------------------------------------------------------------------------------ TITLE: INTELLIGIBILITY OF TRACHEOESOPHAGEAL SPEECH AMONG NAIVE LISTENERS SOURCE: Dept. of Otolaryngology, UTMB, Grand Rounds DATE: March 31, 1993 RESIDENT PHYSICIAN: Lane F. Smith, M.D. FACULTY: Karen H. Calhoun, M.D. DATABASE ADMINISTRATOR: Melinda McCracken, M.S. ------------------------------------------------------------------------------ "This material was prepared by resident physicians in partial fulfillment of educational requirements established for the Postgraduate Training Program of the UTMB Department of Otolaryngology/Head and Neck Surgery and was not intended for clinical use in its present form. It was prepared for the purpose of stimulating group discussion in a conference setting. No warranties, either express or implied, are made with respect to its accuracy, completeness, or timeliness. The material does not necessarily reflect the current or past opinions of members of the UTMB faculty and should not be used for purposes of diagnosis or treatment without consulting appropriate literature sources and informed professional opinion." SUMMARY: Tracheoesophageal (TE) speech is now the most common method of voice rehabilitation after total laryngectomy. The TE Speech intelligibility of laryngectomies who use TE speech as their primary mode of communication was evaluated by twenty listeners. Two speech intelligibility tests were administered using phonetically balanced rhyming words or lists of spondee words. The overall intelligibility for the group of laryngectomies was 76.5%, with a wide range variability among the individual TE speakers. We conclude that TE speech is significantly less intelligible to naive listeners then normal laryngeal speech; further refinement of voice rehabilitation for laryngectomies is needed. Introduction : The earliest attempts at using TE puncture probably occurred in the late 1800's. Since then many advances have been made, most notably with the development of more effective prostheses. TE speech is now the most common method of voice rehabilitation after total laryngectomy. The prosthesis is used to divert pulmonary airflow through a one-way valve into the esophagus and out through the oral cavity thereby permitting speech. Studies comparing TE speech to esophageal speech, artificial larynx and normal speech have shown that generally TE speech is more understandable then artificial larynx and esophageal speech. Most of these studies have used expert listeners to judge speech intelligibility. Since the laryngectomee most often communicates with people unfamiliar with TE speech, we have tested the ability of the TE speaker to communicate with the lay public. Study Objectives: The objective of our study was to characterize TE speech intelligibility to the "naive" listener intelligibility. Materials and Methods This prospective study included eight laryngectomies and twenty naive listeners. All patients used TE speech as their primary means of communication. Twenty naive listeners, ten female and ten male were asked to evaluate the intelligibility of the TE speech. None of these listeners had any experience or familiarity with laryngectomies. Two tests of speech intelligibility were used. Test one consisted of a closed list of phonetically balanced words; test two used an open list of spondee words. For test one each laryngectomee was randomly assigned one word from each of the twenty sets of five rhyming words and told the correct pronunciation of the word. As the subject repeated the words, they were tape recorded. The recordings were produced using the Nachamichi 550 Dual-Tracer Versatile Stereo Cassette System with Dolby Noise Reduction and were performed in a soundproof audiology booth, with the microphone placed at 15 cm from the subjects mouth. The listeners heard the recorded voice of the TE speakers and tried identify which word of each set of five rhyming phonetically balanced words was spoken. Since each laryngectomee was randomly assigned one of the five words in each set of the twenty different sets, no two laryngectomies had the same word list. This was to prevent the naive listeners from becoming familiar with the word list during their listening. Test two used an open list of spondee words. All subjects were given the correct pronunciation of the words prior to being recorded. Four different lists of twenty spondee words were used and these words were scrambled so that no two laryngectomies read exactly the same list. Again this was done to prevent the naive listeners from becoming familiar with the lists and thereby artificially improving the speech intelligibility. The recordings were then played to the naive listeners who were instructed to write down each word as they heard it. The list was "open" in that the listeners had no list from which to choose a word from, but simply had to rely on what they heard. Results: The overall average intelligibility as measured by being able to correctly choose a word from a set of five phonetically balanced rhyming was 71%, and from the open list of spondee words 82%. Combining these two gave an average intelligibility of 76.5%, with a standard deviation of 4.05%. Although the two tests of speech intelligibility compared well with one another it was interesting to see that the open list of spondee words was slightly more intelligible then the closed list of rhyming words. This could be due to the fact that the spondee words, which have two syllables, are more easy to understand then to differentiate between two closely matched single syllable rhyming words. Discussion The subjects in this study were included if they used TE speech as their primary mode of communication. This differs from several previous studies which included only patients with excellent TE speech. Therefore the results of this study more accurately reflect the overall spectrum of patients who use TE speech. In addition, many studies have used expert listeners to evaluate TE speech; however, the general public with whom the laryngectomee most often communicates, consists primarily of those who are unfamiliar or "naive" with respect to TE speech. For these reasons, it is important to use naive listeners to evaluate the intelligibility of the TE speech. The general intelligibility of TE speech is good, but falls short of normal speech. The overall intelligibility was approximately 76.5% This compares favorably with results from Merwin et. al., who found rates of intelligibility from 68.5% to 73.1%, and Doyle et. al., who found overall intelligibility of consonants in TE speakers to be 65%. Our study differs from Pindzola et al., who found normals to have 94% intelligibility and TE speakers to have 93% intelligibility. The results of Test Two (spondee words) were similar to those of Test One (phonetically balanced words, table 2), showing 82% and 71% intelligibility respectively. However there was a wide range of variability among individual TE speakers with those having only 60% to 65% intelligibility (sub. 5 and 6), and those with an intelligibility of 98% to 99% (sub. 2 and 3). Clearly, the possibility of intelligibility as good as normal speech exists, but overall TE speech is significantly less intelligible then normal laryngeal speech. CONCLUSIONS: The overall intelligibility of TE speech when evaluated by naive listeners was 76.5%, with a range of 61% to 91%. There is wide variation with respect to TE speech. Some individuals are able to develop TE speech with intelligibility nearly equivalent to normal laryngeal speech; however, for the majority of patients, TE speech will be significantly less intelligible then normal laryngeal speech. TE speech is an excellent method of voice rehabilitation and is highly recommended, but further research on improving our methods of voice rehabilitation in laryngectomies is indicated. --------------------------------------------------------------------------- BIBLIOGRAPHY 1. Amatsu M, Kinishi M, Jamir JC: Evaluation of Speech of Laryngectomees after the Amatsu Tracheoesophageal Shunt Operation. Laryngoscope 1984;94:696-701. 2. Baugh RF, Lewin JS, Baker SR: Vocal Rehabilitation of Tracheoesophageal Speech Failures. Head Neck 1990;12:69-73. 3. 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