A paired comparison analysis of third-party rater thyroidectomy scar preference.

OBJECTIVE: To determine the length and position of a thyroidectomy scar that is cosmetically most appealing to naïve raters. METHODS: Images of thyroidectomy scars were reproduced on male and female necks using digital imaging software. Surgical variables studied were scar position and length. Fifteen raters were presented with 56 scar pairings and asked to identify which was preferred cosmetically. Twenty duplicate pairings were included to assess rater reliability. Analysis of variance was used to determine preference. RESULTS: Raters preferred low, short scars, followed by high, short scars, with long scars in either position being less desirable (p < 0.05). Twelve of 15 raters had acceptable intra-rater and inter-rater reliability. CONCLUSION: Naïve raters preferred low, short scars over the alternatives. High, short scars were the next most favourably rated. If other factors influencing incision choice are considered equal, surgeons should consider these preferences in scar position and length when planning their thyroidectomy approach.

Enhancing the conceptual clarity and utility of the international classification of functioning, disability & health: the potential of a new graphic representation.

PURPOSE: To present a new graphic representation of the international classification of functioning, disability and health (ICF), entitled the ICF-conceptual revision (ICF-CR). The ICF-CR aims to be clearer and more usable tool than the ICF graphic currently used by starting to address criticisms of the ICF raised in the literature, with a focus on positioning quality of life (QoL) in relation to the ICF's other components. METHOD: This is a conceptual paper based on a review of criticisms of the ICF and related literature published on human functioning. RESULTS: In addition to criticisms of the current graphic, four criticisms of the ICF are discussed in relation to the development of the ICF-CR, including: the lack of development of biopsychosocial theory, the lack of clarity between activities and participation, the language used, and the absence of QoL. General systems theory is used to help construct the new graphic in addressing these criticisms and to position QoL. CONCLUSIONS: The ICF-CR is designed to be a more responsive graphic of human functioning; one which enhances the clarity of principles integral to the ICF, including biopsychosocial theory and universalism. It is hoped the ICF-CR will promote continued discussion toward the goal of enhancing the ICF, both visually and conceptually.

The use of autologous platelet and plasma products in salvage neck dissections: a prospective clinical study evaluating early and late wound healing.

OBJECTIVES: To evaluate the effect of autologous platelet and plasma adhesives (APA) on postoperative drainage and soft-tissue fibrosis following neck dissections. DESIGN: This was a blinded comparative prospective cohort study done as two parts: part one evaluated early post-surgical outcomes and part two evaluated late tissue fibrosis. METHOD: Salvage neck dissections were stratified into two groups based on severity of prior treatment. High risk patients were defined as those who had previously undergone chemoradiation therapy and autologous platelet adhesives were administered to the surgical wound intraoperatively. The low risk group consisted of patients undergoing salvage neck dissections following radiation only and acted as controls. Part one evaluated postsurgical wound drainage as the primary outcome as well as length of hospital stay and complications. Part two evaluated late postoperative tissue fibrosis by comparing neck skin using the Cutometer. R2 and F0 were the specific Cutometer parameters for quantifying the viscoelastic properties of the skin. RESULTS: Postoperative wound drainage was significantly less (253.7 vs. 345.8) in the autologous platelet adhesive group as compared to the control group (p less than 0.03). Length of stay in the APA group versus the control group was 3.13 and 3.86 days respectively (p less than 0.004). Both R2 and F0 measurements showed improved viscoelastic properties of the skin in the APA group (R2 p less than 0.05, F0 p less than 0.05). CONCLUSIONS: APA application following salvage neck dissections may reduce early postperative wound drainage and improve long-term skin quality.

Vocal function following radiation for non-laryngeal versus laryngeal tumors of the head and neck.

OBJECTIVE: The larynx may receive high doses of radiation even in the absence of disease. Preliminary investigation has provided evidence that significant voice alterations exist in patients who received radiotherapy (RT) for non-laryngeal tumors of the head and neck. This study evaluates subjective and objective parameters of vocal function in this patient population compared with a control group of patients irradiated for early glottic tumors. STUDY DESIGN: Retrospective cohort study. METHODS: Vocal function in patients irradiated for non-laryngeal and early glottic tumors was assessed in a comprehensive manner and compared. Microanalytical and macroanalytical acoustic analyses, aerodynamic measurements, and videostroboscopy were performed on vowel production data. The Voice Handicap Index was administered for self-assessment of voice quality. All subjects were male, smokers, and greater than 12 months post-RT. RESULTS: Seventeen patients with non-laryngeal tumors and 13 patients with early glottic tumors were evaluated. Microanalytical acoustic parameters were worse for 75% (6 of 8) of the acoustic measures of vowel production in the non-laryngeal group. These include jitter, relative amplitude perturbation, amplitude perturbation quotient, normalized noise energy, pitch amplitude, and spectral flatness ratio. Macroanalytical acoustic analyses revealed no difference in fundamental frequency but numerically smaller phonational frequency range in the non-laryngeal group. All aerodynamic measures, including mean phonation time, mean airflow, and vocal fold diadochokinetic rate, were decreased in the non-laryngeal group. Videostroboscopy demonstrated increased supraglottic activity in the non-laryngeal group. Voice handicap was significantly greater in the non-laryngeal group. CONCLUSIONS: When compared with patients receiving RT for early glottic tumors, there is objective and subjective evidence of vocal dysfunction in patients treated with wide-field RT for non-laryngeal tumors.

Dysarthric speech: a comparison of computerized speech recognition and listener intelligibility.

The purpose of this study was to identify and compare the recognition of dysarthric speech by a computerized voice recognition (VR) system and non-hearing-impaired adult listeners. Intelligibility "functions" were obtained for six dysarthric speakers who varied in severity and six age- and gender-matched controls. Speakers produced 70-item word lists over 5 sessions. VR using the IBM VoiceType and perceptual judgment scores were obtained and functions plotted by session. Data indicate that computerized recognition of both dysarthric and nonimpaired speech was characterized by initially steep increases in correct recognition with more gradual increases noted during the second through fifth sessions. Perceptual recognition by non-hearing-impaired adults indicates generally stable intelligibility scores over time. Severity of dysarthria did appear to influence recognition of target stimuli. Implications of these data to the application of computerized VR technology are presented.

Microanalytic acoustical voice characteristics of near-total laryngectomy.

Limited acoustic data are available describing vocal characteristics of individuals after near-total laryngectomy. Computer-based acoustic analyses (FO, jitter, shimmer, signal-to-noise ratio) were performed on vowel samples produced by 20 speakers who underwent near-total laryngectomy. On the basis of data obtained, the subjects who had undergone near-total laryngectomy demonstrated (1) higher than normal and more variable modal fundamental frequency values for sustained vowels; (2) increased frequency (jitter) and amplitude (shimmer) perturbation; and (3) decreased spectral noise (signal-to-noise) components. In addition, speakers who had undergone near-total laryngectomy showed an increased percentage of unvoiced sound production during their vowel productions. The large variability and general aperiodicity of the phonatory signal during vowel production suggests an ineffective laryngeal valving system with overcompensation in attempts to generate effective voice. These findings have implications for designing behavioral therapy programs to improve voice quality in speakers who receive conservation laryngectomy procedures for treatment of laryngeal carcinoma.

A comparative acoustic analysis of voice production by near-total laryngectomy and normal laryngeal speakers.

Limited objective data are available on voice characteristics of patients following near-total laryngectomy. Acoustic characteristics of near-total voice were quantified and compared to laryngeal voice production. High quality audio recordings were obtained from 11 subjects who had undergone near-total laryngectomy and 11 age-matched laryngeal speakers. Subjects performed vocal tasks which provided frequency, intensity and duration measures. These data were computer analyzed and indicated that substantial inter and intrasubject variability existed in the acoustic measures for near-total laryngectomy patients. These patients demonstrated a general restriction in fundamental frequency, reduced intensity and a limitation in duration of phonation when compared to laryngeal speakers.

A sindscal analysis of perceptual features for consonants produced by esophageal and tracheoesophageal talkers.

This study was concerned with the perceptual responses of normal-hearing listeners to consonants produced by esophageal and tracheoesophageal (TE) talkers and a single talker who was proficient in both of these alaryngeal speech modes. The listeners' perceptual responses were analyzed using Symmetric Individual Differences Scaling (SINDSCAL) to determine whether distinctive feature differences existed between these two methods of alaryngeal speech. This a posteriori analysis revealed that primary features retrieved for both speech methods included sibilant, affricate, dental, nasal, and sonorant. Although greater perceptual weightings were observed for TE speech, these productive/perceptual features were weighted similarly for both speech methods. Some secondary group-specific feature differences were also observed, but these features did not contribute substantially to the total amount of variance accounted for in the analysis. Thus, the SINDSCAL results showed that the groups did not use different feature systems. These results are discussed in regard to the unique alaryngeal speech production methods employed by esophageal and TE talkers and the relative limitations of the alaryngeal (esophageal) voicing source they use. General clinical implications of the data are discussed.

A comparison of habitual and derived optimal voice fundamental frequency values in normal young adult speakers.

The purpose of this study was to compare habitual (modal) and derived optimal pitch (fundamental frequency) values in 40 young adults. The individual habitual F0 values of 20 male and 20 female nonsmokers with normal larynges, normal voices, and no history of laryngeal pathology or formal vocal training were obtained from high-quality recordings of spontaneous monologue, oral reading, and sustained phonation. Optimal fundamental frequency (F0) was derived from each individual's phonational range using the 25% Method (Fairbanks, 1960; Pronovost, 1942). Using correlative analyses, the predicted optimal F0 values that were derived were compared to habitual F0 values for the male and female speaker groups, and for specific vocal tasks used to identify habitual F0 (i.e., spontaneous monologue vs. oral reading vs. sustained phonation). Results indicate that habitual F0 was not consistent with derived optimal F0 values using the 25% Method; rather, habitual F0 in our normal adults occurred between 8% and 10% up the phonational range from basal F0. Clinical implications of these data and the related limitations associated with the concept of optimal pitch (F0) are discussed.

Perception of pre-vocalic and post-vocalic consonants produced by tracheoesophageal speakers.

The purpose of this project was to investigate the perception of consonant-vowel-consonant (CVC) stimuli produced by four tracheoesophageal (TE) speakers. Stimuli were representative of five phonetic manner classes (stop, fricative, affricate, nasal, and liquidglide). Twelve naive normal-hearing young adults served as listeners. Stimuli were presented via headphones and listeners were prepared and analyses of the data were conducted for individual speakers and for the entire group. The listeners' perceptual judgments were analyzed for each manner of production by phonetic context. Based on statistical analyses of the data obtained, all four speakers were perceived by listeners to produce post-vocalic consonants with significantly better intelligibility.

Perception of stop consonants produced by esophageal and tracheoesophageal speakers.

This preliminary study investigated the perceptual characteristics of stop consonants produced by two esophageal and two tracheoesophageal (TE) speakers, and one normal speaker. Speech stimuli consisting of CVCVC syllables were presented in the sound-field to nine naive, normal-hearing listeners who transcribed their perceptions of each stimulus. Listener responses for each speaker were collapsed into confusion matrices and analyzed for overall intelligibility, place, and voicing features. Error data were also quantified and analyzed. Results indicate that overall, stop consonants produced by TE speakers were significantly more intelligible than those produced by esophageal speakers. For all six stops investigated, intelligibility was greater for TE speakers. Findings are discussed in relation to existing aerodynamic, acoustic, and speech production data for alaryngeal speakers.

Clinical modification of the tracheostoma breathing valve for voice restoration.

The development of the tracheostoma breathing valve and its use in conjunction with tracheoesophageal (TE) puncture prostheses has offered an important option to laryngectomized patients who undergo surgical-prosthetic voice restoration. Despite advantages that the tracheostoma breathing valve provides, some TE speakers are unable to utilize the device although they are successful users of the TE puncture voice prosthesis. This paper presents a safe, simple, and successful modification of the tracheostoma breathing valve in a single patient who demonstrated anatomical limitations for its use. Modification procedures are presented and clinical implications are discussed.

Effects of listener sophistication on judgements of tracheoesophageal talker intelligibility.

The purpose of this project was to provide preliminary data on comparative judgments of tracheoesophageal (TE) speech intelligibility by two groups of listeners who varied in their listening sophistication. Four highly proficient TE talkers produced the stimuli for the study. Stimuli represented all consonant manner classes in both pre- and postvocalic contexts. The two listener groups were composed of 10 naive listeners and 10 experienced speech pathologists. Data from each listener group was analyzed for overall intelligibility and intelligibility by pre- and postvocalic phonetic position. Scores were also quantified by phonetic manner class. Statistically significant differences were identified between judgments of the two listener groups for prevocalic stops and fricatives. Experienced listeners did, however, generally judge talkers to exhibit higher intelligibility compared to naive listeners. The potential clinical implications of these data are discussed.

Listeners' perceptions of consonants produced by esophageal and tracheoesophageal talkers.

The purpose of this study was to investigate the consonant intelligibility of 3 esophageal (E) and 3 tracheoesophageal (TE) talkers, and 1 dual-mode (DM) talker proficient in both E and TE speech modes. Audio recordings of 24 English consonants produced by each talker in a consonant-vowel-consonant-vowel-consonant (CVCVC) context were presented in the sound field to 15 normal-hearing, naïve, young adult listeners who phonetically transcribed their responses using an open-response paradigm. Listeners' pooled responses were converted to confusion matrices and analyzed for overall intelligibility, voicing and manner features, and consonant omissions. Ratings of speech proficiency were also obtained. Overall, the intelligibility of the TE talkers was significantly better than that of the E talkers. The DM talker was also more intelligible in the TE mode. Voiced consonants, plosives, fricatives, nasals, and liquid-glides were significantly more intelligible when produced by TE talkers. Affricates were also more intelligible for the DM talker in his TE mode. The different patterns of intelligibility observed between the E and TE talkers studied may be due to temporal speech distinctions evolving from the influence of dissimilar driving sources upon the vibratory characteristics of the pharyngoesophageal segment. Clinical implications are presented.

The effects of cigarette smoking on voice-fundamental frequency.

Previous group research has shown that the mean voice-fundamental frequency (F0) for individuals who smoke is lower than that of age- and sex-matched nonsmokers. It is believed that this reduction in F0 is a result of edema of the vocal folds caused by tobacco smoke. This study investigated F0 changes during smoking and no-smoking periods. Data were collected before, during, and after a 40-hour period of no-smoking. Analysis of the voice recordings showed a rise in voice F0 for the two smoking subjects during the 40-hour no-smoking period. Age- and sex-matched control subjects did not show a rise in their F0 during the same tasks. Results suggest that the pitch-lowering effects of cigarette smoking may be reversed after as few as 40 hours of smoking cessation.

Effects of noise on NST and NU 6 stimuli.

This study determined how normal-hearing listeners' performance on a nonsense syllable test (NST) was affected by three noise competitors, and how these responses differed from those on the standard NU 6 meaningful word test. Twenty young adult listeners heard the stimuli via earphones and provided verbal responses to the NST and NU 6 items in competition with: white noise, multitalker noise, and white noise which was amplitude modulated by the multitalker noise, each at a 0 dB signal-to-noise ratio. Responses were scored on a whole-word (all-or-none) basis. Statistical analyses revealed that listeners' performance was always poorer on the NST than on the NU 6 regardless of competitor type; and that scores were better in the multitalker noise followed by white noise and amplitude modulated white noise. These data and those from earlier studies indicate that the NST is sufficiently difficult in quiet that it may not warrant testing in noise.