Reed-fistula speech following pharyngolaryngectomy.
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Biomedical subjects
Publications and source records attributed to B Weinberg.
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The voice onset times (VOT) of a large number of stop-consonant initiated syllables produced by esophageal and normal speakers were measured. Esophageal speakers systematically varied VOT during the production of speech-sound categories with the same manner of production. Average voice onset times associated with the production of prevocalic voiceless stops of esophageal speakers were significantly shorter than those of normal speakers, while takler-group comparisons associated with the production of voiced prevocalic stops were nonsignificant. Voice onset times of both esophageal and normal speakers were differentially sensitive to place of articulation. Findings are discussed in terms of furthering current understanding of how effectively esophageal speakers achieve important phonological contrasts.
Audiotape recordings of sustained vowels produced by nine esophageal speakers were subjected to acoustic and perceptual analysis. Results indicated that (1) the magnitude of vocal jitter present in the vowels was substantially larger than that observed in normal speakers and speakers with laryngeal/vocal disturbance, (2) listeners could reliably rate the severity of vocal roughness in the vowels, (3) voices of esophageal speakers were characterized by varying degrees of vocal roughness, and (4) mean fundamental frequency, mean jitter, or jitter ratio measures did not serve as useful predictors of the perceived severity of vocal roughness. These findings are interpreted to suggest that the mechanism esophageal speakers employ to regulate fundamental frequency is substantially different from that employed by normal speakers and that the identity of physical variables underlying the perception of roughness severity in naturally produced human speech is not well understood.
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An assessment was made of oral manometric performance of normal speaking six- and seven-year-old boys. Readings of maximum, sustained, positive and negative pressure with bleed and nostrils occluded and open were obtained from each of forty subjects. It was found that the majority of normal speaking six- and seven-year-old boys had considerable difficulty generating and maintaining stable, maximal positive and negative pressure upon repeated trials of each of four manometric tasks. The findings of this project support the general hypothesis that oral manometric ratio data may be of questionable diagnostic value in predicting velopharyngeal adequacy for speech, particularly if ratio data must be interpreted dichotomously. The observations made were interpreted to support the view that there may be substantial differences even within the normal population in the ability to perform manometric tasks. The present results suggest that operational procedures commonly used during manometric testing merit rigorous scrutiny, re-examination and analysis.
The reed fistula method is under development as a method of voice restoration in patients who have undergone larynogopharyngectomy. Introducing extrinsic sound into the pharynx involves a series of biomedical engineering problems. The approaches to solution of these problems are covered in the present article.
The duration of a large number of representative vowels produced by 10 esophageal and nine normal speakers were measured. Overall vowel durations of esophageal speakers were consistently longer than those of normal speakers, indicating that esophageal speakers do not compensate for their striking diminution in air supply for speech by decreasing vowel duration. The differences in the vowel duration characteristics between normal and esophageal speakers were observed to vary systematically as a function of the voicing features of their consonant environments. Specifically, the durations of vowels of esophageal speakers spoken within voiceless consonant environments were consistently longer than those spoken in similar contexts by normal speakers. There were no significant differences between the average durations of vowels spoken by normal and exophageal speakers within voiced consonant speakers differed significantly as a function of the voicing features of their consonant context was interpreted to support the belief that inherent, rule-governed durational features of English are retained following laryngeal amputation.
Selected speech characteristics of patients with acromegaly, a relatively uncommon endocrine disorder resulting from excessive secretion of growth hormone, are described. In patients with acromegaly, increased quantities of circulating growth hormone may cause hypertrophy of multiple bodily structures, including components of the phonatory and articulatory apparatus. Speech recordings of 11 patients with acromegaly (six women and five men) were subjected to fundamental frequency and articulation analysis. Despite clinically apparent lingual hypertrophy in each of the patients studied, no speech articulation errors were found. In contrast, acromegaly appeared to produce a lowering of voice fundamental frequency (fo) characteristics in some, but not all, patients. Women exhibited more striking changes in fo than did men.
Broad-band masking of speech was used to assess the effects that broad-band masking noise had upon the recognition of consonants and vowels produced by esophageal speakers. Procedures were developed to compare the articulation functions of superior esophageal speech with those of normal speech under comparable levels of masking noise. Within the range of speech-to-noise ratios studied, articulation functions for vowels were essentially the same for esophageal and normal talkers (4% per dB). With respect to consonants, the intelligibility scores for esophageal speech were 12 to 14% lower than for normal speech under adverse noise conditions. Gains in the consonant articulation functions were 2.5%/dB and 4%/dB for normal and esophageal talkers, respectively. For adverse noise conditions, the lowered consonant scores for esophageal speakers were the result of poorer than normal intelligibility for liquid-glides and nasal and, secondarily, for stop consonants. Additional differences between the intelligibility characteristics of esophageal and normal speech were found in work-position and voicing features.
Acoustic features of pharyngeal /s/ substitutions spoken by persons with cleft palate were measured using digital computer processing and analysis techniques. Average short-time spectral characteristics of pharyngeal /s/ sounds produced by four speakers with cleft palate were compared with spectral features of normally gestured /s/ sounds spoken by two normal speakers. The output spectral characterized by a set of distinctive acoustic properties that differed markedly from normal /s/ sounds gestured in the front of the mouth. One consistent feature of pharyngeal /s/'s was the presence of multiple spectral maxima. Pharyngealization of /s/ consonants gave rise to spectral outputs with energy maxima appropriate to high F1 values which were relatively close to F2, as well as to relatively strong, low frequency excitation of F2 speakers with cleft palate were, in general, comparable to those of /h/ fricatives spoken by speakers of Arabic.
Radiographic cephalometry was used to examine the prevalence, magnitude, and relationship between velar stretch and other commonly employed cephalometric measurements in forty (40) normal-speaking 8 and 10-year-old children. Velar stretch was not universally observed although the average soft palate length characteristics of these children measured during speech were significantly longer than the resting or intrinsic palate length measurements. Significant differences in average stretch magnitude were measured as a function of speech task (/u/ vs /s/) and subject age (8 vs 10-year-olds). Although velar stretch was significantly correlated with several commonly used cephalometric measurements, stretch was not well predicted by any single cephalometric measurement used in this research. These findings are interpreted in terms of their implications for determining velopharyneal adequacy for speech and their implications with respect to developmental features of velar function.
Patients who undergo extensive resection of the pharynx along with laryngectomy usually are not able to develop esophageal speech. Since 1971 we have been working on a method for speech rehabilitation for these patients, which utilizes sound from a reed powered by tracheal air outflow. The sound is led into the pharynx via a fistula. Ten patients have been so managed, and six are now using this method of communication with satisfactory results. Preliminary studies on one patient indicated that his speech quality was judged to be superior to that produced by an excellent esophageal speaker. Efforts are continuing to study further the acoustical and perceptual properties of this form of speech and to improve further the method.
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