Surgical Variables Affecting Speech in Treated Patients With Oral and Oropharyngeal Cancer

Abstract

Postoperative speech function may be influenced by a number of treatment variables. The objective of this study was to examine the relationships among various treatment factors to determine the impact of these measures on speech function. Speech function was tested prospectively in 142 patients with surgically treated oral and oropharyngeal cancer 3 months after treatment. Each patient's speech was recorded during a 6- to 7-minute conversation and while performing a standard articulation test, producing speech outcome measures of percent correct consonant phonemes and percent conversational understandability. Correlational analyses were used to determine the relationships among the speech outcome measures and 14 treatment parameters. Speech function was mildly to moderately negatively correlated with most surgical resection variables, indicating that larger amounts of tissue resected were associated with worse speech function. Overall measures of conversational understandability and percent correct consonant phonemes were related to extent of oral tongue resection, floor of mouth resection, soft palate resection, and total volume of tissue resected. These relationships varied depending on the method of surgical closure. Method of surgical reconstruction had a profound impact on postoperative speech function 3 months after treatment and was an important factor in determining how oral tongue resection influenced articulation and intelligibility. The combination of closure type, percent oral tongue resected, and percent soft palate resected had the strongest relationship with overall speech function for patients with surgically treated oral and oropharyngeal cancer 3 months after treatment.

Complications and functional outcomes following complex oropharyngeal reconstruction

“…With regard to speech, over two thirds of patients attained >80% intelligibility in the present study. Similar to the findings of Pauloski et al, 20 the amount of oral tongue resection was significantly associated with postoperative speech intelligibility. Although patients with larger resections extending into the oral cavity demonstrated a trend toward longer periods of tracheostomy dependence that was not statistically significant, most patients (86%) were decannulated within 2 weeks after discharge.…”

Combined chemotherapy and radiation therapy for head and neck malignancies

“…6,35,36 Extensive ablation of the tongue muscles is associated with severe reduction of speech intelligibility. 37 As a result, surgery for advanced tumors (TNM stage T3 and T4) produce a higher degree of speech dysfunction because of the amount of tissue resected to achieve a negative margin.…”

“…35 However, even with reconstructive surgery, a significant decrease in tongue mobility was observed after oral surgery for carcinoma of the floor of the mouth and tongue. 6,37,39 The effect on the intelligibility of speech was more pronounced when the mobility of the tongue base and dorsum was reduced. 36 As a result, surgery of the base of the tongue is associated with significant speech dysfunction compared with other tumor sites.…”

“…Postoperative radiation does not appear to impair speech quality despite the xerostomia produced. 6,9 Swallowing motility disorders are investigated…”

PEAKS – A system for the automatic evaluation of voice and speech disorders

“…For scientific purposes, evaluation is usually performed by a panel of listeners. Semi-standardized instruments for the analysis of speech disorders in children and adults are well known (Panchal et al (1996); Paulowski et al (1998); Mády et al (2003); Enderby (2004)). These subjective methods are still the most commonly used to assess speech intelligibility (Robbins et al (1987); Bodin et al (1994); Brown et al (1997); Knuuttila et al (1999); Haughey et al (2002); Seikaly et al (2003); Markkanen-Leppanen et al (2006)), speech disorders and temporal structure of speech (Mahanna et al (1998); Pauloski et al (1998); Furia et al (2001); Su et al (2003); Bressmann et al (2004); Terai and Shimahara (2004)).…”