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Objective: This study aimed to report on the UK rate of surgical voice restoration usage and investigate the factors that influence its uptake. Method: A national multicentre audit of people with total laryngectomy was completed over a six-month period (March to September 2020) in response to the coronavirus disease 2019 pandemic. This study is a secondary analysis of the data collected, focusing on the primary communication methods used by people with total laryngectomy. Results: Data on surgical voice restoration were available for 1196 people with total laryngectomy; a total of 852 people with total laryngectomy (71 per cent) used surgical voice restoration. Another type of communication method was used by 344 people. The factors associated with surgical voice restoration in the multiple regression analysis were sex (p = 0.003), employment (employed vs not employed, p < 0.001) and time post-laryngectomy (p < 0.001). Conclusion: This study provides an important benchmark for the current status of surgical voice restoration usage across the UK. It found that 71 per cent of people with total laryngectomy used surgical voice restoration as their primary communication method. [ABSTRACT FROM AUTHOR]

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. 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. 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. The cutoff score of the English version of SHI applied on the English-speaking population in the United States demonstrated promising diagnostic accuracy. [ABSTRACT FROM AUTHOR]

To conduct a systematic review of the use and results of the Provox®VegaTMXtraSealTM in the prevention of periprosthetic leakage and to propose a management protocol for this voice prosthesis. Systematic search based on the PRISMA Statement during February 2020. Keywords were double flange, periprosthetic leakage, voice prosthesis, and laryngectomy. Four articles with 315 voice prosthesis (94 XtraSeal and 221 controls) in 55 patients were found. The XtraSeal mean duration was 114.28 ± 73.2 (CI 95%, 98.29–130.26) days compared to 102.98 ± 17.74 (CI 95%, 100.62–105.35) days of the control group. Out of 266 replacements, endoprosthetic leakage was the most frequent cause in both groups (62.41%). Periprosthetic leaks were less frequent in the XtraSeal (9.62%) than in the control group (22.43%). The XtraSeal could be effective in preventing periprosthetic leakage and lengthening the time between replacements. Studies with a robust methodology are necessary to confirm these results. Managing voice prosthesis is complex and requires a multidisciplinary and systematic approach by experienced professionals to reduce replacements and complications. Incorrect placement of the XtraSeal could cause a foreign body reaction and consequently inflammation, extrusion, or pressure lesions. The Tower of Hercules protocol: (1) Measurement of the tracheoesophageal fistula using the Provox® Measure, (2) Minimization of XtraSeal slack by avoiding the complete visualization of the prosthesis' blue ring, (3) Nasofibroscopic examination of the oesophageal wall confirming both flanges are in correct position; could prevent or minimize complications derived from the use of the XtraSeal. [ABSTRACT FROM AUTHOR]

Introduction: The Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) is a 35-item patient-reported questionnaire developed to address the communication needs of patients with laryngectomies. The aim was to translate, cross-culturally adapt, and validate the Croatian version. Methods: The SECEL was translated from English by two independent translators and back-translated by a native speaker, after which it was approved by an expert committee. The Croatian version of the Self-Evaluation of Communication Experiences after Laryngectomy questionnaire (SECEL:HR) was filled in by 50 laryngectomised patients who had completed their oncological treatment a year prior to inclusion in the study. Patients also filled in the Voice Handicap Index (VHI) and the Short Form Health Survey (SF-36) on the same day. All patients completed the SECEL:HR twice, the second time being 2 weeks after the initial test. Maximum phonation time and diadochokinesis of articulation organs were used for objective assessment. Results: Among the Croatian patients, the questionnaire was well-accepted and demonstrated good test-retest reliability and internal consistency for two out of three subscales. The correlations between VHI, SF-36, and SECEL:HR were moderate to strong. There were no significant differences between patients who are using oesophageal speech, tracheoesophageal speech, or the electrolarynx based on the SECEL:HR. Conclusion: Preliminary findings of the research indicate that the Croatian version of the SECEL has sufficient psychometric qualities, high reliability, and good internal consistency, with a Cronbach's alpha of 0.89 for the total score. The Croatian version of SECEL can be recommended as a reliable and clinically valid measure for the assessment of substitution voices in Croatian-speaking patients. [ABSTRACT FROM AUTHOR]

This study aimed to assess the intelligibility of so-called 'pseudo-whispered speech' (pseudo-WS), as produced without voice nor pulmonic airstream by some alaryngeal patients prior to rehabilitation. Several perception tests were submitted to three experienced clinicians and three naive listeners, relying on the speech samples of 20 French native speakers: 10 alaryngeal speakers, solely using pseudo-WS when starting speech therapy up to six months after total laryngectomy, and 10 control speakers, recorded in the closest speech mode available, whispered speech (WS). Experts were asked to identify consonants (C) in the /a/+C+/a/ context and to rate intelligibility, unintended additive noise, and fluency on a likert-scale, while naive listeners completed a quantitative test of intelligibility. Intelligibility of WS was found to be high, with scores ranging from 46.33/54 to 53.67/54 (median 52.5, interquartile range 2.33) for the quantitative test, and segmental intelligibility ranging from 68.75% to 94.79% (median 87.5, interquartile range 17.71). Segmental confusion affected voicing in favour of unvoiced consonants, as previously reported in the literature. By contrast, intelligibility of pseudo-WS was found to be poor, with scores ranging from 1/54 (unintelligibility) to 28.33/54 (median 8.66, interquartile range 14.67) for the quantitative test, and segmental intelligibility ranging from 3.13% to 28.13% (median 9.24, interquartile range 14.58). Segmental intelligibility was not uniformly affected: stops, labials and unvoiced consonants were better identified than other categories. Finally, a significant correlation was found between global intelligibility and articulatory precision, while unintended additive noise and fluency seemed to play no role. [ABSTRACT FROM AUTHOR]

Background: After total laryngectomy, surgical voice restoration is used to establish communication via tracheoesophageal voice prosthesis. Once voice is established, there is a paucity of information on what speech and language therapists (SLTs) should do to improve tracheoesophageal voice quality to ensure functional communication. No existing surveys or studies investigate this specific question. There is also a disconnect between guidelines, knowledge and clinical practice, whereby clinical guidelines stipulate the requirement for SLT intervention, but do not detail what this entails in the rehabilitation context. Aims: (1) To advance understanding of current clinical practice beyond voice prosthesis management and care. (2) To explore what approaches are implemented in clinical practice across the UK and Republic of Ireland to rehabilitate tracheoesophageal voice. (3) To investigate the barriers and facilitators to provision of tracheoesophageal voice therapy. Methods & Procedures: A self‐administered 10‐min online survey was developed using Qualtrics software and piloted before dissemination. Survey development was informed by the Behaviour Change Wheel to identify barriers, facilitators and additional factors contributing to SLTs' provision of voice therapy to tracheoesophageal speakers. The survey was disseminated via social media and professional networks. Eligibility criteria included SLTs with at least one year post‐registration experience and with experience of working with laryngectomy in the past 5 years. Descriptive statistics were used to analyse closed answer questions. Open question responses were analysed using content analysis. Outcomes & Results: The survey received 147 responses. Participants were representative of the head and neck cancer SLT workforce. SLTs believe that tracheoesophageal voice therapy is an important aspect of laryngectomy rehabilitation; however, there was a lack of knowledge about therapy approaches and insufficient resources for implementing therapy. SLTs expressed a desire for more training, specific guidelines and a stronger evidence base to inform clinical practice. Some SLTs expressed feelings of frustration and lack of acknowledgement for the specialist skills required to undertake laryngectomy rehabilitation and tracheoesophageal work in general. Conclusions & Implications: The survey identifies the need for a robust training approach and detailed clinical guidelines to promote consistent practice across the profession. The evidence base within this clinical area is emergent, hence there is a need for increased research and clinical audit to inform practice. Under‐resourcing was highlighted, which should be considered in service planning to ensure that adequate staff, access to expert practitioners or time ring‐fenced for therapy are available for tracheoesophageal speakers to receive the support they require. WHAT THIS PAPER ADDS: What is already known on this subject: Total laryngectomy results in life‐altering changes to communication. Clinical guidelines advocate for speech and language therapy intervention; however, there is no clear information on what SLTs should do to optimize tracheoesophageal voice and the evidence base to support practice is lacking. What this study adds to existing knowledge: This survey identifies what interventions SLTs provide in clinical practice to rehabilitate tracheoesophageal voice; and it explores the barriers and facilitators that influence the provision of tracheoesophageal voice therapy. What are the potential or actual clinical implications of this work?: Specific training, clinical guidelines, increased research and audit are required to support clinical practice in laryngectomy rehabilitation. Service planning should address the under‐resourcing of staff, expert practitioners and therapy allocated time. [ABSTRACT FROM AUTHOR]

The objective of this study was to meticulously examine the diverse vocal rehabilitation techniques that are employed following total laryngectomy, with emphasis on their implications on patients' quality of life and on the determinants influencing the selection of one technique over another. We embarked on a comprehensive literature review, which concentrated on three primary rehabilitation approaches: tracheoesophageal puncture (TEP) accompanied by a vocal prosthesis, esophageal speech acquisition, and electrolarynx utilization. The outcomes assessed included quality of life, functional performance, communication effectiveness, patient satisfaction, and factors governing the choice of technique, such as patient demographics, disease stage, and treatment history. Our findings demonstrated that TEP with vocal prosthesis yielded the most favorable overall quality of life and patient satisfaction. Individuals who underwent TEP exhibited superior speech intelligibility, voice quality, and communication ease compared with those who employed esophageal speech acquisition or electrolarynx utilization. While esophageal speech learning exhibited inferior speech quality and functional performance, it offered cost-effectiveness and diminished maintenance advantages. Electrolarynx utilization emerged as the least preferred approach due to suboptimal speech intelligibility and voice quality. The determinants influencing the choice of vocal rehabilitation technique included patient age, sex, disease stage, and previous treatment history. Patient preferences also substantially contributed to the selection of a specific technique. It is essential for clinicians to consider individual factors and patient inclinations when deliberating on an appropriate vocal rehabilitation method following total laryngectomy. Our investigation underscores the significance of collaborative decision making between clinicians and patients to pinpoint the most fitting rehabilitation technique. Future research endeavors should be directed towards enhancing existing approaches, devising innovative methods, and probing long-term outcomes and cost-effectiveness to optimize patient care in the aftermath of total laryngectomy. [ABSTRACT FROM AUTHOR]

Vocal rehabilitation post total laryngectomy (TL) lacks clinical guidelines, especially with the presence of multiple modalities. To describe the tendencies of vocal rehabilitation post TL in France and compare it with other countries. We try to identify the most practiced modalities and recognize statistically significant influencing factors. An electronic anonymous survey was answered by 75 ENT surgeons from France. The survey outlined the common practiced vocal rehabilitation modalities and had two versions depending on if the participant practices the tracheoesophageal speech (TES) or not. 96% use TES in their practice. Single modality TES and double modality TES with esophageal speech (ES) are the two most practiced modalities. 99% agreed that there is no age limit for the TES. Single modality ES was offered 92% more when more than 10 TL were performed per year (p <.05). No influencing factors found for single modality TES or double modality TES with ES (p >.05). Conclusion: In line with tendencies from other countries, the TES is the most practiced modality of vocal rehabilitation coupled or not with the ES. TES has no age limit as per our participants. The least practiced modality is the singe modality ALS. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract Background Tracheoesophageal puncture (TEP) with use of a prosthesis is nowadays a standard for voice restoration after laryngectomy. Different TEP approaches exist. Methods We retrospectively reviewed our series of patients who underwent TEP by a novel technique, based partially on the Lichtenberger endo-extralaryngeal needle carrier. The instrument is covered with a protective Nelaton catheter and introduced via the mouth to the neopharynx/esophagus. No rigid endoscope is used for visualization of the TEP site. The tip is palpated through the stoma at the posterior tracheal wall and incision is done to the catheter tip. The prosthesis is introduced through the mouth and the neopharynx in a retrograde fashion. Results In 14 laryngectomees with postoperative radiation voice prosthesis was successfully placed with this technique. A total of 18 procedures were performed. One misplacement occurred. No other early or late complications were observed or any other TEP or prosthesis related problems. Conclusions The rationale of our technique is to simplify the procedure, avoid risk-bearing approaches and instruments such as rigid endoscopes, simplify the armamentarium and reduce tissue trauma. The initial clinical experience in 18 TEPs confirmed it usefulness in both standard and anatomically challenging situations. Trial registration The current study obtained the ethical approval from the Faculty of Medicine at Medical University "Prof. Dr. Paraskev Stoyanov"—Varna, Bulgaria (Protocol 087/24.10.2019 (retrospectively registered). Graphical abstract

Hypothesis/Objectives: This study's objective was to develop a method to evaluate the chaotic characteristic of alaryngeal speech. The proposed method will be capable of distinguishing between normal and alaryngeal voices, including esophageal (SE) and tracheoesophageal (TE) voices. It has been previously shown that alaryngeal voices exhibit chaotic characteristics due to the aperiodicity of their signals. The proposed method will be applied for future use to quantify both chaos behavior (CB) and the difference between SE and TE voices. Study Design: A total of 74 voice recordings including 34 normal and 40 alaryngeal (26 SE and 14 TE) were used in the study. Voice samples were analyzed to distinguish alaryngeal voices from normal voices and to investigate different chaotic characteristics of SE and TE speech. Methods: A chaotic distribution detection-based method was used to investigate the CB of alaryngeal voices. This CB was used to detect the difference between SE and TE voice types. Quantification of the CB parameter was performed. Statistical analyses were used to compare the results of the CB analysis for both the SE and TE voices. Results: Statistical analysis revealed that CB effectively differentiated between all normal and alaryngeal voice types (p < 0.01). Subsequent multiclass receiver operating characteristic (ROC) analysis demonstrated that CB (area under the curve) possessed the greatest classification accuracy relative to correlation dimension (D2). Conclusions: The CB metric shows strong promise as an accurate, useful metric for objective differentiation between all normal and alaryngaeal, SE and TE voice types. The CB calculations showed expected results, as SE voices have significantly more CB than TE voices, constituting substantial improvement over previous methods and becoming the first SE and TE classification method. This metric can help clinicians obtain additional acoustic information when monitoring the efficacy of treatment for patients undergoing total laryngectomies. [ABSTRACT FROM AUTHOR]

Background: Tracheoesophageal puncture (TEP) with use of a prosthesis is nowadays a standard for voice restoration after laryngectomy. Different TEP approaches exist. Methods: We retrospectively reviewed our series of patients who underwent TEP by a novel technique, based partially on the Lichtenberger endo-extralaryngeal needle carrier. The instrument is covered with a protective Nelaton catheter and introduced via the mouth to the neopharynx/esophagus. No rigid endoscope is used for visualization of the TEP site. The tip is palpated through the stoma at the posterior tracheal wall and incision is done to the catheter tip. The prosthesis is introduced through the mouth and the neopharynx in a retrograde fashion. Results: In 14 laryngectomees with postoperative radiation voice prosthesis was successfully placed with this technique. A total of 18 procedures were performed. One misplacement occurred. No other early or late complications were observed or any other TEP or prosthesis related problems. Conclusions: The rationale of our technique is to simplify the procedure, avoid risk-bearing approaches and instruments such as rigid endoscopes, simplify the armamentarium and reduce tissue trauma. The initial clinical experience in 18 TEPs confirmed it usefulness in both standard and anatomically challenging situations. Trial registration: The current study obtained the ethical approval from the Faculty of Medicine at Medical University "Prof. Dr. Paraskev Stoyanov"—Varna, Bulgaria (Protocol 087/24.10.2019 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Purpose: This study examined the acoustic properties of Taiwanese (Southern Min) lexical tones produced in esophageal speech (ES) and pneumatic artificial laryngeal speech (PAL), including onset fundamental frequency (F0), slope of F0 contour, duration, and amplitude (intensity) of the vowel portion of syllables carrying seven Taiwanese tones. Method: Seven ES speakers, seven PAL speakers, and 18 normal laryngeal (NL) speakers (all male) read aloud target syllables carrying the tones in monosyllables, disyllables, and sentences. Acoustic features were measured with Praat. Results: Acoustic analysis revealed (a) no significant effects of linguistic level on acoustic parameters except for duration, which generally significantly decreased from monosyllables to disyllables to sentences for Tones 1 and 5; (b) significant differences across the speaker groups in onset F0 (PAL > ES > NL), duration (PAL > NL and PAL > ES for all tones), and mean amplitude (PAL > NL > ES); and (c) no significant difference in mean slope of F0 contour across the speaker groups. Conclusions: These preliminary data on acoustic properties of Taiwanese tones produced by ES and PAL speakers could facilitate the design of therapeutic strategies for improving the intelligibility of alaryngeal lexical tones. Further studies are recommended to examine the relative perceptual importance of the acoustic parameters. [ABSTRACT FROM AUTHOR]

Background/Aim: The purpose of this study was to provide preliminary data concerning the effect of clear speech (CS) on Cantonese alaryngeal speakers' intelligibility. Methods: Voice recordings of 11 sentences randomly selected from the Cantonese Sentence Intelligibility Test (CSIT) were obtained from 31 alaryngeal speakers (9 electrolarynx [EL] users, 10 esophageal speakers and 12 tracheoesophageal [TE] speakers) in habitual speech (HS) and CS. Two naïve listeners orthographically transcribed a total of 1,364 sentences. Results: Significant effects of speaking condition on speaking rate and CSIT scores were observed, but no significant effect of alaryngeal communication methods was noted. CS was significantly slower than HS by 0.78 syllables/s. Esophageal speakers demonstrated the slowest speech rate when using CS, while EL users demonstrated the largest decrease in speaking rate when using CS compared to HS. TE speakers had the highest CSIT scores in HS (listener 1 = 81.4%; listener 2 = 81.3%), and esophageal speakers had the highest CSIT scores in CS (listener 1 = 87.5%; listener 2 = 89.7%). EL users experienced the largest increase in intelligibility while using CS compared to HS (9.1%) followed by esophageal speakers (8.9%) and TE speakers (1.4%). Conclusion: Preliminary data indicate that CS may significantly affect Cantonese alaryngeal speakers' speaking rate and intelligibility. However, intelligibility appeared to vary considerably across speakers. Further research involving larger, heterogeneous groups of speakers and listeners alongside longer and more refined CS training protocols should be conducted to confirm that CS can improve Cantonese alaryngeal speakers' intelligibility. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the number, reasons and costs of surgical voice restoration related tracheoesophageal valve attendances over 36 months at a head and neck oncology unit. Method: Demographic, medical and valve related details from all patient contacts were recorded, including self-change information, urgent appointment information, modifications required and costs of prostheses. Results: Over 3 years, 99 patients underwent 970 valve changes. The main reasons for changes were central leakage, prophylactic change and self-change at home. Changes were significantly more frequent in the first 12 months (mean, 42 days) compared with longstanding patients (mean, 109.96). Intervals between changes were unpredictable; no predictive factors reached statistical significance. Mean expenditure on valves was £966.63 per week (including value added tax and in-house customisation). Conclusion: Valve lifespan is comparable with outcomes in similar units despite more pre-emptive and patient-led changes and more comprehensive data inclusion. Investigation into how patient satisfaction and costs relate to valve selection and units' service delivery models is needed. [ABSTRACT FROM AUTHOR]

This study investigates three aspirated voiceless stop consonants and their unaspirated counterparts produced in Taiwan's Southern Min dialect by 10 laryngeal speakers (LA), 10 speakers with pneumatic artificial larynxes (PA), and 10 oesophageal speakers (ES). Listeners' perceptions of the accuracy of the three groups in producing these six stop consonants were also examined. Each of the voiceless stop consonants /p, pʰ, t, tʰ, k, kʰ/, followed by the vowel /a/, was represented by a Southern Min character and appeared three times on a list in random order. Each character had a consonant-vowel syllable structure, and all were read with Tone 1 (high and level). Voice onset time (VOT) was measured for each stop consonant. A separate group of 20 listeners was then asked to identify the consonants produced by the LA, PA, and ES speakers. The VOT values of aspirated voiceless stop consonants from PA and ES were shorter than those from LA. Although PA and ES had aspiration contrast in their VOT values, perceived accuracy was low for PA (/pʰ/: 16.3%; /tʰ/: 13.5%; /kʰ/: 22.8%) and ES (/pʰ/: 33.7%; /tʰ/: 25.9%; /kʰ/: 31.9%). The mean percentages of correctly identified /pʰ, tʰ, kʰ/ produced by PA were at chance level. In terms of VOT values, it is recommended that, when producing aspirated voiceless stop consonants, PA and ES elongate the duration between the release of the oral constriction and the onset of their vibratory sound source. Moreover, it is also recommended that further investigation into other phonetic properties that support stop contrast is needed. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of total laryngectomy on vowel production, the present study examined the change in vowel articulation associated with different types of alaryngeal speech in comparison with laryngeal speech using novel derived formant metrics. Method: Six metrics derived from the first two formants (F1 and F2) including the First and Second Formant Range Ratios (F1RR and F2RR), triangular and pentagonal Vowel Space Area (tVSA and pVSA), Formant Centralisation Ratio (FCR) and Average Vowel Spacing (AVS) were measured from vowels (/i, y, ɛ, a, ɔ, œ, u/) produced by oesophageal (ES), tracheoesophageal (TE), electrolaryngeal (EL), pneumatic artificial laryngeal (PA) speakers, as well as laryngeal speakers. Result: Data revealed a general reduction in articulatory range and a tendency of vowel centralisation in Cantonese alaryngeal speakers. Significant articulatory difference was found for PA and EL compared with ES, TE, and laryngeal speakers. Conclusion: The discrepant results among alaryngeal speakers may be related to the difference in new sound source (external vs internal). Sensitivity and correlation analyses confirmed the use of the matrix of derived formant metrics provided a more comprehensive profile of the articulatory pattern in the alaryngeal population. [ABSTRACT FROM AUTHOR]

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Purpose: The aim of this study was to investigate the characteristics of electrolaryngeal (EL) speech among untrained speakers to aid in its effective introduction and to identify syllables and words that are easy or difficult to pronounce. Method: A total of 21 healthy individuals who had never used an EL were included. The participants were briefed, and tests comprising 100 Japanese syllables and 50 single words were conducted to evaluate EL speech intelligibility. A trained speaker was defined as a certified speech-language pathologist who underwent EL training for 3 months. A 5-point electrolarynx effectivity score (EES) was used for the subjective assessment of EL. Results: The median (interquartile range) intelligibility scores of the untrained and trained groups were 24.0% (20.0%-34.0%) and 40.0% (36.0%-45.0%) for syllables and 48.0% (38.0%-60.0%) and 88.0% (82.0%-90.0%) for words, respectively. The intelligibility scores for syllables and words were higher in the trained group than those in the untrained group. Only two syllable subgroups (/m/ and /w/) had > 80% correct answers among untrained speakers. A total of 14 syllable subgroups (/k, kj, s, ɞ, t, tɞ, ts, ɲ, h, ç, φ, p, pj, and a/), a number of which contained voiceless consonants, had < 40% correct answers among both speaker groups. A greater number of morae were associated with higher intelligibility scores. An EES of 4, indicating that the EL was effective, was the most frequent score. Conclusions: It was difficult for untrained speakers to produce intelligible speech using an EL. Syllables, including voiceless consonants, were difficult to pronounce using an EL. Longer words with a greater number of morae were more intelligible, even for untrained EL speakers. Supplemental Material: https://doi.org/10.23641/asha.16632622 [ABSTRACT FROM AUTHOR]

Purpose: Following a total laryngectomy in which the larynx is completely removed, individuals in the USA have three primary options for alaryngeal verbal communication including tracheoesophageal speech (TES), oesophageal speech (ES) and electrolarynx (EL). Using a large sample of participants from across the USA, this study investigated listener impressions of each primary type of alaryngeal communication. As these are the individuals more likely to be participating in social interactions and in positions of hiring for employment, the general public's impressions of TES, ES and EL may be a vital consideration during the treatment process. Method: A total of 381 individuals rated eight speech samples, including samples from speakers of each alaryngeal communication modality as well samples from age and sex matched laryngeal speakers, with regards to three outcome measures: intelligence, likability and employability. Result: Listener impressions of alaryngeal speech samples were modulated by the type of communication mode. Further, the patterns of results differed by speaker sex, with ES speech rated consistently more favourable for female speakers across all outcome measures and TES rated consistently more favourable for male speakers across all outcome measures. Conclusion: An overall preference for laryngeal speech was noted, particularly with male speakers. The female ES stimuli, interestingly, was the highest rated alaryngeal communication modality. Regardless of speaker sex, all alaryngeal modes greatly affected impressions of employability relative to impressions of likeability and intelligence. [ABSTRACT FROM AUTHOR]

Accurate tracheoesophageal prosthesis (TEP) size is essential for optimal functioning. Current sizing techniques do not afford direct visualization. The clinical utility of direct visualization with unsedated transnasal esophagoscopy (TNE) to improve TEP sizing accuracy has not been established. The purpose of this investigation was to determine if endoscopic visualization with TNE during TEP fitting improves sizing accuracy. Participants undergoing secondary TEP placement had their TEP sized without visualization and with visualization during TNE. The effect of endoscopic visualization on TEP sizing was assessed. The mean age (SD) of the cohort (N = 15) was 61.20 (±10.19) years. The percent disagreement between non-visualized and endoscopic-visualized puncture tract measurement was 60%. The mean difference in puncture tract length with visualization compared to without visualization was 1.75 mm (±1.91). Discordance between non-visualized and endoscopic-visualized puncture tract length was worse for persons with a history of radiation (66.7%) than without radiation (33.3%) (p <.05). The overall test agreement between endoscopic and non-endoscopic sizing techniques was moderate (Cohen's kappa coefficient = 0.254; (p <.05). The percent disagreement between non-visualized and endoscopic-visualized TEP sizing is high (60%). The data suggest that endoscopic visualization with TNE improves sizing accuracy during TEP placement. [ABSTRACT FROM AUTHOR]

The present study examined and compared the Lombard effect among laryngeal and alaryngeal speakers including esophageal, tracheoesophageal, pneumatic artificial laryngeal, electrolaryngeal speakers of Cantonese. The subsequent change in intelligibility was also examined. A total of 52 native Cantonese-speaking laryngeal and alaryngeal speakers (10 laryngeal , 8 laryngeal , 13 electrolaryngeal , 11 esophageal, and 10 tracheoesophageal) participated in a reading task involving three 10-syllable Cantonese sentences under 10 background conditions: quiet, 60 dB, 65 dB, 70 dB, 75 dB, 80 dB, 85 dB, 90 dB, 95 dB, and 100 dB white background noise. Speech intelligibility associated with speaking conditions were evaluated by five naïve Cantonese speakers. Output intensity was significantly increased in all speaker types under all nine noisy background conditions when compared with the quiet condition. However, the amount of increase was different for different modes of phonation. In addition, significant difference in speech intelligibility between laryngeal and alaryngeal speakers was found at all conditions, but not among any alaryngeal speech. The Lombard reflex is still present after total laryngectomy. Yet, different alaryngeal speech was associated with different amount of loudness change, and subsequent improvement in intelligibility was not observed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to report the variability of electrolarynx (EL) users’ speech intelligibility in quiet and in multitalker babble. Method: Ten EL users (five Servox® Digital, five TruTone™) who were at least 2 years postlaryngectomy provided recordings of five sentences from the 1965 Revised List of Phonetically Balanced Sentences. Recordings were judged by two groups of naïve listeners in quiet and in the presence of multitalker babble. Fifteen listeners orthographically transcribed a total of 750 sentences containing 3,750 key words in quiet, and another 15 listeners orthographically transcribed the same sentences mixed with multitalker babble. Results: Significant differences in speech intelligibility were observed between listening conditions; 17.9% more key words were correctly identified in quiet compared to multitalker babble. Significant differences in fundamental frequency (F0) standard deviation and range but not speech intelligibility were observed between EL device types. A positive correlation of moderate significance was observed between F0 standard deviation and intelligibility for TruTone users in multitalker babble. Conclusions: Findings suggest that listeners are able to identify a significantly higher percentage of EL users’ speech in quiet compared to multitalker babble, but a large variability in EL users’ speech intelligibility exists. Continued investigation involving a larger number of EL users is necessary to confirm this study’s findings. Future research should explore the relationships among F0 measures, speaker characteristics (e.g., rate of speech, articulatory precision), and speech intelligibility, in addition to improving alaryngeal rehabilitation training protocols for EL users. [ABSTRACT FROM AUTHOR]

Background: It has long been recognized that tracheoesophageal speech (TES) rehabilitation after laryngectomy is a specialized area of practice for speech and language therapist (SLTs) due to the complex nature of patient presentation and the invasive components of the SLT's role in this area. Therefore, postgraduate experience and training is required to work competently and safely in this clinical area. However, it is generally acknowledged that the steps and processes followed by individual clinicians to achieve this training and clinical skill development are inconsistent and vary widely across services. There is a need to identify critical elements deemed most beneficial to clinical skill development in order to inform future training models. Aims: To explore clinicians' perceptions of factors that contribute to training and clinical skills development in the area of TES rehabilitation post‐laryngectomy. Methods & Procedures: All participants were SLTs working in an Australian clinical service, with a current or recent clinical caseload that included patients using TES. A total of 36 SLTs were recruited and then grouped by level of experience (novice n = 15, intermediate n = 7, experienced n = 14). Each participant took part in one small focus group with other participants of similar experience level. Ten focus groups were conducted, each of approximately 60 min in duration. A semi‐structured interview guide was used to facilitate the discussion of issues relating to training in this area. Thematic analysis was used to analyse transcripts and identify themes. Outcomes & Results: Interviews identified six key themes, including: Learning with and from others; Formal programmes; Hands‐on learning; Processes that influence training; and Individual influences. SLTs reported both positive issues and elements that were challenging across all five themes. The final (sixth) theme was identified regarding clinician perceptions of how this area differed to specialized training in other areas of the profession. The majority of themes were discussed equally by clinicians across all three experience levels. Conclusions & Implications: Participants across all experience levels identified that multiple factors contributed to clinicians successfully gaining skills, understanding and competency when working in TES rehabilitation post‐laryngectomy. These factors, when fully considered and incorporated into future SLTs training pathways and opportunities, have the potential to optimize competency, skill acquisition and maintenance in this area. What this paper addsWhat is already known on this subjectWhile studies have considered the training, preparation and knowledge base of SLTs working in the clinical area of TES, the focus has predominantly been at the immediate postgraduate level or assessment of university course work. No studies have used a qualitative methodology to consider the reflections and perceptions of clinicians' training pathways and training needs across all levels of experience for this clinical area.What this paper adds to existing knowledgeThe results of this study build upon the existing body of literature regarding education and training in this area, determining factors SLTs feel are required to successfully gain skills, understanding and competency when working in TES rehabilitation. The findings highlight that training pathways and methods in this clinical area are an ongoing consideration for SLTs regardless of experience level and have the ability to impact on future competency programmes, training opportunities and delivery methods in this area.What are the potential or actual clinical implications of this work?Effective and ongoing postgraduate training programmes and professional development opportunities have the potential to positively impact on professional competence and confidence, patient safety and overall service delivery. Hence, the themes generated from this research highlight essential factors to include within training and professional development programmes for SLTs in TES rehabilitation. This information can be used to help optimize current training pathways for all experience levels. [ABSTRACT FROM AUTHOR]

Background: Successful speech rehabilitation has a great impact on the quality of life in totally laryngectomized patients. Objectives: The aim of this paper was to compare the self-assessed voice handicap of totally laryngectomized patients with two different methods of alaryngeal speech – esophageal (ES) and tracheoesophageal speech (TES). Method: The research comprised 83 totally laryngectomized, disease-free patients, split into two groups. The first group included 43 participants with successfully rehabilitated ES, and the second group included 40 participants with successfully established TES after secondary implantation of Provox 2TM voice prosthesis. All subjects filled in the Serbian version of the Voice Handicap Index (VHI-30). The results (overall score and three VHI subscales) were analyzed and compared with those of the subjects of both groups. The impact of age in the subgroups (<65 years old and ≥65 years old) and previous irradiation on the examined VHI values were also analyzed. Results: The median value of the overall VHI score in the participants with TES was 29.03 ± 23.479 (range: 0–97), and in the participants with ES it was 64.51 ± 21.089 (range: 19–99). The VHI scores (overall and three VHI subscales) were significantly higher in participants with ES compared to those with TES (p < 0.01), indicating a larger voice handicap. No significant difference was found in the overall VHI score and VHI subgroups in terms of age subgroups and previous irradiation (p > 0.05). Conclusions: Our data reveal a significantly higher voice handicap in participants with ES compared to the TES group, with a large interindividual variation within both groups. VHI values are not significantly different between the two age subgroups, nor are they significantly influenced by irradiation. [ABSTRACT FROM AUTHOR]

Background/Aims: This study examined the effect of clear speech on vowel productions by electrolaryngeal speakers. Method: Ten electrolaryngeal speakers produced eighteen words containing /i/, /ɪ/, /ɛ/, /æ/, /eɪ/, and /oʊ/ using habitual speech and clear speech. Twelve listeners transcribed 360 words, and a total of 4,320 vowel stimuli across speaking conditions, speakers, and listeners were analyzed. Analyses included listeners' identifications of vowels, vowel duration, and vowel formant relationships. Results: No significant effect of speaking condition was found on vowel identification. Specifically, 85.4% of the vowels were identified in habitual speech, and 82.7% of the vowels were identified in clear speech. However, clear speech was found to have a significant effect on vowel durations. The mean vowel duration in the 17 consonant-vowel-consonant words was 333 ms in habitual speech and 354 ms in clear speech. The mean vowel duration in the single consonant-vowel words was 551 ms in habitual speech and 629 ms in clear speech. Conclusion: Finding suggests that, although clear speech facilitates longer vowel durations, electrolaryngeal speakers may not gain a clear speech benefit relative to listeners' vowel identifications. [ABSTRACT FROM AUTHOR]

Background/Aims: The aims of this study were (1) to determine locations of increased effort in the body when talking using tracheoesophageal speech (TES); (2) to compare talking effort for participants using TES and those using laryngeal speech; (3) to compare tongue-palate contact pressure during talking for TES and laryngeal speech; and (4) to assess the relationship between talking effort and articulatory contact pressure (ACP). Methods: This cohort comparison study included 16 individuals using TES and 10 using laryngeal speech. Participants rated talking effort on a visual analog scale and then rated effort in the lungs, throat, oral cavity, brain (cognitive) and arm/shoulder. ACP for /t/, /d/, and /n/ produced in sentences was measured using a pressure sensor on the alveolar ridge. Results: Factor analysis of effort ratings across body locations by participants using TES revealed two latent variables associated with non-voice production locations and voice production. Ratings of effort and ACP were statistically significantly higher in participants using TES. The correlation between overall talking effort and ACP was strong and statistically significantly. Conclusions: The effort ratings suggest adults with functional TES experience talking as more effortful than adults with a larynx. Some increased effort was focused in the voice production process, but regions outside of voicing were also implicated. [ABSTRACT FROM AUTHOR]

Background: The management of tracheoesophageal speech (TES) rehabilitation is an area of speech and language therapists' (SLTs) clinical practice where knowledge and skills are primarily developed through postgraduate workplace experience and training. Although recent research suggests clinicians in Australia perceive there is adequate access to workplace training, little is known about how clinicians develop and/or maintain clinical confidence when working in this specialist caseload. Aims: To investigate factors that contribute to development of clinician confidence as well as the factors that impact on improving and maintaining confidence when working in the clinical area of TES rehabilitation. Methods & Procedures: SLTs working in an Australian clinical service and in a current or recent caseload including patients using TES were eligible to participate. A total of 36 SLTs were recruited and then grouped by level of experience (novice n = 15, intermediate n = 7, experienced n = 14). Ten focus groups of 60‐min duration were conducted each with three to four participants from the same experience level. A semi‐structured interview guide was used to facilitate the discussion of issues relating to training and confidence; however, only the content pertaining to clinical confidence is reported. Thematic analysis was used to analyse the transcripts. Outcomes & Results: Four themes were identified as contributing to the development of confidence: training, exposure, accessing support and mentorship, and leadership opportunities. Three themes were identified as critical for improving or maintaining clinical confidence: ongoing management of a caseload, ongoing support and further learning. An additional overarching theme was the desire for SLTs to classify or quantify their level of confidence, typically using a numeric scale or in years of clinical experience. The impact of varying contexts and caseloads on confidence levels was highlighted by all participants, but particularly those in the novice focus groups. Conclusions & Implications: The findings highlight the fact that the acquisition and maintenance of confidence is an ongoing consideration for SLTs, both those starting out and those with years of clinical experience. With patient presentation increasing in complexity, the importance of understanding contributing factors for gaining and maintaining confidence should be considered alongside postgraduate training and the provision of ongoing support for SLTs working in this specialized clinical area, regardless of experience level. [ABSTRACT FROM AUTHOR]

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

Introduction: Tracheo-oesophageal (TE) speech is one of the most commonly used alaryngeal voice restoration options for individuals who have undergone a total laryngectomy. Cepstral Peak Prominence (CPP) implies the overall voice quality objectively. Aim: To compare the CPP between Blom-Singer nonindwelling low pressure and classic indwelling voice prosthesis across vowel phonation /a/ and text-reading tasks in male TE speakers. Materials and Methods: The study included 10 male TE speakers in the age range of 45-75 years. Dr. Hillenbrand’s ‘Speech Tool’ software was used to measure CPP. Two types of speech prosthesis used were Blom-Singer non-indwelling low pressure and classic indwelling voice prosthesis (both of 16 French diameter) and the tasks vowel phonation and text-reading were considered. The SPSS software, version 15.0 (SPSS Inc., Chicago, IL) was used for data analysis. The parametric paired t-test was applied to compare CPP between two types of voice prostheses across speech tasks. Results: There was no significant difference between BlomSinger non-indwelling low pressure voice prosthesis and classic indwelling voice prosthesis for CPP during vowel phonation/a/ task {t(9)=0.74, p=0.516} and text-reading task {t(9)=0.72, p=0.947)}. Similarly, there was no significant difference for CPP between speech tasks for Blom-Singer non-indwelling low pressure voice prosthesis {t(9)=1.11, p=0.347)} and Blom-Singer classic indwelling voice prosthesis {t(9)=0.51, p=0.644)}. Conclusion: In TE speakers, CPP is not influenced by prosthesis type in terms of mode of fitting, prosthesis design and valve opening pressure across speech tasks, implying no difference in the objective measure of overall voice quality.

As a surgical procedure for late-stage laryngeal cancer, total laryngectomy aims to remove the entire laryngeal structure, including the entire phonatory apparatus. As such, laryngectomized patients suffer the loss of ability to make sound. They have to rely on an alternative phonation method in order to regain speech. Currently, esophageal(SE), tracheoesophageal(TE), electrolaryngeal(EL), and pneumatic artificial laryngeal(PA)speech are available. Different sound characteristics are associated with different alaryngeal speech, mainly due to the use of different phonatory methods. The present paper discusses various alaryngeal phonation and reviews the acoustic, perceptual, and aerodynamic characteristics associated with the four alaryngeal speech, with a special focus on Mandarin and Cantonese Chinese.

Objectives: The present study investigated the articulatory contact pressure during the production of bilabial plosives by esophageal (ES), tracheoesophageal (TE), and laryngeal speakers. Methods: The peak contact pressure (PCP) during bilabial plosive production of /CVCVCVCVCV/ syllable strings of /p/ and /ph/ was obtained from 10 ES, 10 TE, and 10 laryngeal speakers of Cantonese. PCP values were obtained by using a pressure transduction system (Iowa Oral Performance Instrument) during speech production. Results: The results showed that ES speakers exhibited a significantly greater PCP value than TE and laryngeal speakers, as revealed by cheek muscle compression force. In addition, the unaspirated bilabial plosive /p/ was associated with a greater PCP than its aspirated counterpart /ph/. Conclusion: The current findings might support the hypothesis of over-exaggerated speech for better intelligibility among alaryngeal speakers. In addition, the increased oral muscular effort could be associated with a compensatory strategy for maintaining a high intraoral pressure or the unique air intake by ES speakers. [ABSTRACT FROM AUTHOR]

Purpose: Anecdotally it is recognised that management of tracheoesophageal speech (TES) post-laryngectomy varies between speech language pathology (SLP) services and clinicians. This study reviewed patterns of practice for TES management to examine patterns of practice and explore factors influencing variability. Method: A national survey was completed by SLP's from clinical services which manage TES. This online survey examined demographic and caseload information, initial voice prosthesis (VP) placement and procedures, VP cleaning and care recommendations, humidification management, equipment and service provision, and service delivery options at each site. Result: Lead clinicians from 34 sites (85% response rate) responded. Most clinical practice regarding initial VP insertion and management, as well as the timing and delivery of voice rehabilitation was highly consistent. Patient use of antifungal medications, TES and associated equipment provision, humidification management immediately post-surgery and some aspects of initial VP insertion were variable between services. The nature of the clinical setting, equipment funding and level of research evidence influenced variability in practice. Conclusion: Variability exists in a number of aspects of practice across Australian services offering TES management. Sources of variability need to be addressed nationally to ensure there is consistent, quality care available for all patients. [ABSTRACT FROM AUTHOR]

Purpose: Sense of effort and fatigue associated with talking was compared in individuals with and without a total laryngectomy. Method: An online survey of individuals using tracheoesophageal speech (TES; n = 222), electrolaryngeal speech (ELS; n = 132), esophageal speech (n = 41), and laryngeal speech (LS; n = 112) asked about 3 domains of effort when talking: frequency of occurrence, withdrawal from talking, and location in the body. Three aspects of fatigue were explored: frequency of occurrence, fatigue type, and duration of talking before fatigue. Results: Alaryngeal groups reported significantly more talking-related effort and fatigue than the LS group. Sixty-three percent of all respondents indicated that effort caused them to talk less, with no group differences on this item. Significantly more effort was localized to the lips and tongue by ELS compared with TES and LS groups. Both the ELS and TES groups had higher shoulder/arm effort when talking compared with the esophageal speech and LS groups. ELS respondents reported less fatigue than the TES group. When fatigue was present, the TES group had more physical and less mental fatigue than the ELS group. The duration of talking before experiencing fatigue was significantly shorter for the alaryngeal groups compared with the LS group. Conclusions: Effort and fatigue associated with talking are a common report for individuals using alaryngeal speech. The location of effort within the body and the type of fatigue experienced vary to some extent across alaryngeal speaking methods. [ABSTRACT FROM AUTHOR]

Objective: We used a questionnaire to investigate olfactory function and the present state of olfactory rehabilitation for laryngectomized patients in Japan.Methods: This study was conducted using a questionnaire survey. We mailed questionnaires to 190 members of a Japanese laryngectomized patient group (the nonprofit organization YOUSAY-KAI). The survey queried the following items: (1) basic information (age, sex, alaryngeal speech method, etc.); (2) questions about olfactory rehabilitation, such as the individual's experience of olfactory rehabilitation, the number of days from laryngectomy to the start of olfactory rehabilitation, and the location of rehabilitation (i.e., hospital or patient association); (3) free comments; and (4) the self-administered Odor Questionnaire (SAOQ).Results: We received 121/190 questionnaires by the submission deadline. Of these, 105 questionnaires were valid. All 105 responders used the Provox voice prosthesis as the alaryngeal speech method. Only 4.7% (5/105) of the patients received olfactory rehabilitation in hospitals. Many comments in the free comment column included demands for olfactory rehabilitation such as "I want to know where we can have olfactory rehabilitation" and "I want to have rehabilitation if olfaction recovers." The SAOQ score was significantly higher in the rehabilitation group (mean, 42.5%) compared to the nonrehabilitation group (mean, 22.1%) (p<0.05). There was no correlation between the SAOQ score and the number of days from laryngectomy to the start of rehabilitation (r=0.08, p=0.76)． CONCLUSION: Patient demand for olfactory rehabilitation is strong, but this therapy is not widely offered to laryngectomized patients in Japan. Notably, the SAOQ scores showed that olfactory rehabilitation may have an effect, even if it is initiated after laryngectomy. We believe that when patients choose voice prosthesis for speech, their olfaction deteriorates unless they undergo olfactory rehabilitation separately from speech rehabilitation. It is therefore necessary to administer olfactory rehabilitation for laryngectomized patients who have never received olfactory rehabilitation, as well as for patients scheduled to undergo laryngectomy. [ABSTRACT FROM AUTHOR]

Highlights • Electrolaryngeal speakers reduce their speaking rate while using clear speech. • Clear speech does not negatively influence listener comfort. • Listeners perceive electrolaryngeal speech to be less acceptable in clear speech. • Clinical considerations warrant subjective and objective indices. Abstract Purpose To determine the influence of clear speech on auditory-perceptual judgments of speech acceptability and listener comfort for electrolaryngeal speech. Method Voice recordings were obtained from 10 electrolaryngeal speakers. Each speaker read the Rainbow Passage in two conditions: habitual speech and clear speech. Speakers were encouraged to speak as clearly as possible and over-articulate in the clear speech condition. Auditory-perceptual rating tasks were completed by 20 normal-hearing adults who evaluated 20 randomized voice recordings. Two counterbalanced listening sessions were used to gather ratings of speech acceptability and listener comfort. Results A significant effect of speaking condition was found on listener judgments of speech acceptability, but not listener comfort. However, listener scores for speech acceptability and listener comfort were found to be significantly related. For all speakers, objective temporal measures indicated reduced speaking rates in the clear speech condition. Conclusions These findings suggest that volitional attempts to improve electrolaryngeal speech using clear speech might negatively impact listener judgments of speech acceptability, but not listener comfort. Further, the data suggest that speech acceptability and listener comfort might address unique perceptual entities. Overall, the strong relationship between these auditory-perceptual dimensions provide support for the use of scaled measurements to assess the impact of speech rehabilitation on individuals who use the electrolarynx. [ABSTRACT FROM AUTHOR]

Introduction: Tracheoesophageal speech is considered the gold standard for rehabilitation following total laryngectomy. Current literature is limited and contradictory about the possible causes of device failure. The aim of the study is to compare the device life-time between the Provox 2 and Provox Vega and to examine possible related factors that influence their duration.Methods: Retrospective case-crossover study in 34 laryngectomized patients who had undergone tracheoesophageal voice rehabilitation using indwelling Provox 2 and Provox Vega voice prostheses between 2010 and 2016 in a tertiary care centre.Results: A total of 440 prostheses were evaluated. The most frequent reason for replacement was due to an endoprosthesis leakage (n = 221, 64.2%) in both models. Radiotherapy increases the risk of prosthesis replacement (IRR = 1.88, p = 0.007) as well as bilateral neck dissection (IRR = 1.56, p = 0.017) in Provox 2. Age and unilateral neck dissection do not seem to influence the duration of the prosthesis. Mean life-time of Provox 2 was 106.64 days and 124.19 days for Provox Vega (p = 0.261). Complementary treatment with radiotherapy demonstrated a lower device survival (p < 0.001).Discussion: Results confirmed the non-significant differences on device life between Provox Vega and Provox 2, as well as the relevant role of radiotherapy treatment in the increase of replacements and diminution of the device duration. [ABSTRACT FROM AUTHOR]

Introduction: Tracheo-oesophageal (TE) speech is one of the most commonly used alaryngeal voice restoration options for individuals who have undergone a total laryngectomy. Cepstral Peak Prominence (CPP) implies the overall voice quality objectively. Aim: To compare the CPP between Blom-Singer nonindwelling low pressure and classic indwelling voice prosthesis across vowel phonation /a/ and text-reading tasks in male TE speakers. Materials and Methods: The study included 10 male TE speakers in the age range of 45-75 years. Dr. Hillenbrand's 'Speech Tool' software was used to measure CPP. Two types of speech prosthesis used were Blom-Singer non-ndwelling low pressure and classic indwelling voice prosthesis (both of 16 French diameter) and the tasks vowel phonation and text-reading were considered. The SPSS software, version 15.0 (SPSS Inc., Chicago, IL) was used for data analysis. The parametric paired t-test was applied to compare CPP between two types of voice prostheses across speech tasks. Results: There was no significant difference between Blom-Singer non-indwelling low pressure voice prosthesis and classic indwelling voice prosthesis for CPP during vowel phonation/a/ task {t(9)=0.74, p=0.516} and text-reading task {t(9)=0.72, p=0.947)}. Similarly, there was no significant difference for CPP between speech tasks for Blom-Singer non-indwelling low pressure voice prosthesis {t(9)=1.11, p=0.347)} and Blom-Singer classic indwelling voice prosthesis {t(9)=0.51, p=0.644)}. Conclusion: In TE speakers, CPP is not influenced by prosthesis type in terms of mode of fitting, prosthesis design and valve opening pressure across speech tasks, implying no difference in the objective measure of overall voice quality. [ABSTRACT FROM AUTHOR]