Influence of Speaker Gender on Listener Judgments of Tracheoesophageal Speech

Perceptions of employability related to severity of hypernasality: a pilot study

The primary aim of this investigation was to evaluate listener auditory-perceptual assessment of employability for individuals with hypernasal speech. Using an online survey platform, listeners with managerial experience evaluated speech samples from individuals with varying hypernasal resonance disorder severity to determine auditory-perceptual judgements regarding intelligence and employability. Speech samples of individuals with hypernasal speech were rated lower on scales of intelligence and employability, and more likely to be selected for jobs with infrequent rates of communication and lower levels of responsibility. Additionally, males with hypernasal speech were perceived as less intelligent, less employable, and more likely to be selected for a job with infrequent communication in comparison to females with hypernasal speech. Results of this preliminary investigation suggest that individuals with hypernasal speech may face employment barriers. The conclusions collected from this initial investigation open the doors for further research addressing linguistic considerations and aspects of employability. This is an important consideration for individuals with either acquired or congenitally related hypernasal resonance disorder.

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.

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.

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.

The study of speech naturalness in communication disorders: A systematic review of the literature

The concept of speech naturalness is used widely in clinic and research applications. Unfortunately, the lack of consistency in research methods means that comparing findings between studies is difficult at best. In order to better understand the state of research on speech naturalness in communication disorders and quantify these impressions, this study looks at publications from the last 18 years in a systematic manner. A literature search for the exact phrase "speech naturalness" of the PubMed/MEDLINE, EBSCO, and ASHAWire databases was conducted. Articles included in the review were studies of communication and communication disorders published between 1990 and the end of 2014, in English, and in a peer-reviewed journal. 63 articles were selected and coded using a coding sheet adapted from a prior systematic review on intelligibility and cleft palate. Speech naturalness is an object of study in many subfields of communication disorders. Several concerns were raised as a result of the review, including the reliability and validity of measures, inadequate definitions of terminology, lack of detail in method descriptions, and the need to address relationships between naturalness and other variables included in the studies. Future studies should more carefully report methods and operational definitions used and more studies examining the relationship between naturalness and other speech variables in a variety of communication disorders are greatly needed.

The multidimensional impact of total laryngectomy on women

Based on society's expectations of what defines the norms for what is deemed "masculine" and "feminine", and a propensity for society's members to adhere to these expectations, women may face a unique set of circumstances and pressures following surgical treatment for laryngeal cancer. This is primarily due to the changes that occur to women's physical, psychological, and social functioning when dealing with cancer diagnosis and treatment outcomes. Because of concerns related to physical disfigurement, acoustic and perceptual changes to one's voice, and threat of the psychological sequelae associated with total laryngectomy (TL) (or, the surgical removal of one's voicebox and surrounding structures), there is an increased potential for violation of social expectations that cross these areas of functioning. As such, efforts that seek to better understand the potentially differential impact of TL on women and identify the specific needs they may have leading up to and after such treatment pursuant to contemporary societal expectations are warranted. Thus, this paper provides an examination of the potentially differential impact of TL on women. In addressing this position, this paper examines the unique challenges women may face postlaryngectomy through the framework of the International Classification of Functioning, Disability, and Health (ICF). Through the use of the ICF, this paper will provide an expanded perspective related to the interactions between body functioning, active participation in daily activities, and contextual factors that may act as facilitators or barriers to women's societal reintegration secondary to TL.

LEARNING OUTCOMES

Readers will be able to describe the multiple factors that may contribute to the differential impact of total laryngectomy (TL) on women. More specifically, readers will gain an understanding about women's physical, psychological, and social functioning secondary to TL. This paper also provides readers with exposure to the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) framework. This framework provides readers with an expanded perspective related to the interactions between body functioning, active participation in daily activities, and contextual factors that may act as either facilitators or barriers to the societal reintegration of women secondary to TL.

Auditory-perceptual speech outcomes and quality of life after total laryngectomy

OBJECTIVE

(1) To determine potential relationships between speech intelligibility, acceptability, and self-reported quality of life (QOL) after total laryngectomy and (2) to determine whether relationships are stronger when QOL is measured by a head and neck cancer-specific or discipline-specific QOL scale.

STUDY DESIGN

Cross-sectional.

SETTING

University-based laboratory and speech clinic.

SUBJECTS AND METHODS

Twenty-five laryngectomized individuals completed disease-specific (University of Washington Quality of Life; UW-QOL) and discipline-specific (Voice Handicap Index-10; VHI-10) QOL scales. They also provided audio recordings that included the Sentence Intelligibility Test (SIT) and a reading passage. Thirty-three listeners transcribed the SIT sentences to yield intelligibility scores. Fifteen additional listeners judged speech acceptability of the reading passage using rating scales.

RESULTS

The QOL scores were moderate across the UW-QOL physical (mean = 77.63) and social-emotional (mean = 78.02) subscales and the VHI-10 (mean = 17.91). Speech acceptability and intelligibility varied across the samples, with acceptability only moderately related to intelligibility (r = 0.41, P < .05). Relationships were weak between ratings of intelligibility and self-reported QOL (range, r = 0.00-0.22) and weak to moderate between acceptability with QOL (range, r = 0.01-0.46). The only statistically significant, but moderate, relationship was found between speech acceptability with the UW-QOL speech subscore (r = 0.46, P < .05).

CONCLUSION

Listeners' ratings of speech acceptability and intelligibility were not strongly predictive of disease-specific or voice-related QOL, suggesting that listener-rated and patient-reported outcomes are complementary.

Effect of fundamental frequency on judgments of electrolaryngeal speech

PURPOSE

To determine (a) the effect of fundamental frequency (f₀) on speech intelligibility, acceptability, and perceived gender in electrolaryngeal (EL) speakers, and (b) the effect of known gender on speech acceptability in EL speakers.

METHOD

A 2-part study was conducted. In Part 1, 34 healthy adults provided speech recordings using electrolarynges set at 75 Hz, 130 Hz, and 175 Hz, and 36 listeners transcribed the recordings. In Part 2, 22 speech samples were presented to 16 listeners. First, listeners identified the gender of each speaker and judged his or her speech acceptability using rating scales. Second, listeners judged the same samples for speech acceptability when gender information was provided.

RESULTS

In Part 1, speakers were significantly more intelligible when using 75-Hz devices. In Part 2, the f₀ of the speech signal significantly impacted listeners' accuracy in perceiving the speaker's gender: In gender-incongruent conditions (males using 175-Hz devices, females using 75-Hz devices), listeners were unable to identify female speakers. Speech acceptability judgments were directly related to intelligibility. Finally, listeners differentially penalized female speakers who used 75-Hz devices when gender information was known.

CONCLUSION

Low f₀ facilitated speech intelligibility. However, at low f₀, listeners were unable to identify females as female, and females were differentially penalized for speech acceptability. Results may have implications for rehabilitation.

Listener effort for highly intelligible tracheoesophageal speech

The purpose of this study was to determine whether: (a) inexperienced listeners can reliably judge listener effort and (b) whether listener effort provides unique information beyond speech intelligibility or acceptability in tracheoesophageal speech. Twenty inexperienced listeners made judgments of speech acceptability and amount of effort required to listen to 14 male tracheoesophageal speakers using a paired comparison paradigm. Intelligibility was controlled to limit the analysis to the relationship between ratings of listener effort and speech acceptability. Results showed that as a group, inexperienced listeners reliably rated both speech acceptability and listener effort. In addition, ratings of speech acceptability and listener effort were strongly correlated (r>.99); however, there was evidence that some individual listeners assigned different ratings for each dimension for the same speech samples. Results have important implications for communication success for tracheoesophageal speakers.

LEARNING OUTCOMES

Readers will be able to describe: (a) the measurement of listener burden in speech and (b) the differences and relationships among listener effort, speech acceptability and speech intelligibility.

Automatic intelligibility assessment of speakers after laryngeal cancer by means of acoustic modeling

OBJECTIVE

One aspect of voice and speech evaluation after laryngeal cancer is acoustic analysis. Perceptual evaluation by expert raters is a standard in the clinical environment for global criteria such as overall quality or intelligibility. So far, automatic approaches evaluate acoustic properties of pathologic voices based on voiced/unvoiced distinction and fundamental frequency analysis of sustained vowels. Because of the high amount of noisy components and the increasing aperiodicity of highly pathologic voices, a fully automatic analysis of fundamental frequency is difficult. We introduce a purely data-driven system for the acoustic analysis of pathologic voices based on recordings of a standard text.

METHODS

Short-time segments of the speech signal are analyzed in the spectral domain, and speaker models based on this information are built. These speaker models act as a clustered representation of the acoustic properties of a person's voice and are thus characteristic for speakers with different kinds and degrees of pathologic conditions. The system is evaluated on two different data sets with speakers reading standardized texts. One data set contains 77 speakers after laryngeal cancer treated with partial removal of the larynx. The other data set contains 54 totally laryngectomized patients, equipped with a Provox shunt valve. Each speaker was rated by five expert listeners regarding three different criteria: strain, voice quality, and speech intelligibility.

RESULTS/CONCLUSION

We show correlations for each data set with r and ρ≥0.8 between the automatic system and the mean value of the five raters. The interrater correlation of one rater to the mean value of the remaining raters is in the same range. We thus assume that for selected evaluation criteria, the system can serve as a validated objective support for acoustic voice and speech analysis.

Sexual problems after total or partial laryngectomy

OBJECTIVES

To investigate sexual problems that can occur after laryngeal and hypopharyngeal cancer surgery and to specify possible influencing factors.

STUDY DESIGN

Multi-institutional cross-sectional study.

METHODS

Two hundred six patients were interviewed in person using the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Head and Neck Module (EORTC QLQ-H&N35), the Hospital Anxiety and Depression Scale, and a structured interview assessing alcohol and tobacco consumption, sociodemographic data, and specific sexual problems. Type of surgery, tumor site, and tumor stage were documented according to the participants' medical records. Multivariate analysis of variance was used to assess the independent impact of each factor.

RESULTS

More than half of the patients in our study reported having reduced libido and sexual enjoyment after treatment. Sixty percent considered it an important issue for their contentment with life. Sexual difficulties were found to be unrelated with gender, formal education, alcohol and tobacco consumption, type of surgery (partial vs. total laryngectomy), radiotherapy, and tumor site. Psychological distress (F = 46.27, P < .001) was seen to have a strong independent impact on the occurrence of sexual difficulties and stage of disease (F = 4.50, P < .05) and age (F = 4.79, P < .05), a moderate independent impact.

CONCLUSIONS

Reduced libido and sexual enjoyment is a common problem after laryngeal and hypopharyngeal cancer surgery. However, it is not caused by the oncological treatment but rather by the cancer itself. Depression is often associated with sexual problems. Both should be discussed in medical consultations with head and neck cancer patients when appropriate to provide adequate treatment.