Voice quality and surgical detail in post-laryngectomy tracheoesophageal speakers

Abstract

The objective of this study is to assess surgical parameters correlating with voice quality after total laryngectomy (TL) by relating voice and speech outcomes of TL speakers to surgical details. Seventy-six tracheoesophageal patients' voice recordings of running speech and sustained vowel were assessed in terms of voice characteristics. Measurements were related to data retrieved from surgical reports and patient records. In standard TL (sTL), harmonics-to-noise ratio was more favorable after primary TL + postoperative RT than after salvage TL. Pause/breathing time increased when RT preceded TL, after extensive base of tongue resection, and after neck dissections. Fundamental frequency (f0) measures were better after neurectomy. Females showed higher minimum f0 and higher second formants. While voice quality differed widely after sTL, gastric pull-ups and non-circumferential pharyngeal reconstructions using (myo-)cutaneous flaps scored worst in voice and speech measures and the two tubed free flaps best. Formant/resonance measures in/a/indicated differences in pharyngeal lumen properties and cranio-caudal place of the neoglottic bar between pharyngeal reconstructions, and indicate that narrower pharynges and/or more superiorly located neoglottic bars bring with them favorable voice quality. Ranges in functional outcome after TL in the present data, and the effects of treatment and surgical variables such as radiotherapy, neurectomy, neck dissection, and differences between partial or circumferential reconstructions on different aspects of voice and speech underline the importance of these variables for voice quality. Using running speech, next to sustained/a/, renders more reliable results. More balanced data, and better detail in surgical reporting will improve our knowledge on voice quality after TL.

A Volumetric Analysis of the Vocal Tract Associated with Laryngectomees Using Acoustic Reflection Technology

“…Many studies consistently reported a different formant pattern between alaryngeal and laryngeal speakers [9,15,17,18,[22][23][24]. As the filtering properties of the vocal tract can be reflected by vowel formants, these findings tend to point to the hypothesis that the vocal tract configuration of alaryngeal and laryngeal speakers are different.…”

“…Somewhat similar results were reported for Indian English and Dutch vowels. Maruthy et al [23] reported an increase only in F1 in Indian TE speakers, while Jacobi et al [24] found an increase only in F2 of Dutch TE speakers. Such findings are in line with the imaging studies of the vocal tract after laryngectomy using X-ray and magnetic resonance imaging (MRI) [25][26][27][28].…”

The applicability of high resolution manometry in total laryngectomy

“…The voice quality and speech effort in patients with laryngectomy rehabilitated with esophageal voice are widely different. The tone of the pharyngoesophageal segment and the quality of the new sound source are based on the dynamics of adaptation and vibration of the pharyngeal mucosa (3) , varying according to the individual characteristics of this population (4) .…”

Rehabilitation Nursing in Head Neck Cancer Patients

“…Beslenme desteğinin etkili olabilmesi için ise operasyondan yaklaşık 7-15 gün önce ağız yoluyla, tüp ile veya damar yoluyla başlanması gerekmektedir. 29,30 Beslenme desteğinde bütün baş-boyun kanserli hastalar tedavi öncesi gıda alımı ve beden kitle indeksi açısından değerlendirilmeli, kilo kaybına dikkat edilmelidir. .…”