8.11.12 voice ppt final

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

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):


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


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


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:


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 -


• 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:


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


TE: 65 dBSPL

Veena.K.D (1998) 5 each normals, Esophageal and TE

N: 72.3 dBSPL


TE: 32.6 dBSPL

Comparison of Intensity characteristics in normal, TEP and EP individuals:


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


• 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.


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


• 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


Rajashekar et al. (1990).

TE Greater RT and FT in TE. Attributed to more

pressure required to initiate and sustain

phonation in TE speakers


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


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.


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.


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


/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.

8.11.12 voice ppt final

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