Speech disorders in patients with Tongue squamous cell carcinoma: A longitudinal observational study based on a questionnaire and acoustic analysis.

BACKGROUND: Speech disorders are common dysfunctions in patients with tongue squamous cell carcinoma (TSCC) that can diminish their quality of life. There are few studies with multidimensional and longitudinal assessments of speech function in TSCC patients. METHODS: This longitudinal observational study was conducted at the Hospital of Stomatology, Sun Yat-sen University, China, from January 2018 to March 2021. A cohort of 92 patients (53 males, age range: 24-77 years) diagnosed with TSCC participated in this study. Speech function was assessed from preoperatively to one year postoperatively using the Speech Handicap Index questionnaire and acoustic parameters. The risk factors for postoperative speech disorder were analyzed by a linear mixed-effects model. A t test or Mann‒Whitney U test was applied to analyze the differences in acoustic parameters under the influence of risk factors to determine the pathophysiological mechanisms of speech disorders in patients with TSCC. RESULTS: The incidence of preoperative speech disorders was 58.7%, which increased up to 91.4% after surgery. Higher T stage (P＜0.001) and larger range of tongue resection (P = 0.002) were risk factors for postoperative speech disorders. Among the acoustic parameters, F2/i/decreased remarkably with higher T stage (P = 0.021) and larger range of tongue resection (P = 0.009), indicating restricted tongue movement in the anterior-posterior direction. The acoustic parameters analysis during the follow-up period showed that F1 and F2 were not significantly different of the patients with subtotal or total glossectomy over time. CONCLUSIONS: Speech disorders in TSCC patients is common and persistent. Less residual tongue volume led to worse speech-related QoL, indicating that surgically restoring the length of the tongue and strengthening tongue extension postoperatively may be important.

Cross-Cultural Adaptation and Validation of the Speech Handicap Index into Persian.

PURPOSE: The aim of the present study was to adapt and validate the Speech Handicap Index (SHI) into the Persian language. PATIENTS AND METHODS: The original published English version of the SHI was translated into Persian using the translation protocol and guidelines of the International Quality of Life Assessment. One hundred participants with oral and oropharyngeal cancer and 40 healthy participants completed the Persian SHI. Forty participants of the patient group completed the Persian SHI a second time after a 2-weeks period to evaluate test-retest reliability. Content validity (content validity index and content validity ratio), internal consistency (Cronbach α coefficient), test-retest reliability (intraclass correlations), and construct validity (confirmatory factor analysis) were examined. Control group and patient group values were compared to determine the clinical validity. RESULTS: A significant discrimination coefficient was found across all items, and the content and clinical validity were found to be acceptable. The Persian SHI showed a high internal consistency and test-retest reliability. The construct validity was within the acceptable range. CONCLUSIONS: The P-SHI is considered to be a valid and reliable questionnaire for speech assessment in Persian-speaking patients with head and neck cancer.

Subjective and perceptive assessment of speech/voice and swallowing function before and after radiation therapy in patients of head-and-neck squamous cell cancer.

Aim: To prospectively assess subjective and perceptive speech/voice and swallowing function before and after radiation therapy (RT) in patients of head-and-neck squamous cell cancer (HNSCC). Materials and Methods: The study cohort comprised eligible consecutive HNSCC patients planned for curative RT from April 2018 to July 2018 who consented for the study. Prospective evaluation of speech/voice and swallowing function was done before and after RT. For subjective and perceptive evaluation of speech/voice, speech handicap index (SHI) and Grade, Roughness, Asthenia, Breathiness, and Strain (GRABS) Scale was used, respectively. For subjective and perceptive evaluation of swallowing, M D Anderson Dysphagia Inventory (MDADI) and Performance Status Scale for head and neck (PSSHN) were used, respectively. All patients were taught speech/voice and swallowing exercises before RT. Statistical analysis was performed using SYSTAT version-12 (Cranes software, Bengaluru). Results: The study cohort comprised 30 patients of HNSCC with a median age of 57 years and male-to-female ratio of 4:1. The most common subsite was the oral cavity (43.33%) and a majority (76.66%) presented in the locally advanced stage. Post-RT there was significant improvement in speech/voice function (SHI P = 0.0006, GRABS score P = 0.003). Perceptive assessment of swallowing function by PSSHN showed significant improvement (P = 0.0032), but subjective assessment by MDADI showed no significant (P = 0.394) improvement until the first follow-up. Conclusion: Speech/voice function improved significantly after radiotherapy when combined with rehabilitation exercises. Swallowing function did not improve till the first follow-up. Future studies with the large number of patients and long-term follow-up are needed to document the changes in organ function.

Marathi translation, linguistic validation, and cross-cultural adaptation of speech handicap index and voice handicap index in patients of head and neck squamous cell cancer.

Background: Patient reported treatment outcomes is a better way to measure the quality of life (QOL). This study was undertaken to translate the speech handicap index (SHI) and voice handicap index (VHI) in Marathi language and its linguistic validation and cross-cultural adaptation in patients of head and neck squamous cell cancer (HNSCC). Methods: SHI and VHI were translated into Marathi with prior permission from the respective authors of original English questionnaire (RAs). The translation procedure for each tool included two forward translations (English to Marathi), the formation of first intermediate Marathi translation (FIT), two back translations (Marathi to English) of FIT, and interim Marathi translation (IT) formation. The second intermediate Marathi translation (SIT) was prepared after face validation of IT by a subject expert. Pretesting of SIT was done in 20 patients of HNSCC to validate linguistic and cross-cultural adaptation. By incorporating the patient's suggestions, the final Marathi translation was prepared and sent to primary authors for approval. Results: The grammatically and conceptually acceptable and face validated SIT was prepared and administered to HNSCC patients. The patients of the oral cavity and larynx were in SHI and VHI group, respectively (ten patients in each group). The questionnaire was well understood reflecting its linguistic and cross-cultural adaptation. Some of the patients suggested changes in a few words which were then corrected, rechecked with back translation, and final Marathi translated questionnaire was prepared. It was approved by RAs. Conclusion: Marathi translation of SHI and VHI are well accepted and comprehensible. It can be used for future studies.

Validation and Psychometric Evaluation of the Kannada Version of the Speech Handicap Index in Individuals with Oral and Oropharyngeal Cancer.

The current study aimed to adapt and validate the speech handicap index into the Kannada language, and also to investigate its psychometric properties in Kannada speaking individuals with oral and oropharyngeal cancers. This is a cross-sectional study and it was carried out in two phases. The first phase dealt with the translation of the English version of SHI into the Kannada language, and its validation on 95 healthy individuals and 25 individuals with oral or oropharyngeal cancer. The second phase dealt with the investigation of speech-related quality of life among 50 Kannada speaking individuals with oral and oropharyngeal cancers. The SHI-K has very good internal consistency (Cronbach's Alpha is 0.98) and exhibited good test-retest reliability (ICC = 0.94). The mean scores of the disordered group, for the psychosocial scores (t (118) = 25.87, p < 0.01), for speech scores (t (118) = 19.74, p < 0.01), for total SHI scores (t (188) = 26.45, p < 0.01), for overall rating (t (118) = 16.81, p < 0.01) were statistically significant and greater than the healthy group (p < 0.01). A statistically significant association was found between clinical-stage, total SHI scores, and rating [χ2 (4, N = 50) = 3.82, p = 0.02], but not for sex, tumor site, and type of treatment received. SHI-K is a valid and reliable tool to assess the speech-related quality of life of individuals with speech disorders. This tool can allow clinicians to plan better rehabilitation, and it can be used as an outcome tool for any treatment studies. The findings of the study emphasize the importance of considering patient priorities before commencing surgical or therapeutic interventions.

An investigation of the cutoff point of the English version of speech handicap index in the American total laryngectomees.

OBJECTIVES: The present article aims to identify the optimal cutoff score and the diagnostic accuracy for the English version of Speech Handicap Index (SHI) to screen out individuals with and without speech disorders in daily life. MATERIALS AND METHODS: In this cross-sectional cohort study, a volunteer sample of 104 adult patients after total laryngectomy and 99 healthy controls in the United States completed the English version of SHI online questionnaire. Sensitivity and specificity were computed for a range of cut-off values using the Receiving Operating Characteristics (ROC) analysis to establish an optimal cutoff point for the SHI. Other measures of diagnostic accuracy, such as likelihood ratios (LR), positive predictive values (PPV), and negative predictive values (NPV) were also computed. RESULTS: Patients after total laryngectomy obtained a higher score than the healthy controls on the mean scores of SHI. According to the ROC analysis, an optimal cutoff score of 17 points determined by Youden index was identified on the head and neck cancer population with a sensitivity of 92.31%, specificity of 92.31%, PPV of 90.60%, NPV of 91.75%, LR + of 9.14, and LR- of 0.09. CONCLUSIONS: The cutoff score of the English version of SHI applied on the English-speaking population in the United States demonstrated promising diagnostic accuracy.

Psychometric properties of the Italian version of the Speech Handicap Index.

OBJECTIVE: Speech impairment is common in patients affected by head and neck cancer and impact on quality of life. Therefore, specific instruments are required for its evaluation. The aim of this study is to evaluate the psychometric properties of the Italian Speech Handicap Index. METHODS: Data were obtained from 50 patients and 75 asymptomatic subjects. The study consisted of five phases: (1) item generation, (2) internal consistency and reliability analysis, (3) normative data generation, (4) validity analysis, performed by comparing the Italian Speech Handicap Index scores obtained in patients and asymptomatic subjects, and by correlating its scores with the results of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module, and (5) cut-off value. RESULTS: Internal consistency was good (Cronbach α = 0.9) and the test-retest reliability was strong. A significant difference in Italian Speech Handicap Index total score between patients and asymptomatic subjects was found. Moderate correlations between the two questionnaires were observed. A cut-off value of 14.5 demonstrated a sensitivity of 96% and a specificity of 100%. CONCLUSION: The Italian Speech Handicap Index is a reliable and valid clinical tool. Its application in everyday practice and outcome research is recommended.IMPLICATIONS FOR REHABILITATIONRehabilitation of speech in head and neck cancer patients is frequently needed, especially after surgical treatment.Speech impairment represents one of the most essential factors influencing the quality of life in head and neck cancer patients.The evaluation of the speech impairment should be performed using dedicated assessment tools.

Speech handicap index: cross-cultural adaptation and validation in European Portuguese speakers with oral and oropharyngeal cancer.

INTRODUCTION: To date, no valid outcome measure has been developed in European Portuguese (EP) to assess the opinion of the patients with oral and oropharyngeal cancer about the speech impact in his/her related quality of life. OBJECTIVES: This study aimed to cross-culturally adapt the speech handicap index (SHI) in EP and contribute to its validation in oral and oropharyngeal cancer patients. MATERIALS AND METHODS: A cross-sectional study was carried out in two phases: (i) SHI translation, back-translation, expert analysis, and pilot study; (ii) application of the EP version of the SHI (EP-SHI) to 95 patients with oral and oropharyngeal cancer and 83 gender- and age-matched healthy individuals. A total of 23 randomly chosen patients were asked to re-fill the EP-SHI questionnaire after 3 weeks. The psychometric properties (feasibility, practicability, reliability, and validity) were assessed. RESULTS: The EP-SHI version brought together expert consensus and the acceptability of 75% of the participants in the pilot study. The EP-SHI questionnaire is feasible (no missing data and floor effect < 7%), practical (an average of 5.5 min to complete), possesses internal consistency reliability (Cronbach's alpha ≥ 0.90), test-retest reliability (interclass correlation coefficient, ICC ≥ 0.90), significantly strong convergent validity with EP-voice handicap index (VHI) (rô≥0.94), distinguishes patients from healthy speakers and within the patients' group according to individual speech rating and glossectomy surgery. CONCLUSIONS: The EP-SHI is a culturally relevant, valid and reliable patient reported outcome measure (PROM), and therefore, it is appropriate to be recommended for used with oral and oropharyngeal cancer patients.

Validation of the Lithuanian Version of the Speech Handicap Index.

OBJECTIVE: The objective is to study the cultural adaptation and validation of the Speech Handicap Index (SHI) questionnaire to the Lithuanian language. METHODS: Cultural adaptation and validation of the translated Lithuanian version of the SHI (SHI-LT) was performed as described by the Scientific Advisory Committee of the Medical Outcomes Trust. The SHI-LT was completed by 46 patients after total laryngectomy and by 60 healthy subjects of the control group. Validity and reliability of the SHI-LT were evaluated. RESULTS: The SHI-LT showed a statistically significant high internal consistency and test-retest reliability (Cronbach's α = 0.96-0.98). Good validity of SHI-LT was reflected by statistically significant (P < 0.001) difference between the mean scores of the patients and control groups (74.7 ± 26.9 and 5.5 ± 6.5, respectively). No age or gender dependence of SHI-LT was found (P > 0.05). Receiver operating characteristic test indicated that SHI-LT scores exceeding 17.0 points (cutoff value) distinguish patients from healthy controls, with a sensitivity of 97.8% and specificity of 95.0%. CONCLUSION: SHI-LT is considered to be a valid and reliable speech assessment tool for Lithuanian-speaking patients after laryngectomy.

Validity and reliability of the Korean version of the Speech Handicap Index in patients with oral cavity cancer.

The aims of this study were to evaluate the cross-cultural adaptation of the Speech Handicap Index (SHI) for Korean subjects and to determine its reliability and utility in patients with oral cavity cancer. The Korean version of the SHI was administered to 50 healthy subjects and 56 patients with speech problems resulting from treatment for oral cavity cancers. The content and construct validity, internal consistency, and test-retest reliability were examined. Healthy subject and patient group scores were compared, and the Mann-Whitney U-test was used to determine discriminatory ability. The Korean version of the SHI had high internal consistency (Cronbach's alpha=0.99) and test-retest reliability for the total and subscales: total (T) 0.98, speech (S) 0.99, and psychosocial (P) 0.97. Mean scores in the healthy group were 0.5 (T), 0.2 (S), and 0.2 (P), whereas those in the patient group were 34.3 (T), 16.6 (S), and 15.5 (P). The scores differed significantly between the groups (P<0.05). The Korean version of the SHI can be a useful tool to evaluate a patient's self-perception of their speech dysfunction in daily life and to better understand postoperative speech disorders in patients with oral cavity cancer.

The Validation and Reliability of the Chinese Version of the Speech Handicap Index for Patients With Oral and Oropharyngeal Cancer.

OBJECTIVES: The purpose of this study was to investigate the validity and reliability of the translated Chinese version of the Speech Handicap Index (SHI) questionnaire for Chinese-speaking patients with oral and oropharyngeal cancer. METHODS: The original English version of the SHI was translated into Chinese. Forty-two consecutive patients with oral and oropharyngeal cancer were included in the study. All subjects were asked to complete the Chinese version of the SHI and the University of Washington Quality of Life Questionnaire (UWQOL V.04). Fifteen patients were randomly retested on both questionnaires 2 weeks later. The internal consistency, test-retest reliability, construct validity, and group validity of the Chinese version of the SHI were tested using Cronbach α, Spearman correlation coefficient (r), and Mann-Whitney U tests. Descriptive and bivariate statistics were computed, and the P value was set to 0.05. RESULTS: The Cronbach α for the total SHI, the speech domain, and the psychosocial domain were 0.96, 0.90, and 0.92, respectively. The test-retest reliability scores for the total SHI, the speech domain, the psychosocial domain, and the overall question were 0.94, 0.97, 0.90, and 0.83, respectively. To measure construct validity, Spearman correlation coefficients between different items of the SHI and the UWQOL were all >0.4, which signified a moderate to significant correlation. There were significant differences between patient groups when divided by age, clinical stage, educational level, radiotherapy, and reconstruction, on all or on parts of the various SHI domains. CONCLUSIONS: The Chinese version of the SHI is a valid and reliable tool for the speech assessment of patients with oral and oropharyngeal cancer.

Acoustic parameters of speech: Lack of correlation with perceptual and questionnaire-based speech evaluation in patients with oral and oropharyngeal cancer treated with primary surgery.

BACKGROUND: Acoustic evaluation of speech is the least explored method of speech evaluation in patients with oral cavity and oropharyngeal cancer. The purpose of this study was to explore acoustic parameters of speech and their correlation with questionnaire evaluation and perceptual evaluation in patients with oral cavity and oropharyngeal cancer. METHODS: One hundred seventeen subjects (65 consecutive patients with oral cavity and oropharyngeal cancer and 52 controls) participated in this study. Formant frequencies (by Linear Predictive Coding), Speech Handicap Index, and London Speech Evaluation scale were used for acoustic evaluation, questionnaire evaluation, and perceptual evaluation, respectively. RESULTS: Men showed significant elevation in second formant (F2) values for patients with oral cavity cancer and those who underwent surgery alone. Female patients with early T classification cancers and those who underwent surgery and chemoradiation showed significant reduction in the mean F2 values. Importantly, however, acoustic evaluation parameters did not correlate with either perceptual evaluation or questionnaire evaluation parameters, although there was moderate correlation between questionnaire evaluation and perceptual evaluation speech parameters. CONCLUSION: Acoustic evaluation modalities have no clear role in the management of patients with oral cavity and oropharyngeal cancer.