The Relationship Between Acoustic Signal Typing and Perceptual Evaluation of Tracheoesophageal Voice Quality for Sustained Vowels.

OBJECTIVES: To investigate the relationship between acoustic signal typing and perceptual evaluation of sustained vowels produced by tracheoesophageal (TE) speakers and the use of signal typing in the clinical setting. METHODS: Two evaluators independently categorized 1.75-second segments of narrow-band spectrograms according to acoustic signal typing and independently evaluated the recording of the same segments on a visual analog scale according to overall perceptual acoustic voice quality. The relationship between acoustic signal typing and overall voice quality (as a continuous scale and as a four-point ordinal scale) was investigated and the proportion of inter-rater agreement as well as the reliability between the two measures is reported. RESULTS: The agreement between signal type (I-IV) and ordinal voice quality (four-point scale) was low but significant, and there was a significant linear relationship between the variables. Signal type correctly predicted less than half of the voice quality data. There was a significant main effect of signal type on continuous voice quality scores with significant differences in median quality scores between signal types I-IV, I-III, and I-II. CONCLUSIONS: Signal typing can be used as an adjunct to perceptual and acoustic evaluation of the same stimuli for TE speech as part of a multidimensional evaluation protocol. Signal typing in its current form provides limited predictive information on voice quality, and there is significant overlap between signal types II and III and perceptual categories. Future work should consider whether the current four signal types could be refined.

A prospective, randomized comparative study of patient perceptions and preferences of two types of indwelling voice prostheses.

BACKGROUND: Technical and device life issues are frequently the focus of post-laryngectomy rehabilitation studies examining indwelling voice prostheses. Patient perceptions and preferences are considered less often. AIMS: To determine patient perceptions of two indwelling voice prostheses across parameters relating to device use and maintenance and to determine what factors contribute to patient preferences. METHODS & PROCEDURES: In a randomized, cross-over study, 31 laryngectomy patients completed a 3-week trial of both the new indwelling Provox Vega and a comparator device, the Blom-Singer Classic Indwelling. Patient perceptions of the insertion process, cleaning and care, and voicing were explored after each trial. At the end, overall preference and factors influencing device preference were examined. OUTCOME & RESULTS: At the conclusion of the crossover trial, a significantly higher proportion of patients felt voice effort, overall voicing, bloating, and ease and effectiveness of cleaning were superior for the Provox Vega. No preference was noted for insertion processes. Overall device preference was influenced by improved voicing followed by cleaning and care. CONCLUSIONS & IMPLICATIONS: Patients do not perceive all indwelling devices as equal and should have the opportunity to trial different devices to find the best device for their needs.

Perceptual characteristics of tracheoesophageal speech production using the new indwelling Provox Vega voice prosthesis: a randomized controlled crossover trial.

BACKGROUND: The objective of this study was to determine if the design enhancements incorporated into the new Provox Vega Indwelling Voice prostheses result in any positive benefits in vivo. METHODS: Using a randomized, crossover study design, 31 participants using tracheoesophageal speech postlaryngectomy completed a 3-week trial of the Provox Vega and a comparator device. Main outcome measures included patient perceptions of vocal effort and quality using each device, and perceptual judgments of voice quality produced. RESULTS: The majority of patients (72%) indicated the Provox Vega gave them overall better voice quality and 52% felt they required less effort to phonate. Voice samples produced with the Provox Vega were also perceived by listeners to be significantly (p < .05) less strained, easier to understand, produced with less effort, and the better speech sample overall. CONCLUSION: Results support that the aerodynamic improvements incorporated in the design of the new Provox Vega facilitate enhanced voice and speech qualities.

Trismus in head and neck cancer patients in Sweden: incidence and risk factors.

BACKGROUND: The aim was to retrospectively investigate trismus (reduced mandible mobility) development in specified head and neck (H&N) cancer diagnosis according to different radiotherapy dosage regimens. MATERIAL/METHODS: Sixty-nine out of 246 patients with different H&N cancer diagnoses and available maximum interincisal opening (MIO) measurements before and after treatment were analyzed according to age, gender, radiation dose, tumor site and stage, and Karnofsky Performance Status Scale index. MIO was measured over time (range: 3-48 months), with a cutoff criterion for trismus of 35 mm. RESULTS: Overall, 42% of the patients had post-treatment MIO <35 mm, and trismus incidence was highest in patients treated for parotid gland tumors followed by those treated for nasopharyngeal cancers. The mean MIO values at baseline were significantly different (p=0.0078) between patients who developed trismus (i.e. MIO <35 mm; mean: 43 mm) and those who did not (mean: 51 mm). The trismus patients also had significantly larger tumors (p=0.0437), poorer physical function before start of treatment (p=0.0344), and had more often received a higher total tumor radiation dose (p=0.0418). CONCLUSIONS: This study reports a high incidence of trismus in H&N cancer patients after treatment. Furthermore, it was found that poor physical function before the start of treatment and high external beam radiation therapy (EBRT) dosages (>50 Gy) were related to significantly more trismus. Future prospective studies are needed to provide a better understanding of different risk factors associated with trismus development, the impact on health-related quality of life, and the effects of early treatment.

Acoustic analysis of the voiced-voiceless distinction in Dutch tracheoesophageal speech.

PURPOSE: Confusions between voiced and voiceless plosives and voiced and voiceless fricatives are common in Dutch tracheoesophageal (TE) speech. This study investigates (a) which acoustic measures are found to convey a correct voicing contrast in TE speech and (b) whether different measures are found in TE speech than in normal laryngeal (NL) speech. The main focus was on plosives. METHOD: Nine TE and 5 NL speakers were included in this study. Fourteen acoustic measures were selected and analyzed. Comparisons were made between voiced and voiceless for the groups separately and between TE and NL speakers. Conditional inference trees were used to establish the most important distinguishing cue. RESULTS: TE speakers do not differ significantly from NL speakers, except for pitch-related measures. For plosives, all measures distinguished between voiced and voiceless for both speaker groups. The main distinguishing measure for the plosives was relative phonation time in the closure. CONCLUSIONS: TE and NL speakers differ less in the way the voiced-voiceless distinction is conveyed than expected. Further research is needed to show whether the main acoustic cue is also perceptually most relevant.

The effect of a Heat and Moisture Exchanger (Provox HME) on pulmonary protection after total laryngectomy: a randomized controlled study.

The goal of this randomized controlled study was to investigate the effect of Heat and Moisture Exchanger use on pulmonary symptoms and quality of life aspects in laryngectomized patients. Eighty laryngectomized patients were included and randomized into an HME and Control group. The effect of the HME was evaluated by means of Tally Sheets and Structured Questionnaires. The results showed a significant decrease in the frequency of coughing, forced expectoration, and stoma cleaning in the HME group. There were trends for the prosthetic speakers to report more fluent speech with the HME and for the HME group to report fewer sleeping problems. In conclusion, this study, performed in Poland, confirms the results of previous studies performed in other countries, showing that pulmonary symptoms decrease significantly with HME use and that related aspects such as speech and sleeping tend to improve, regardless of country or climate.

Acoustic signal typing for evaluation of voice quality in tracheoesophageal speech.

SUMMARY: Because of the aperiodicity of many tracheoesophageal voices, acoustic analysis of the tracheoesophageal voice is less straightforward than that of the normal voice. This study presents the development and testing of an acoustic signal typing system based on visual inspection of a narrow-band spectrogram that can be used by researchers for classification of voice quality in tracheoesophageal speech. In addition to this classification system, a selection of acoustic measures [median fundamental frequency, standard deviation of fundamental frequency, jitter, percentage of voiced (%Voiced), harmonics-to-noise ratio (HNR), glottal-to-noise excitation (GNE) ratio, and band energy difference (BED)] was computed to provide more insight into the acoustic components of tracheoesophageal voice quality. For clinical relevance, relationships between the acoustic signal types and an overall judgment of the voice were investigated as well. Results showed that the four acoustic signal types form a good basis for performing more acoustic analyses and give a good impression of the overall quality of the voice.

First clinical experience with a new non-indwelling voice prosthesis (Provox NID) for voice rehabilitation after total laryngectomy.

CONCLUSION: The new Provox NID non-indwelling voice prosthesis investigated in this study provides a good option for laryngectomized patients using non-indwelling voice prostheses and can potentially improve safety and increase patients' satisfaction with their voice and speech. OBJECTIVE: To investigate the feasibility of and patient satisfaction with the Provox NID non-indwelling voice prosthesis. MATERIAL AND METHODS: Pre- and post-study questionnaires were used to evaluate the patients' former voice prosthesis and the Provox NID voice prosthesis. In addition, measurements of pull-out force, maximum phonation time and loudness were made for both voice prostheses. In vitro measurements of airflow characteristics were also made. Following a 6-week trial, all patients provided feedback on the new voice prosthesis and the results were used to further improve the Provox NID. This final version of the new voice prosthesis was subsequently trialled and evaluated by 10 patients 6 months later. RESULTS: Overall results showed that patient satisfaction with the Provox NID non-indwelling voice prosthesis was favourable. The pull-out force for the new prosthesis was significantly higher than that for the formerly used prosthesis and its aerodynamic characteristics were better.

Anatomical and functional correlates of voice quality in tracheoesophageal speech.

The purpose of the current study was to assess the anatomic and functional correlates of voice quality in tracheoesophageal speech, with dynamic imaging studies of the neoglottis. Videofluoroscopy (providing a lateral view), digital high-speed endoscopy (providing a "birds-eye" view), and their relationships with perceptual evaluations of voice quality were investigated. Several significant relationships were found. Imaging with videofluoroscopy revealed that the following anatomic and functional parameters (established during phonation) are related to voice quality: presence of a neoglottic bar, regurgitation of barium, tonicity of the neoglottis, and minimal neoglottic distance. Furthermore, the index of the increase of the maximal subneoglottic distance from rest to phonation also showed a significant relationship with voice quality. Imaging with digital high-speed endoscopy revealed features relevant to voice quality, including amount of saliva, visibility of the origin of the neoglottis, shape of the neoglottis, and regularity of the vibration. Knowledge of the anatomic and functional correlates of tracheoesophageal voice quality provides prerequisite information for future (phono-) surgical and/or clinical improvements to the voice quality of postlaryngectomy (prosthetic) voice production.