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ACOUSTIC AND PERCEPTUAL ASPECTS OF ALARYNGEAL SPEECH
PRESENTED BY: RITHU MFACULTY: Dr M PUSHPAVATHI
Mr GOPIKISHORE P
Laryngectomy??
Types of laryngectomy ??
Laryngectomy
Partial
Hemilaryngectomy Supraglottic supracricoid Subtotal Cordectomy
Total
Rehabilitation
Artificial/electromec
hanicalEsophageal Prosthesis
Artificial/electromechanical
Transcervical
Transoral
Intraoral
Esophageal
•Consonant Injection•Injection Method •Inhalation Method
•Swallowing
Prosthesis
Non-Indwelling Prosthesis:
Must be removed every 3-4 days
Patient can change prosthesis independently
More education is required for removal, cleaning, etc.
Must have 2cm or greater tracheostoma
Must pass esophageal insufflation test
Indwelling Prosthesis:Can stay in place for 3-6
months
Requires SLP to remove/replace
Less maintenance required
Must have 2cm or greater tracheostoma
Must pass esophageal insufflation test
TEP
Overview: F0 in phonation, speech
Intensity
Perturbations
Range
Temporal aspects - VOT, Rise Time, Fall Time in phonation, MPD, Vowel duration, Rate of speech, Pause time and Total duration
Spectral aspects – Format structures, LTAS
Prosody in alaryngeal speech
Fundamental Frequency (Fo)
• Most of the mechanical speech aids are electronic and have a manually adjustable fundamental frequency.
• These are typically set to a low pitch for a male voice (about 100 Hz) and, where possible, to a higher value for a female voice (about 200 Hz).
Electrolarynx/ Artificial Larynx:
•Some have a variable frequency adjustment.
• Because Fo is determined by the electronic design of the specific instrument, little data have been reported on the Fo characteristics of speech produced with the electro larynx.
Esophageal Speech:
• The F0 of the esophageal voice is typically about 1 octave lower than the average laryngeal Fo of a male voice, whereas the female esophageal voice is about 2 octaves lower than normal.
• Better esophageal speakers tend to produce somewhat higher Fos whereas poorer speakers may produce somewhat lower Fos.
Slavin and Ferrand (1995)
26 esophageal speakers
grouped according to their average Fo and variability
characteristics
Most of them had difficulty controlling
their Fo during dynamic speech.
esophageal speakers exhibit greater
variability than normal speakers.
Some authors believe the Fo of esophageal voice depends on the exact location of the vibrating segment, but there is little evidence to support this
hypothesis.
• Weinberg (1980) normal pattern of high Fo with high vowels
• higher Fo in females than males. This is due to the morphology of PE segment in females which is smaller and thinner.
• Ranges from 29.37Hz (Perry & Tikofsky, 1965) to 86.50 (Horri, 1982).
F0 characteristics of Esophageal Speech (Reading Task):
Study N Sex Mean S.D Range
Damste, 1958 20 M 67.50 - -
Snidecor & Curry, 1959)
6 M 62.80 4.80 -
Shipp, 1967 16 M 64.74 4.98 16.00
Wienberg & Bennet, 1972
15 F 86.65 3.94 21.25
Robbins et al. 1984
15 M 77.10 4.43 34.23
pharyngoesophageal segment
The total laryngectomy procedure produces a defect
in the hypopharynx that must be reconstructed to
form the pharyngoesophageal segment
(PES)
This tubular shaped region, composed largely of skeletal muscle tissue, serves as the
neoglottis and enables production of esophageal
voice
Extends over C4, C5 and
C6
Air flows through the PE segment causing it to
vibrate
Spasticity or hypertonicity
results in poor speech
Morphology at RestLength• The excellent TEP speakers- the shortest
visible vibratory segment, followed in increasing order by the good, fair and poor speaking groups
These differences are generally very
small
Length of the PES is a significant
contributor to TEP speech proficiency
Thickness
Multilayered and/or mucosally redundant structure
Excellent, good, and fair groups- very thin and very thick extremes.
Poor speaking group exhibit mildly to moderately thickness
• Subjects with thicker vibratory segments generally produce more hoarse-harsh-strained vocal quality, greater dysfluency, and pitch and loudness dyscontrol.
PES thickness
voice and speech proficiency.
lack of synchronous
mucosal vibratory activity caused by
thickened PES mucosa
Biomechanics During Phonation
• Dyssynchronous PES vibratory patterns
• Positive correlation between the synchrony of PES vibrations and the associated level of TEP speech proficiency
Vibratory rhythmicity
Vibratory stiffness
• Exhibits at least some degree of vibratory stiffness
Excellent good fair poor
• As the pathophysiologic signs increase in severity, communication efficiency decreases
PES spasmodic hypertonic vibratory activity
speech proficiency.
Mucosal waves
excellent, good and fair groups- moderately retarded mucosal waves
more severe disturbances observed in the poor group
A relatively strong interrelationships
TEP speech proficiency PES mucosal wave integrity.
strong positive correlation
degree of perceived PES spasms or hypertonicity
mucosal wave abnormalities.
Muscular control
The speakers in the excellent, good, and fair groups- moderate degrees of PES muscular control
poor group- mild degree o f PES muscular control
Tracheoesophageal Speech:
• Tracheoesophageal speakers tend to produce Fos that are closer to normal laryngeal speakers, at least for male speakers.
• The variability of Fo is also somewhat less than esophageal speakers, but individual speakers may show considerable variation.
• Juarbe et.al (1989) collected data from 10 subjects with flap reconstruction. For these 10 subjects, the range in Fo was the most limited.
• F0 Ranges from 50.40 (Kyatta, 1964) to 100 (Zanoff et al., 1990).
As noted above the Fo of TEP is commonly aperiodic. Damste (1958) quoted reasons for this aperiodicity
Due to variation in subneoglottic pressure.
Length and elasticity of the PE segment is not constant
and adjustable as in normals.
Weinberg (1980)
Higher Fo in TEP compared to esophageal speech due to pulmonary air supply.
Fo characteristics of TE Speech (Reading Task):
Study N Sex Mean S.D Range
Robbins, et al, 1984
15 M 101.70 3.56 37.46
Trudeau & Qi, 1990
10 F 108.6 2.68 -
Moon & Wienberg, 1987
16 M 64.74 4.98 16.00
Wienberg & Bennet, 1972
5 M 72.73 .91 22.44
Merwin et al, 1985
8 M 83.80 - -
Comparison of Fundamental Frequency characteristics in normal, TEP and EP individuals:
(Robbins, et al, 1984).
Vocal Intensity
Electrolarynx/ Artificial Larynx:
Users of an electro larynx can produce average intensity
levels during speech ranging between 75
and 85 dB
This level is typical of normal laryngeal
speakers during ordinary
conversation or reading.
There is some evidence for a
reduced intensity range for users of electro larynges.
As was the case for Fo, the intensity of
the electronic vibrator is largely determined by the design of the
instrument.
Intensity characteristics of individuals with Electrolarynx
Study N Sex Mean S.D Range
Hymen, 1955
8 M 83.007.00
Weiss & Komshian, 1979
5 M 74.00 1.87 5.00
Esophageal Speech:
The intensity of esophageal speech is more variable and somewhat lower in overall loudness than normal.
The range of voice intensity that esophageal speakers are able to produce is much less than the intensity range of normal laryngeal speakers (about 10 dB vs. 30 dB).
Intensity characteristics of individuals with Esophageal Speech:
Study N Sex Mean S.D Range
Hymen, 1955 7 M 73.00 11.00
Snidecor & Isshiki, 1965
1 M 85.00 20.00 -
Hoops & Noll, 1969
22 M 62.40 3.60 10.55
Baggs & Pine, 1983
5 M 8.96 (Recorded in mm from a graphic level recording. Not converted to dB).
1.58 4.33
Robbins et al, 1984
15 M 59.30 10.09 -
Tracheoesophageal Speech:
• The intensity of tracheoesophageal speech appears to be only slightly less than the levels produced by laryngeal speakers.
• Variation of intensity may be somewhat greater than normal speakers.
• Some tracheoesophageal speakers habitually produce greater than normal intensity levels.
• Robbins et al (1984) compared TE, esophageal and normal speech under identical sets of conditions.
• In terms of vocal intensity laryngeal speech occupied the middle ground, being on the average 10 dB more intense than the esophageal speech and 10 dB less intense than the TE speech in oral reading and sustained vowel phonation.
Intensity characteristics of individuals with TEP:
Study N Sex Mean S.D Range
Robbins, et al, 1984
15 M 79.40 2.10 13.8
Trudeau & Qi, 1990
10 F 70.80 8.50 29.00
Baggs & Pine, 1983
5 M 19.56 3.22 15.69
Author Method Results
Baggs and Pine (1983) Comparison of vocal intensity between Esophageal and TE speakers.
Larger intensity in TEP speakers. Due to greater intraoral pressure.
Singer (1983) Esophageal speaker and TEP speaker.
Considerable lower intensity with TE speaker.
Blood (1984) Laryngeal and TEP Higher intensity with TEP speakers.
Robbins et al (1984) 15 normals, esophageal, TEP
sustained vowels,
Paragraph reading.
Sustained vowels:
N: 76.9 dBSPL
Eso: 74 dBSPL
TE: 88 dBSPL
Paragraph reading:
N: 69.3 dBSPL
Esophageal: 59.3 dBSPL
TEP: 79.4dBSPL
Debruyne (1994) 12 TE, 12 Esophageal Vowel
Esophageal: 79.7 dBSPL
TE: 65 dBSPL
Veena.K.D (1998) 5 each normals, Esophageal and TE
N: 72.3 dBSPL
Esophageal: 35.5 dBSPL
TE: 32.6 dBSPL
Comparison of Intensity characteristics in normal, TEP and EP individuals:
(Robbins, et al, 1984).
Perturbation Measures
Frequency perturbation (jitter)
reflects the frequency stability of the vocal
folds.
mean period difference, jitter ratio, jitter factor,
relative average perturbation (RAP), and
directional perturbation.
• Jitter ratio - ratio of the average period difference and the average period.
• Directional jitter - number of sign changes of the period differences divided by the total number of periods.
• This ratio is then multiplied by 100 to yield a percentage measurement.
frequency perturbation in alaryngeal sp
Jitter ratio directional jitter
Electrolarynx/ Artificial Larynx:
• No reported studies of frequency perturbation in speakers using an electro larynx.
• However, jitter expected to be directly related to the stability of the electronic circuit producing the tone
• would not reflect the speech characteristics of the speaker.
Esophageal Speech:
Esophageal speech - more unstable than
normal laryngeal speech - as reflected in much
larger jitter ratios.
Directional jitter is about the same
magnitude as normal speakers.
Author Method Results
Hoops and Noll (1969)
22 esophageal rainbow passage
Jitter(%): 41.1%
Smith et al (1978) 9 esophagealphonation /a/
Jitter: 0.62 to 5.13 msecJitter ratio:
95:47
Tracheoesophageal Speech:
• The data on jitter characteristics of tracheoesophageal speakers are unclear.
• One study reports a jitter ratio very similar to normal speakers, whereas another reports a much higher than normal value.
Jitter values to be similar to those of esophageal speakers as both groups of speakers use the same anatomical system as the vibrator, that
is, the PE segment.
Author Measure Laryngeal TE Esophageal
Robbins et. al (1982)
% jitter 0.77 5.14 18.25
Kinshi and Amatsu (1986)
Mean jitterJitter ratio
0.0710
0.4730
0.8260
Trudeau and Qi (1990)
Mean jitterJitter ratio
Directional jitter
-
1.78 msec134.863.7
-
Pindzola and Cain (1989)
Jitter % 2.03 4.59 7.65
Rajashekar (1990) Single case
Extent of fluctuationSpeed of
fluctuation
- 19 Hz36 Hz
9.2 Hz14 Hz
Rajashekar (1991)
20 TE and Esophageal
speakers
extent of fluctuation
speed of fluctuation
- 13.3 Hz14.6 Hz
10.4 Hz16.5 Hz
Bertino et al (1996) Jitter and shimmer of TE is more similar to normal speakers than esophageal speakers.
Larger jitter in females for TE speakers
attributed to their higher Fo and small VC.
In TE speech
more regular pattern in jitter values
due to expiratory airflow which is more efficient driving force than the small ejections
of air out of esophagus.
Trudeau and Qi (1990)
jitter ratio
elapsed time between
laryngectomy and voice recording
These combined findings seem to indicate the type of surgery, particularly as the surgery
transplants other tissue into the area of the PE segment, affects the acoustical nature of
speech produced by the puncture.
Amplitude perturbation (Shimmer)
• index of the stability of a sound source • The average difference in amplitude between
adjacent cycles of vibration (dB) • Directional shimmer, like directional jitter, is
the number of changes of sign between adjacent periods divided by the total number of period differences, again multiplied by 100.
• reflect the electronic design and construction of the instrument and not the inherent anatomical or physiological capabilities of the speaker.
Electro larynx
• Shimmer of is greater than normal whereas directional shimmer is very similar to normal speakers
Esophageal speakers
• Both shimmer and directional shimmer are greater than normal speakers.
Tracheoesophageal
Author Method Task Laryngeal TE Esophageal
Robbins (1982)
Shimmer ratio /a/ 0.43 10.55 24.15
Robbins (1984)
Mean shimmer /a/ 0.3 dB 0.80 1.90
Rajashekar (1991)
20 TE, 20 Esophageal
Extent of fluctuation
Speed of fluctuation
6.8 dB
28.4 dB
3.8 dB
3.3 dB
Pauloski et al (1989)
Lower shimmer in TE speakers who wore low pressure prosthesis and spoke by digital occlusion.
Temporal Characteristics
Temporal measurements reported on alaryngeal speech
words per minute (wpm)
syllables per second
total duration of
reading
words or syllables per air charge
wpm as a measure of
speech rate.
percentage of silence during reading aloud,
used as a measure of pause
time.
total vowel duration, or the
maximum time a speaker can
sustain a vowel.
To a large extent, all of these measures reflect the speaker’s ability to control the regressive air stream.
For the esophageal speaker, they also reflect the ability to quickly recharge the esophagus with sufficient air.
• For users of an electro larynx, phonation time is dependent on the vibrator
• Silence is dependent on the speaker’s facility with the on/off button.
Esophageal speaker
Small air volumes present in
the esophagus
TE speakers
full pulmonary
air supply
• The reading rate of normal adults speakers (between 40 and 70 years of age; ages most appropriate for comparison with laryngectomies) is about 173 wpm.
• Rates much less than 140 wpm are usually perceived as slow and rates above 185 wpm are perceived as fast (Franke, 1939).
• Normal speakers can produce about 13 words per breath of air, which averages to about 4 seconds in duration (Snidecor & Curry, 1959).
• Reading rates are slower when using an electro larynx compared to normal phonation or to tracheoesophageal speech (Merwin et al. 1985; Weiss & Yeni-Komshian, 1979).
• We might expect longer reading times for electro larynx users because of the need to produce more precise articulation to maintain an acceptable level of intelligibility.
Esophageal speakers read slower than normal laryngeal speakers.• Rates between 100-115 wpm appear typical for these speakers,
which is about 60-70% of the rate of normal speakers.
Esophageal speakers generally spend about 30-45% of their reading time in silence. • These abnormally long silent periods reflect the more frequent
need to recharge air supply.
A much shorter sustained duration of “phonation” than normal speakers, typically less than 6 seconds (vs. 15-20 seconds for normal speakers).
small volume of air in the esophagus.
Better esophageal speakers have much shorter periods of silence
more rapid air intake with less interruption of speech flow.
Tracheoesophageal speakers also can produce long phonation durations (about 12 seconds) for the same
reason
These speakers spend bout 10-30% of their time in silence
The ability to use full pulmonary air supply to drive the PE segment.
Tracheoesophageal speakers read at a slower rate than normal speakers but faster than esophageal speakers.
difficulty in controlling the PE segment and the need to articulate precisely.
esophageal speakers (110-115 wpm)
TE speakers (97-136 wpm)
laryngeal speakers (166 wpm)
Studies on Esophageal speech:
Author Results
Snidecor and Curry (1960)
Eso: group average of 113 wpm
Filter and Hyman (1975)
2.5 syllables per second for good Esophageal speaker
Sanyogeetha (1993)
Rate of speech was less in Esophageal compared to
normals
Studies done on TE speakers:Author Method Results
Singer (1983). 4 TE 97-136 wpm.
Pauloski et al. (1989) TEDuck-bill Vs Low-
pressure
High rate of speech with low pressure
prosthesis
Sedory et al (1989) TE 2.86 syllables/seconds
Robbins (1984); Sedory (1989)
TE Fast rate of speech ranging from 2.6 to
3.6 syllables per second in TE speakers
Rate of speech across groups:Author Method Laryngeal Esophageal TE
Baggs and Pine (1983)
Sentences 182.5 wpm. 117.7 wpm.
132.4 wpm
Robbins et al (1984)
Rainbow passage
172.8 wpm. 99.1 wpm.
127.5 wpm
Veena K.D (1998).
5 each normals, Eso and TE
5.43 syllables per second.
1.85 syllables per second
3.44 syllable per second
Comparison of WPM in normal, TEP and EP individuals: (Robbins, et al, 1984)
Other temporal characteristics:
VOT RT-FT in phonation MPD
Pause time
Total duration
VOT
physical characteristics of neoglottis
myoelastic motor control properties
responsible for VOT in alaryngeal speech
Author Method ResultsKlor and Milanti
(1980)VOT for pre-vocalic stop
consonantsLaryngeal, Esophageal
speakers
Reduced VOT in alaryngeal speakers
Weinberg (1982) Esophageal and TE speakers
Esophageal speakers are far less consistent than
normals in effective variations in timing of
voicing onset
Robbins, Chrinstensen and Kempstar (1986)
VOT in voiceless consosnants
Normals, Esophageal and TE speakers
Longer VOTLaryngeal>TE>Esophage
al
Santhosh Kumar (1993)
Normals and TE speakers
Greater VOT in TE than normals (contrasts with
Robbins et al)
Author Method ResultsVenkatraj Ajthal (1997) Normals & TE VOT for /p/ /t/ /k/ and /th/ was
longer in TE than normals in both initial and final positions. Slightly shorter VOT for TE for/b/ /d/ /g/ and /dh/ compared to normals in both initial and medial positions.
Sacco, Mann and Schultz (1967); Marshall (1974)
Esophageal Listeners misidentified consonant voicing contrasts in Esophageal. He attributed this as a cause for reduced intelligibility.
Chrinstensen, Weinberg and Alfonso (1978)
VOT in a large number of consonants
Average VOT associated with prevocalic voiceless stops of Esophageal was significantly shorter than normal
2. Rising time; Falling time in phonation
Author Method Results
Rajashekar et al. (1990).
TE Greater RT and FT in TE. Attributed to more
pressure required to initiate and sustain
phonation in TE speakers
Santhosh Kumar (1993)
Normals and TE speakers
RT shorter than normals. TE showed longer FT than
normals on/i/ and /u/ whereas normals showed
longer FT in /a/.
3. MPDAuthor Results
Baggs and Pine (1983)
Longer PD in TE compared to Esophageal, however, MPD in TE was shorter than normals
Robbins (1984). Attributed reduced MPD in TE to High airflow ratesPoor digital occlusion of the stomaPoor MPD in Esophageal to limited air supply
Robbins, Fisher, Blom and Singer (1984)
MPD:Laryngeal: 22 secs.TE: 12 secs.Esophageal: 6 secs
Santhosh Kumar (1993).
Lower mean MPD in TE compared to normals.
Comparison of MPD in normal, TEP and EP individuals
(Robbins, et al, 1984).
4. Vowel duration:Author Method Results
Christensen and Weinberg (1976)
VD
normals and Esophageal
Longer VD in voiced for Esophageal as against the
voiceless in normals
Robbins, Chrinstensen and Kempstar (1986).
15 each normals, Esophageal and TE.
Normals had shorter VD, Esophageal intermediate
and the TE longest.
Hariprasad (1992). 10 vowels
Esophageal.
Alryngeal speaker uses longer VD as a
compensatory strategy to increase intelligibility of
speechSanyogeetha (1993 Normal and Esophageal Esophageal had longer VD
than normals for /a/ /o/ and /u/. shorter VD for /u/
/a/
Longer VD in TE speakers attributed to:
• Pulmonary air as a driving source.• Greater air pressure and sustained
flow rates driving the neoglottis, producing slower decay in PE segment vibration.
5. Word duration:
This is attributed to lack of efficient timing control in initiation and termination of voice in
Te speakers and also changes in articulatory behavior secondary to laryngectomy.
Author Method Results
Venkataraj
Aithal (1997)
Laryngeal and TE speakers.
Word reading task.
TE used longer WD compared to
normals.
Pause time:
• Esophageal: 30-40% in silence.• Better Esophageal speakers-shorter PT.• TE: 10-30%
Author Method Laryngeal Esophageal TE
Robbins et al (1984)
Rainbow passage
0.62 0.65 0.89
Spectral aspects:
Esophageal:
Sindecore (1968):
irregular striations.
Weinberg (1982):
elevated formant
frequency.
Author Method Results
Sanyogeetha (1993)
Normals, Esophageal
Mean F1, F2, and F3 for vowels /a/, /i/, /u/, /o/, /e/
Higher except /o/, /u/ in Esophageal
Hariprasad (1992).
Normals and Esophageal Space between formants increase, speech intelligibility increases
TEAuthor Method Results
Christensen and Weinberg (1976)
vowels Wider space between formants
Santhosh Kumar (1993)
/a/ /i/ /u/ /e/ /o/ reduced F3
VenkatrajAithal (1997)
10 vowels Higher Fo, F2 and F3
Hammberg and Nord (1989)
Normals and TE Alaryngeal voice had weaker Fothan F1
Prosody in alaryngeal speech
Intonation and stress:
Weinberg (1980):• TE were able to control Fo duration.
• Intonation and stress as like normals but change in frequency is discontinous.
TE and Eso-produce stress syllable but not on the
same syllable. Intonation contrasts were seen in laryngeal, TE and
Eso but Electro-larynx-not able to achieve these
intonation distinctions.