UNASSIGNED: Patients lose their voice after laryngectomy for laryngeal cancer or aspiration prevention surgery for severe dysphagia. To assist such patients, we developed and verified the utility of a novel vocalization method using a device termed the voice retriever (VR), in which the sound source is placed in the mouth.
UNASSIGNED: We investigated the effectiveness of the VR in patients. The VR consists of a mouthpiece with a built-in speaker and a dedicated application that serves as the sound source. We compared the speech intelligibility and naturalness in normal participants using VR and an electrolarynx (EL) for the first time as well as the voice-related quality of life (V-RQOL) in patients with dysphonia before and after using the VR.
UNASSIGNED: The VR produced significantly higher 100-syllable test scores as well as fluency, amount of additional noise, intonation, intelligibility and overall long reading test ratings in the first-time VR and EL users. Furthermore, the VR use significantly improved the V-RQOL of participants with dysphonia.
UNASSIGNED: Compared to EL, VR allows more effective speech improvement in participants without experience using an alternative vocalization method and improves the V-RQOL in patients with dysphonia.
UNASSIGNED: Step 4.

Voice restoration following laryngectomy has a significant influence on quality of life (QOL). Three main techniques exist to provide voice: esophageal speech (ES), artificial larynx (electrolarynx [EL]), and tracheoesophageal puncture (TEP). Although the EL was historically the most used technique, TEP has quickly become the gold standard. ES remains the least frequently used technique in developed countries. Technique selection must be made on an individual basis, considering the patient\'s cancer history and comorbidities. Ultimately, the choice in voice-restoration technique requires joint decision making with the surgeon, speech pathologist, and patient.

UNASSIGNED: The current work aims to design and develop an automatically controlled wearable electrolarynx, a voice substitution device for laryngeal carcinoma survivals.
UNASSIGNED: The physical activity of mouth opening is sensed, amplified, and made to act as an enable signal to trigger the wearable electrolarynx. The resulting speech is recorded and compared for its voice reaction durations with that of manual electrolarynx and normal speaking methods. Perception evaluations of 5 subjects from 10 speech-language therapists are obtained.
UNASSIGNED: The wearable electrolarynx turn-on in 13 μs once the mouth movement for speech is sensed. The voice initiation time and termination durations are 215.68 m and 231.41 ms, respectively. Results indicate that there is no significant difference (P < 0.05) between the voice reaction durations of wearable electrolarynx and normal speaking methods. The subjective evaluation results show that there is a significant improvement (P < 0.05) in intelligibility and noise reduction when compared to a commercially available electrolarynx with an average intra-class correlation coefficient of 0.68 from analysis of variance two factors without replication.
UNASSIGNED: The assessment of the wearable and automatically controlled electrolarynx provides hands-free speech and easy control over the device.

The normal functioning of the larynx or voicebox gives humans the ability to converse with others effortlessly. However, if the larynx is permanently removed due to injury or illness, speech cannot be produced. The electrolarynx, a noninvasive device used to produce speech for such persons, has a motor-induced hum which hinders telephone-based communication among electrolaryngeal speakers. This adversely affects the morale of electrolarynx users, leading to abandonment of technology, psychological issues and decreased quality of life. This paper examines a technique based on bandpass filtering of electrolaryngeal speech which has the potential of increasing the quality and intelligibility of speech produced by means of an electrolarynx. Finite impulse response and infinite impulse response filtering with bandpass frequencies analogous to telephone landline and wideband filtering were investigated. Objective testing and subjective testing of quality and intelligibility of electrolaryngeal speech have been performed in each phase of the work. Statistical analysis based on one-way analysis of variance (ANOVA) has been conducted after each round of subjective testing. Results indicate that the quality as well as intelligibility of electrolaryngeal speech can be improved with the help of bandpass filtering.

Purpose: Following a total laryngectomy in which the larynx is completely removed, individuals in the USA have three primary options for alaryngeal verbal communication including tracheoesophageal speech (TES), oesophageal speech (ES) and electrolarynx (EL). Using a large sample of participants from across the USA, this study investigated listener impressions of each primary type of alaryngeal communication. As these are the individuals more likely to be participating in social interactions and in positions of hiring for employment, the general public\'s impressions of TES, ES and EL may be a vital consideration during the treatment process.Method: A total of 381 individuals rated eight speech samples, including samples from speakers of each alaryngeal communication modality as well samples from age and sex matched laryngeal speakers, with regards to three outcome measures: intelligence, likability and employability.Result: Listener impressions of alaryngeal speech samples were modulated by the type of communication mode. Further, the patterns of results differed by speaker sex, with ES speech rated consistently more favourable for female speakers across all outcome measures and TES rated consistently more favourable for male speakers across all outcome measures.Conclusion: An overall preference for laryngeal speech was noted, particularly with male speakers. The female ES stimuli, interestingly, was the highest rated alaryngeal communication modality. Regardless of speaker sex, all alaryngeal modes greatly affected impressions of employability relative to impressions of likeability and intelligence.

UNASSIGNED: Effective interaction with orally intubated patients is important for critical care rehabilitation. An electrolarynx (EL) has reportedly proven useful for facilitating verbal communication during oral intubation. The EL allows patients to express their wishes instantly. Nevertheless, this method is not commonly applied, probably because articulation is often unsatisfactory. Here, we report a case of successful EL-based communication during early mobilization and describe the key factors involved in this success.
UNASSIGNED: An 82-year-old man, who was intubated and undergoing mechanical ventilation for the treatment of acute respiratory failure caused by severe pneumonia, was referred to the rehabilitation department for early mobilization. The patient tried to speak during the spontaneous awakening trials and breathing trials for weaning off mechanical ventilation. However, he was frustrated by communication difficulties and consequently exhibited negative behavior toward physical therapy. We attempted to use an EL to facilitate communication, but initially the patient failed to achieve intelligible articulation. We eventually established that the intubation tube should be located at the corner of the mouth to minimize the restriction of tongue movement. Intelligible sounds were recognized and successful communication between the patient and staff was subsequently achieved.
UNASSIGNED: The use of an EL is worthy of consideration during early mobilization of orally intubated patients. To achieve successful communication with an EL, both patient selection (Richmond Agitation-Sedation Scale score of 0 or -1) and the proper placement of the intubation tube are necessary to ensure intelligible articulation.

Total laryngectomy or laryngopharyngectomy is the main treatment strategy of choice for advanced laryngeal/hypopharyngeal carcinoma.However,the operation is associated with important consequences over and above the loss of normal voice.Therefore,it is necessary toachieve voice in the absence of a functional larynx.The objective of this article is to provide an over view of current methods and a summary of the present progress about voice rehabilitation after total laryngectomy.

To determine the influence of clear speech on auditory-perceptual judgments of speech acceptability and listener comfort for electrolaryngeal speech.
Voice recordings were obtained from 10 electrolaryngeal speakers. Each speaker read the Rainbow Passage in two conditions: habitual speech and clear speech. Speakers were encouraged to speak as clearly as possible and over-articulate in the clear speech condition. Auditory-perceptual rating tasks were completed by 20 normal-hearing adults who evaluated 20 randomized voice recordings. Two counterbalanced listening sessions were used to gather ratings of speech acceptability and listener comfort.
A significant effect of speaking condition was found on listener judgments of speech acceptability, but not listener comfort. However, listener scores for speech acceptability and listener comfort were found to be significantly related. For all speakers, objective temporal measures indicated reduced speaking rates in the clear speech condition.
These findings suggest that volitional attempts to improve electrolaryngeal speech using clear speech might negatively impact listener judgments of speech acceptability, but not listener comfort. Further, the data suggest that speech acceptability and listener comfort might address unique perceptual entities. Overall, the strong relationship between these auditory-perceptual dimensions provide support for the use of scaled measurements to assess the impact of speech rehabilitation on individuals who use the electrolarynx.

To assess feasibility of producing intelligible and comprehensible speech with an electrolarynx; measure anxiety, communication ease, and satisfaction before/after electrolarynx training; and identify barriers/facilitators.
We included tracheostomized adults from 3 units following commands, reading English, and mouthing words. On enrolment, we measured anxiety, ease, and satisfaction with communication. We gave electrolarynx instruction for ≤5 days then 2 independent raters assessed intelligibility, sentence comprehensibility (9-point difficulty scale), and Electrolarynx Effectiveness Score (EES), and re-evaluated anxiety, communication ease, and satisfaction. Interviews explored barriers/facilitators.
We recruited 24 participants (Jan2015-Dec2016). Mean (SD) intelligibility was 45%(18%) words correct: 57%(21%) when facing. Mean comprehension difficulty was 6.4(2.0) overall, indicating moderate difficulty (5.5(2.5) scored visualizing). Mean EES was 2.9(1.0) (3 = improved lip-reading through recognizable sounds). Anxiety decreased from median 3.8 to 2.0 (P = .007). Communication was rated easier (median 15 vs 12, P = .04) whereas satisfaction remained similar (P = .06). Facilitators included device friendliness, patient independence, and word intelligibility. Barriers were patient weakness, difficulty positioning the device, and limited sentence as opposed to word intelligibility.
The electrolarynx may aid intelligible speech for some tracheostomized patients if the communication partner can visualize the users face, and reduce anxiety and make patient perceived communication easier.

Perceived listening effort is a perceptual dimension used to identify the amount of work necessary to understand disordered speech. The purpose of this study was to investigate the utility of perceived listening effort to provide unique information about disordered speech. The relationships between perceived listening effort and two current outcome measures (speech acceptability, intelligibility) were examined for listeners rating electrolaryngeal speech, along with their reliability and intra-rater agreement.
Ten healthy male speakers read low-context sentences using an electrolarynx. Twenty-five inexperienced listeners orthographically transcribed and rated the stimuli for perceived listening effort and speech acceptability using a visual analog scale. Strict reliability and agreement criteria were set.
Perceived listening effort was moderately to strongly correlated with intelligibility (r = -0.76) and acceptability (r = -0.80), each of which contributed uniquely to ratings of perceived listening effort. However, only 17 listeners met stringent reliability and agreement criteria.
Ratings of perceived listening effort may provide unique information about the communicative success of individuals with communication disorders. There is great variability, however, among inexperienced listeners\' perceptual ratings of electrolaryngeal speech. Future research should investigate variables that may affect perceived listening effort specifically and auditory-perceptual ratings in general.