of several factors such as high source driving pressures and vocal tract volume changes postlaryngectomy. Attempts at more precise articulation, and subsequently less coarticulation, by the TE speakers may explain the V(n) and VP orifice area estimates for /p/ and /m/. TE speakers may be limiting the oral-nasal cavity coupling for /p/ (smaller VP gap, less V(n)) in an attempt to produce a very precise oral /p/. For /m/, TE speakers may be attempting to overtly mark the consonant as a nasal (greater V(n), larger VP gap). Further studies are needed to confirm/refute the explanations postulated here regarding the VP aerodynamic differences that were identified.

Impairments in dichotic listening in patients presenting anterior communicating artery aneurysm.

Impaired dichotic listening has been documented in numerous etiologies, but there is limited information on patients who present with anterior communicating artery (ACoA) aneurysm. The sequelae following ACoA aneurysm is frequently associated with neurobehavioral impairments, such as confabulation, memory, and behavior, as a result of the areas of innervation (DeLuca, 1992; DeLuca & Diamond, 1995). Clinical experience, however, shows ACoA aneurysm to also be associated with impairments in dichotic listening. Participants in this study were divided into 2 groups: patients who presented with ACoA aneurysm with age-matched controls, and patients who presented moderate to severe traumatic brain injury (TBI) with age-matched controls. TBI patients were included for test-validity purposes and to allow a comparison between diffuse and focal cerebral damage. Dichotic listening results revealed a similar pattern for patients with ACoA aneurysm and those with brain injury. The findings suggest that central auditory pathways are susceptible to damage following ACoA aneurysm.