Objective and perceptual analysis of outcome of voice rehabilitation after laryngectomy in an Indian tertiary referral cancer centre

Tracheo Esophageal Prosthesis Insertion Under Endoscopic Guidance and Local Anaesthesia- Feasibility and Outcome

OBJECTIVES

Voice rehabilitation after laryngectomy is by tracheo esophageal puncture (TEP) and prosthesis insertion. Secondary TEP is very difficult due to neck fibrosis. Puncture under local anaesthesia with endoscopy guidance is a feasible option.

METHODS

Retrospective review of all laryngectomy patients from March 2009 till March 2019 was done and the methods of voice rehabilitation were assessed. The patients undergoing the procedure were classified according to the timing of insertion and type as primary insertion under general anaesthesia (Group P), secondary insertion under local anaesthesia (Group L), secondary insertion under general anaesthesia (Group G). The speech outcome and the procedure outcome were compared.

RESULTS

There were 148 patients who underwent laryngectomy, of which groups P, G, L were 12, 12 and 11. The rate of successful insertion was 100% in primary, 91.6% in secondary in general anaesthesia and 91% in secondary under local anaesthesia. All secondary TEP were done after surgery and radiotherapy. Complications related to the insertion techniques were minimal. Speech outcome were similar on intelligibility rating scale and longevity was not affected by the method.

CONCLUSION

TEP in local anaesthesia is feasible and has comparable outcome with TEP in general anaesthesia. Financial burden was very much less in group L compared to the other two groups.

Talker identification across source mechanisms: experiments with laryngeal and electrolarynx speech

PURPOSE

The purpose of this study was to determine listeners' ability to learn talker identity from speech produced with an electrolarynx, explore source and filter differentiation in talker identification, and describe acoustic-phonetic changes associated with electrolarynx use.

METHOD

Healthy adult control listeners learned to identify talkers from speech recordings produced using talkers' normal laryngeal vocal source or an electrolarynx. Listeners' abilities to identify talkers from the trained vocal source (Experiment 1) and generalize this knowledge to the untrained source (Experiment 2) were assessed. Acoustic-phonetic measurements of spectral differences between source mechanisms were performed. Additional listeners attempted to match recordings from different source mechanisms to a single talker (Experiment 3).

RESULTS

Listeners successfully learned talker identity from electrolarynx speech but less accurately than from laryngeal speech. Listeners were unable to generalize talker identity to the untrained source mechanism. Electrolarynx use resulted in vowels with higher F1 frequencies compared with laryngeal speech. Listeners matched recordings from different sources to a single talker better than chance.

CONCLUSIONS

Electrolarynx speech, although lacking individual differences in voice quality, nevertheless conveys sufficient indexical information related to the vocal filter and articulation for listeners to identify individual talkers. Psychologically, perception of talker identity arises from a "gestalt" of the vocal source and filter.