Temporal and Spectral Models as Correlates to Auditory-Perceptual Judgments of Overall Severity and Listener Comfort in Tracheoesophageal Voice.

INTRODUCTION: This study pursued two objectives: (1) to determine the potential association between listener (n = 51) judgments of 20 male tracheoesophageal speaker samples for two auditory-perceptual dimensions of voice, overall severity (OS) and listener comfort (LC); and (2) to assess the temporal and spectral acoustic correlates for these auditory-perceptual dimensions. METHODOLOGY: Three separate correlation analyses were performed to evaluate the association between OS and LC. First, scores of OS and LC from all listeners were pooled together, and then the correlation between OS and LC was computed. Second, scores of OS and LC were averaged over all listeners to derive a single estimate of OS and LC for each TE speaker sample; the correlation between the average OS and LC was then computed. Third, listener-to-listener variability in the association between OS and LC was evaluated by computing the correlation between OS and LC scores from each listener across all TE samples. Finally, two stepwise multiple regression models were created to relate the average LC score to spectral and temporal variation in the acoustic signal. RESULTS: While the pooled OS and LC scores had a moderate positive correlation (r = 0.66, p < 0.00001), the averaged OS and LC exhibited a near perfect positive correlation (r = 0.99, p < 0.00001). The significant differences between the pooled and averaged scores were explained by significant listener-to-listener variability in the association between OS and LC. OS and LC scores from 5 listeners had non-significant correlations, 10 had moderate correlations (r < 0.7), 35 listeners had high correlations (0.7 < r < 0.9), and 1 listener had a very high correlation (r < 0.9 < 1). Finally, the acoustic models created based on the spectral and temporal variations in the signal were able to account for 87.7% and 61.8% of variation in the average LC score. CONCLUSIONS: The strong correlations between OS and LC suggest that LC may, in fact, provide a more comprehensive auditory-perceptual surrogate for the voice quality of TE speakers. Although OS and LC are distinct conceptual dimensions, LC appears to have the advantage of assessing the social impact and potential communication disability that may exist in interactions between TE speakers and listeners.

A Scoping Review of Artificial Intelligence Detection of Voice Pathology: Challenges and Opportunities.

OBJECTIVE: Survey the current literature on artificial intelligence (AI) applications for detecting and classifying vocal pathology using voice recordings, and identify challenges and opportunities for advancing the field forward. DATA SOURCES: PubMed, EMBASE, CINAHL, and Scopus databases. REVIEW METHODS: A comprehensive literature search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews guidelines. Peer-reviewed journal articles in the English language were included if they used an AI approach to detect or classify pathological voices using voice recordings from patients diagnosed with vocal pathologies. RESULTS: Eighty-two studies were included in the review between the years 2000 and 2023, with an increase in publication rate from one study per year in 2012 to 10 per year in 2022. Seventy-two studies (88%) were aimed at detecting the presence of voice pathology, 24 (29%) at classifying the type of voice pathology present, and 4 (5%) at assessing pathological voice using the Grade, Roughness, Breathiness, Asthenia, and Strain scale. Thirty-six databases were used to collect and analyze speech samples. Fourteen articles (17%) did not provide information about their AI model validation methodology. Zero studies moved beyond the preclinical and offline AI model development stages. Zero studies specified following a reporting guideline for AI research. CONCLUSION: There is rising interest in the potential of AI technology to aid the detection and classification of voice pathology. Three challenges-and areas of opportunities-for advancing this research are heterogeneity of databases, lack of clinical validation studies, and inconsistent reporting.

Sarcopenia as a Predictor of Feeding Tube Placement in Individuals with Oropharyngeal Cancer.

Purpose: In oropharyngeal squamous cell carcinoma (OPSCC), systemic loss of skeletal muscle mass (SMM), or sarcopenia, is a strong prognostic predictor of survival outcomes. However, the relationship between sarcopenia and nutrition-related outcomes is not well understood. This investigation evaluated the prognostic significance of sarcopenia for feeding tube (FT) placement in a cohort of OPSCC patients. Methods and Materials: A retrospective cohort study was conducted with data collected from 194 OPSCC patients treated with definitive radiation therapy (RT) or chemoradiation therapy (CRT). Sarcopenia was assessed from computed tomography imaging at the level of the third cervical (C3) and fourth thoracic (T4) vertebrae. The prognostic nature of pretreatment sarcopenia and its relationship with FT placement was explored using logistic regression. Results: The median age of patients included was 61.0 years, and the majority were male (83%). In this patient cohort, 87.6% underwent concurrent CRT, and 30.9% received a FT over the course of treatment. Sarcopenia was identified at baseline in 72.7% of patients based on C3 SMM measurements and in 41.7% based on measures at the level of T4. Based on measures at both C3 and T4, those with sarcopenia were significantly more likely to receive a FT and had significantly worse freedom from FT placement compared with patients without sarcopenia. Sarcopenia assessed at T4 was a significant predictor of FT placement. Conclusions: SMM measured at T4 may represent a novel and practical biomarker for sarcopenia detection that is associated with the need for FT placement. These findings suggest that the detection of baseline sarcopenia could guide decision-making related to the need for nutritional support in OPSCC patients undergoing RT/CRT.

The Effect of Rating Method on Reliability of Judgments of Strain Across Populations.

PURPOSE: Variability in auditory-perceptual ratings of voice limits their utility, with the poorest reliability often noted for vocal strain. The purpose of this study was to determine whether an experimental method, called visual sort and rate (VSR), promoted stronger rater reliability than visual analog scale (VAS), for ratings of strain in two clinical populations: adductor laryngeal dystonia (ADLD) and vocal hyperfunction (VH). METHOD: Connected speech samples from speakers with ADLD and VH as well as age- and sex-matched controls were selected from a database. Fifteen inexperienced listeners rated strain for two speaker sets (25 ADLD speakers and five controls; 25 VH speakers and five controls) across four rating blocks: VAS-ADLD, VSR-ADLD, VAS-VH, and VSR-VH. For the VAS task, listeners rated each speaker for strain using a vertically oriented 100-mm VAS. For the VSR task, stimuli were distributed into sets of samples with a range of severities in each set. Listeners sorted and ranked samples for strain within each set, and final ratings were captured on a vertically oriented 100-mm VAS. Intrarater reliability (Pearson's r) and interrater variability (mean of the squared differences between a listener's ratings and group mean ratings) were compared across rating methods and populations using two repeated-measures analyses of variance. RESULTS: Intrarater reliability of strain was significantly stronger when listeners used VSR compared to VAS; listeners also showed significantly better intrarater reliability in ADLD than VH. Listeners demonstrated significantly less interrater variability (better reliability) when using VSR compared to VAS. No significant effect of population or interactions was found between listeners for measures of interrater variability. CONCLUSIONS: VSR increases intrarater reliability for ratings of vocal strain in speakers with VH and ADLD. VSR decreases variability of auditory-perceptual judgments of strain between inexperienced listeners in these clinical populations. Future research should determine whether benefits of VSR extend to voice clinicians and/or clinical settings.

End-to-end deep learning classification of vocal pathology using stacked vowels.

Objectives: Advances in artificial intelligence (AI) technology have increased the feasibility of classifying voice disorders using voice recordings as a screening tool. This work develops upon previous models that take in single vowel recordings by analyzing multiple vowel recordings simultaneously to enhance prediction of vocal pathology. Methods: Voice samples from the Saarbruecken Voice Database, including three sustained vowels (/a/, /i/, /u/) from 687 healthy human participants and 334 dysphonic patients, were used to train 1-dimensional convolutional neural network models for multiclass classification of healthy, hyperfunctional dysphonia, and laryngitis voice recordings. Three models were trained: (1) a baseline model that analyzed individual vowels in isolation, (2) a stacked vowel model that analyzed three vowels (/a/, /i/, /u/) in the neutral pitch simultaneously, and (3) a stacked pitch model that analyzed the /a/ vowel in three pitches (low, neutral, and high) simultaneously. Results: For multiclass classification of healthy, hyperfunctional dysphonia, and laryngitis voice recordings, the stacked vowel model demonstrated higher performance compared with the baseline and stacked pitch models (F1 score 0.81 vs. 0.77 and 0.78, respectively). Specifically, the stacked vowel model achieved higher performance for class-specific classification of hyperfunctional dysphonia voice samples compared with the baseline and stacked pitch models (F1 score 0.56 vs. 0.49 and 0.50, respectively). Conclusions: This study demonstrates the feasibility and potential of analyzing multiple sustained vowel recordings simultaneously to improve AI-driven screening and classification of vocal pathology. The stacked vowel model architecture in particular offers promise to enhance such an approach. Lay Summary: AI analysis of multiple vowel recordings can improve classification of voice pathologies compared with models using a single sustained vowel and offer a strategy to enhance AI-driven screening of voice disorders. Level of Evidence: 3.

Self-perception of fatigue in individuals diagnosed with head and neck cancer.

PURPOSE: Head and neck cancer (HNCa) presents numerous challenges secondary to treatment. While there is substantial clinical awareness to the range of challenges demonstrated in this population, information on the impact of post-treatment fatigue is limited. This study investigated the degree of perceived fatigue in those treated for HNCa. METHODS: The study was a cross-sectional, self-report, survey design. Adult participants (n = 47) completed a series of three questionnaires; two validated fatigue measures - the Fatigue Screening Inventory (FSI) and the Multidimensional Fatigue Inventory (MFI-20) and a general health-related quality of life measure the European Organisation of Research on the Treatment of Cancer - Quality of Life Questionnaire (EORTC-QLQC30) and the head and neck site specific module (QLQ - H&N 35) were administered. RESULTS: Of the 47 participants, more than half (55%) were identified as having clinically significant self-reported levels of fatigue. Correlational analysis revealed an inverse relationship between fatigue and overall health-related quality of life (HRQOL) implying that as fatigue increases, one's perceived HRQOL decreases. CONCLUSIONS: These data suggest that efforts to proactively screen for and index fatigue and seek anticipatory interventions may benefit both short- and long-term HRQOL outcomes in those diagnosed with HNCa. LEVEL OF EVIDENCE: IV.

Auditory-Perceptual and Pupillometric Evaluation of Vocal Roughness and Listening Effort in Tracheoesophageal Speech.

OBJECTIVES: This study evaluated auditory-perceptual judgments of perceived vocal roughness (VR) and listening effort (LE) along with pupillometric responses in response to speech samples produced by tracheoesophageal (TE) talkers. METHODS: Twenty normal-hearing, naive young adults (eight men and twelve women) served as listeners. Listeners were divided into two groups: (1) a with-anchor (WA) group (four men and six women) and (2) a no-anchor (NA) group (four men and six women). All were presented with speech samples produced by twenty TE talkers; listeners evaluated two auditory-perceptual dimensions-VR and LE-using visual analog scales. Anchors were provided to the WA group as an external referent for their ratings. In addition, during the auditory-perceptual task, each listener's pupil reactions also were recorded with peak pupil dilation (PPD) measures extracted as a physiologic indicator associated with the listening task. RESULTS: High interrater reliability was obtained for both the WA and NA groups. High correlations also were observed between auditory-perceptual ratings of roughness and LE, and between PPD values and ratings of both dimensions for the WA group. The inclusion of an anchor during the auditory-perceptual task improved interrater reliability ratings, but it also imposed an increased demand on listeners. CONCLUSIONS: Data obtained offer insights into the relationship between subjective indices of voice quality (ie, auditory-perceptual evaluation) and physiologic responses (PPD) to the abnormal voice quality that characterizes TE talkers. Furthermore, these data provide information on the inclusion/exclusion of audio anchors and potential increases in listener demand in response to abnormal voice quality.

Adoption and Utilization of Heat and Moisture Exchangers (HMEs) in the Tracheostomy Patient.

OBJECTIVE: Management of tracheostomized patients typically involves a conventional external humidification system (CEHS). CEHS are noisy, negatively impact patient mobility, and increases costs. Additionally, they prevent phonation and the ability to cough. Alternatively, heat and moisture exchange (HME) devices have been used in laryngectomized patients. We present an institutional quality improvement project exploring the use and efficacy of an HME device following tracheostomy. METHODS: Health care professionals and stakeholders from multiple disciplines were identified: otolaryngology, nursing, administration, case management, and speech-language pathology. The focus was on an otolaryngology acute care nursing unit. Protocols for product acquisition, nursing education, care flowcharts, and discharge planning were established. Efficacy was assessed by tracking patient pulmonary status, nursing notes, and questionnaires. RESULTS: Seventy-one tracheostomized patients were enrolled. Two patients (2.8%) were unable to tolerate the HME. There were no complications from mucous plugging or respiratory distress. Eighty-nine percent of nursing staff surveyed preferred the use of an HME device over CEHS, particularly for ease of patient mobility. Additional favorable findings were patient satisfaction, cost savings, reduced noise, communication, and ease of discharge education and planning. DISCUSSION: Replacing CEHS with HMEs provides distinct advantages, with a positive impact on patients, family members, and health care personnel. Resistance to changing from the traditional standard of care was alleviated with education, focused training, and positive outcomes. IMPLICATIONS FOR PRACTICE: These data indicate that an HME device is safe and offers advantages to both patients and nurses over traditional CEHS.

Usage of Heat and Moisture Exchange Devices, Virtual Visits, Masking, and Vaccinations Among People With a Laryngectomy During COVID-19.

PURPOSE: This study described the COVID-19 risk mitigation actions of people with a total laryngectomy (TL) during the pandemic. METHOD: An online survey was completed by 215 people with a TL who lived in the United States. The survey was open from December 1, 2021, to January 15, 2022. RESULTS: There was a significant increase in frequency of heat and moisture exchange (HME) device use during the pandemic compared with pre-COVID-19. Frequency of HME use was significantly greater for those who were vaccinated and those who had at least one clinical visit with their speech-language pathologist (SLP). The use of virtual visits increased from 9% pre-COVID-19 to 37% during the pandemic. Seventy percent of respondents were "satisfied" or "very satisfied" with virtual visits and 51% judged them "as good as in-person." Eighty percent were vaccinated for COVID-19 and 75% received a booster. One third reported that they did not wear mask over the face or over the tracheostoma. Twenty percent had tested positive for COVID-19 with 70% of these people requiring hospitalization. CONCLUSIONS: HME use and virtual SLP visits increased during the pandemic and the vaccination rate was high among this group of respondents. Overall, there were still large percentages of people with a TL who were not using an HME, not vaccinated, and did not wear a mask. SLPs should consider reaching out directly to their TL caseload, particularly those not yet seen during the pandemic, to support uptake of COVID-19 mitigation activities specific to people with a TL as the pandemic persists.

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.

Sarcopenia in head and neck cancer: A scoping review.

OBJECTIVES: In those undergoing treatment for head and neck cancer (HNC), sarcopenia is a strong prognostic factor for outcomes and mortality. This review identified working definitions and methods used to objectively assess sarcopenia in HNC. METHOD: The scoping review was performed in accordance with Arksey and O'Malley's five-stage methodology and the Joanna Briggs Institute guidelines. INFORMATION SOURCES: Eligible studies were identified using MEDLINE, Embase, Scopus, Cochrane Library, and CINAHL databases. STUDY SELECTION: Inclusion criteria represented studies of adult HNC patients in which sarcopenia was listed as an outcome, full-text articles written in English, and empirical research studies with a quantitative design. DATA EXTRACTION: Eligible studies were assessed using a proprietary data extraction form. General information, article details and characteristics, and details related to the concept of the scoping review were extracted in an iterative process. RESULTS: Seventy-six studies published internationally from 2016 to 2021 on sarcopenia in HNC were included. The majority were retrospective (n = 56; 74%) and the prevalence of sarcopenia ranged from 3.8% to 78.7%. Approximately two-thirds of studies used computed tomography (CT) to assess sarcopenia. Skeletal muscle index (SMI) at the third lumbar vertebra (L3) (n = 53; 70%) was the most prevalent metric used to identify sarcopenia, followed by SMI at the third cervical vertebra (C3) (n = 4; 5%). CONCLUSIONS: Currently, the most effective strategy to assess sarcopenia in HNC depends on several factors, including access to resources, patient and treatment characteristics, and the prognostic significance of outcomes used to represent sarcopenia. Skeletal muscle mass (SMM) measured at C3 may represent a practical, precise, and cost-effective biomarker for the detection of sarcopenia. However, combining SMM measurements at C3 with other sarcopenic parameters-including muscle strength and physical performance-may provide a more accurate risk profile for sarcopenia assessment and allow for a greater understanding of this condition in HNC.

Symptom Expression Across Voiced Speech Sounds in Adductor Laryngeal Dystonia.

OBJECTIVES: Differential diagnosis for adductor laryngeal dystonia (AdLD) is often carried out by comparing symptom expression during sentences with either all voiced or voiced and voiceless consonants. However, empirical research examining the effects of phonetic context on symptoms is sparse. The purpose of this study was to examine whether symptom probabilities varied across voiced speech segments in an all-voiced sentence, and whether this variability was systematic with respect to phonetic features. METHODS: Eighteen speakers with AdLD read aloud a sentence comprised entirely of voiced speech sounds. Speech segment boundaries and AdLD symptoms (phonatory breaks, frequency shifts, and creak) were labeled separately, and speech segments were coded as symptomatic or asymptomatic based on their temporal overlap. Generalized linear mixed effects models with a binomial outcome variable were used to compare the probability of symptom expression across: 1) all speech segments in the sentence, and 2) four speech sound classes (vowels, approximants, nasals, and obstruents). RESULTS: Significant symptom variability was found across voiced speech segments in the sentence. Furthermore, the estimated probability of a symptom occurring on vowels and approximants was significantly greater than that of nasals and obstruents. CONCLUSION: These results indicate that AdLD symptoms are not uniformly distributed across voiced speech segments with systematic variation across speech sound classes.To explain these findings, future work should investigate how the complex interactions between the vocal tract articulators and glottal configurations may influence symptom expression in this population.

Has Esophageal Speech Returned as an Increasingly Viable Postlaryngectomy Voice and Speech Rehabilitation Option?

PURPOSE: The literature on postlaryngectomy voice and speech rehabilitation is long-standing. Although multiple rehabilitation options have existed over the years, the acquisition and use of esophageal speech (ES) has decreased significantly over the past 40 years. This reduction coincides with the increased application of tracheoesophageal puncture (TEP) voice restoration. The literature suggests that voice acquisition failures observed secondary to TEP may represent a similar phenomenon that led to ES acquisition failures. METHOD: A comprehensive review of the literature on ES and TEP voice/speech was conducted. Specific attention was directed toward information on ES and TEP speech failures. Information on pharyngoesophageal segment (PES) spasm in the context of ES and TEP voicing failures was of specific importance. RESULTS: Similarities between voicing failures with both ES and TEP were identified. In order to resolve spasm in TEP speech, proactive efforts to eliminate it were undertaken, and regardless of the method used, voicing improvements were observed. These data suggest that both ES and TEP speech acquisition failures may be related to the same control mechanisms influencing the PES. CONCLUSIONS: The elimination of PES spasm provides evidence that justifies the reconsideration of ES. Consequently, ES may return as an increasingly viable postlaryngectomy voice and speech rehabilitation option.

Spectral Aggregate of the High-Passed Fundamental Frequency and Its Relationship to the Primary Acoustic Features of Adductor Laryngeal Dystonia.

OBJECTIVE: Currently, no clinically feasible objective measures exist that are specific to the signs of adductor laryngeal dystonia (LD), deterring effective diagnosis and treatment. This project sought to establish concurrent validity of a new automated acoustic outcome measure, designed to be specific to adductor laryngeal dystonia (AdLD): the spectral aggregate of the high-passed fundamental frequency contour (SAHf o). METHOD: Twenty speakers with AdLD read voiced phoneme-loaded (more symptomatic) and voiceless phoneme-loaded (less symptomatic) sentences. LD discontinuities (defined as phonatory breaks, frequency shifts, and creak), the acoustic ramifications of laryngeal spasms, were manually identified. The frequency content of the f o contour was examined as a function of time, and content above 1000 Hz was summed to automatically calculate SAHf o. Multiple linear regression analysis was applied to SAHf o based on LD discontinuities and sentence type (voiced or voiceless phoneme-loaded). RESULTS: The regression model accounted for 41.1% of the variance in SAHf o. Both the LD discontinuities and sentence type were statistically related to SAHf o. CONCLUSION: Results of this study provide evidence of concurrent validity. SAHf o is an automatic outcome measure specific to acoustic signs of AdLD that may be useful to track treatment progress.

Image representation of the acoustic signal: An effective tool for modeling spectral and temporal dynamics of connected speech.

Recent studies have advocated for the use of connected speech in clinical voice and speech assessment. This suggestion is based on the presence of clinically relevant information within the onset, offset, and variation in connected speech. Existing works on connected speech utilize methods originally designed for analysis of sustained vowels and, hence, cannot properly quantify the transient behavior of connected speech. This study presents a non-parametric approach to analysis based on a two-dimensional, temporal-spectral representation of speech. Variations along horizontal and vertical axes corresponding to the temporal and spectral dynamics of speech were quantified using two statistical models. The first, a spectral model, was defined as the probability of changes between the energy of two consecutive frequency sub-bands at a fixed time segment. The second, a temporal model, was defined as the probability of changes in the energy of a sub-band between consecutive time segments. As the first step of demonstrating the efficacy and utility of the proposed method, a diagnostic framework was adopted in this study. Data obtained revealed that the proposed method has (at minimum) significant discriminatory power over the existing alternative approaches.

Supporting Patient Autonomy in Shared Decision Making for Individuals With Head and Neck Cancer.

PURPOSE: Management of head and neck cancer (HNC) can result in substantial long-term, multifaceted disability, leading to significant deficits in one's functioning and quality of life (QoL). Consequently, treatment selection is a challenging component of care for patients with HNC. Clinical care guided by shared decision making (SDM) can help address these decisional challenges and allow for a more individualized approach to treatment. However, due in part to the dominance of biomedically oriented philosophies in clinical care, engaging in SDM that reflects the individual patient's needs may be difficult. CONCLUSIONS: In this clinical focus article, we propose that health care decisions made in the context of biopsychosocial-framed care-one that contrasts to decision making directed solely by the biomedical model-will promote patient autonomy and permit the subjective personal values, beliefs, and preferences of individuals to be considered and incorporated into treatment-related decisions. Consequently, clinical efforts that are directed toward biopsychosocial-framed SDM hold the potential to positively affect QoL and well-being for individuals with HNC.

Influence of Phonatory Break Duration and Pause Time on Auditory-Perceptual Ratings of Speech Aceptability and Listener Comfort in Adductor-Type Laryngeal Dystonia.

INTRODUCTION: This study empirically evaluated the influence of phonatory break duration and pause time on auditory-perceptual measures of speech produced by 26 adult speakers diagnosed with adductor-type laryngeal dystonia (AdLD). TYPE OF STUDY: Experimental. METHODS: Fifteen inexperienced, young adult normal-hearing listeners provided ratings of speech acceptability and listener comfort for samples of running speech. Four phonatory break and pause time conditions were assessed using visual analog scaling methods. All stimuli were randomized for presentation and listeners were presented with experimental stimuli in a counterbalanced manner. RESULTS: Results indicate that the duration of phonatory breaks directly influenced listener ratings of speech acceptability (P < 0.001) and listener comfort (P < 0.001), with significant differences between original and modified recordings for both. Speech acceptability and listener comfort ratings were strongly correlated across all timing conditions (r = 0.85-0.97). CONCLUSIONS: The duration of phonatory breaks and pauses have significantly influence judgments of speech acceptability and listener comfort for AdLD. This suggests that temporal factors such as phonatory break duration and pause time in AdLD may carry substantial negative impact on listeners' perception relative to other auditory-perceptual features that co-exist in the signal.

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 Impact of COVID-19 on Speech-Language Pathologists Engaged in Clinical Practices With Elevated Coronavirus Transmission Risk.

Purpose This study assessed and described potential clinical practice changes secondary to COVID-19 that emerged as an early response to the pandemic for speech-language pathologists (SLPs) engaged in voice, alaryngeal, and swallowing activities that may increase the risk of virus transmission. Method SLPs from the United States and Canada (n = 665) who were engaged in clinical activities that might elevate the risk of COVID-19 exposure completed an online survey regarding their clinical practices. Topics assessed included potential clinical service modifications, COVID-19 testing and health, and potential financial impacts in the early time period of the pandemic. Results The percentage of SLPs completing the most endoscopic procedures prepandemic (≥ 10/week) was reduced from 39% of respondents to 3% due to the pandemic. Those who completed the most tracheoesophageal puncture voice prosthesis changes (≥ 5/week) reported a reduction in frequency from 24% to 6%. Twenty-five percent of SLPs reported that they were tested for COVID-19, and 6% reported a positive result. Descriptive statistics suggest that COVID-19 testing rates of SLPs, the percentage of SLPs experiencing a financial impact, and the percentage who were furloughed varied across SLP work setting. Conclusions These findings provide the first data characterizing the impact on COVID-19 on clinical practice for SLPs engaged in procedures such as endoscopy and laryngectomy care. The results indicate that, as frontline workers, SLPs were directly impacted in their practice patterns, personal health, safety, and financial security, and that these reported impacts occurred differently across SLP work settings.

Comprehensive metrics for evaluating surgical microscope use during tympanostomy tube placement.

PURPOSE: Learning to use a surgical microscope is a fundamental step in otolaryngology training; however, there is currently no objective method to teach or assess this skill. Tympanostomy tube placement is a common otologic procedure that requires skilled use of a surgical microscope. This study was designed to (1) implement metrics capable of evaluating microscope use and (2) establish construct validity. STUDY DESIGN: This was a prospective cohort study. METHODS: Eight otolaryngology trainees and three otolaryngology experts were asked to use a microscope to insert a tympanostomy tube into a cadaveric myringotomy in a standardized setting. Microscope movements were tracked in a three-dimensional space, and tracking metrics were applied to the data. The procedure was video-recorded and then analyzed by blinded experts using operational metrics. Results from both groups were compared, and discriminatory metrics were determined. RESULTS: The following tracking metrics were identified as discriminatory between the trainee and expert groups: total completion time, operation time, still time, and jitter (movement perturbation). Many operational metrics were found to be discriminatory between the two groups, including several positioning metrics, optical metrics, and procedural metrics. CONCLUSIONS: Performance metrics were implemented, and construct validity was established for a subset of the proposed metrics by discriminating between expert and novice participants. These discriminatory metrics could form the basis of an automated system for providing feedback to residents during training while using a myringotomy surgical simulator. Additionally, these metrics may be useful in guiding a standardized teaching and evaluation methodology for training in the use of surgical microscopes.