La voz del laringectomizado: incapacidad, percepción y análisis acústico

Membiela, Carla María Granda; Gutiérrez, María José Fernández; Andrés, Sandra Mamolar; Rabanal, Liliana Santamarina; Rodríguez, Paloma Sirgo; Marcos, César

doi:10.1016/j.rlfa.2016.03.002

Cited by 11 publications

(6 citation statements)

References 11 publications

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“…The acoustic analysis of the voice of the patients showed a difference in the parameters F0, NHR, and MFT between the patients rehabilitated with ES and those rehabilitated with TES. Granda et al,20 reported that patients rehabilitated with TES showed significantly better values in relation to the acoustic parameters F0 (mean value), NHR, and MPT, whereas Arias et al,21 found no significant differences in acoustic parameters between the two rehabilitation modalities. The different findings of these studies based on the acoustic analysis of voices rehabilitated with TEP might be attributed to several factors, including the type of prosthesis used.…”

Section: Discussionmentioning

confidence: 99%

<p>Verbal performance of total laryngectomized patients rehabilitated with esophageal speech and tracheoesophageal speech: impacts on patient quality of life</p>

Allegra¹,

Mantia

Bianco³

et al. 2019

PRBM

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Introduction Total laryngectomy has important psychophysical and social consequences for patients’ quality of life because of the functional changes resulting from the removal of the larynx. Voice deprivation is perhaps the most relevant limiting factor in social relationships, increasing feelings of solitude and tending to drive individuals into social isolation. Multiple voice rehabilitation methods after total laryngectomy are available. This study aimed to determine the acoustic quality of the rehabilitated voice achieved with esophageal speech (ES) and tracheoesophageal speech (TES), and acoustic quality impacts on patients’ perceptions of their quality of life. Materials and methods The patient inclusion criterion was the completion of a speech rehabilitation course with ES or TES at least 6 months after total laryngectomy. The voice acoustic analysis was carried out automatically by using the Multidimensional Voice Program. The following parameters were extracted: fundamental frequency (F0), Jitter% (Jitt), Shimmer% (Shim), and noise-to-harmonic ratio (NHR). Subjective voice evaluation was performed by using the following questionnaires: Voice Handicap Index (VHI), Voice-related Quality of Life (V-RQOL), and Voice Performance Questionnaire (VPQ). Results The acoustic analysis showed a difference between ES and TES patients on all acoustic parameters; this difference was significant for F0 (133.09±2.4 and 119±3.3, respectively; p <0.001), NHR (0.43±0.21 and 0.31±0.14, respectively; p =0.02), and maximum phonation time (2.02±038 s and 10.64±0.28 s, respectively; p =0.01. Regarding patient-related outcomes, TES correlated with better total scores compared with ES; however, the differences in the total scores on the VHI ( p =0.09), V-RQOL ( p =0.39), and VPQ ( p =0.52) were not statistically significant. Conclusion The rehabilitation of laryngectomized patients must be addressed by a multidisciplinary team that considers the personalities, personal needs, and relational conditions of individual patients in order to determine and apply the phonatory rehabilitation method most suitable for achieving a better quality of life.

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Section: Discussionmentioning

confidence: 99%

<p>Verbal performance of total laryngectomized patients rehabilitated with esophageal speech and tracheoesophageal speech: impacts on patient quality of life</p>

Allegra¹,

Mantia

Bianco³

et al. 2019

PRBM

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“…A systematic review by Van Sluis and colleagues [ 18 ] saw that studies on speech outcomes after TL have been flawed in design and represent weak levels of evidence; they reiterated that is there is no standardized means of evaluating voice in substitute voice speakers [ 29 ]. In GPU, the transferred stomach is more patulous than the vibrating pharyngoesophageal segment in either esophageal or tracheoesophageal speech [ 9 ], and even those techniques are known to produce more noise components and less regularity than laryngeal voice [ 30 ]. Our acoustic analysis of GPU with secondary TEP demonstrated low vocal intensity which is in keeping with previous studies of alaryngeal speech [ 8 , 30 – 34 ], and in particular, tracheoesophageal speech in other methods of circumferential reconstruction (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…In GPU, the transferred stomach is more patulous than the vibrating pharyngoesophageal segment in either esophageal or tracheoesophageal speech [ 9 ], and even those techniques are known to produce more noise components and less regularity than laryngeal voice [ 30 ]. Our acoustic analysis of GPU with secondary TEP demonstrated low vocal intensity which is in keeping with previous studies of alaryngeal speech [ 8 , 30 – 34 ], and in particular, tracheoesophageal speech in other methods of circumferential reconstruction (e.g. tubed cutaneous free flap, jejunal grafts, etc) [ 5 , 8 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Prospective cohort study of voice outcomes following secondary tracheoesophageal puncture in gastric pull-up reconstruction after total laryngopharyngoesophagectomy

Deane

Parhar

Rammage

et al. 2021

Journal of Otolaryngology - Head & Neck Surgery

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Background Gastric pull-up is a reconstructive option for circumferential defects after resection of advanced laryngopharyngeal malignancy. Voice loss is expected and vocal rehabilitation remains a challenge. Our study objectives were to investigate the feasibility of secondary tracheoesophageal puncture following gastric pull-up and to analyze voice outcomes. Methods This was a prospective cohort study of patients with advanced laryngopharyngeal malignancies who underwent gastric pull-up and secondary tracheoesophageal puncture between 1988 and 2017 at a tertiary-care academic institution. Objective acoustic measures included fundamental frequency and vocal intensity. Perceptual analysis was performed using voice recordings (“Rainbow Passage”) randomly presented in a blinded fashion to four clinicians using the validated GRBAS scale. Speech intelligibility was assessed in a blinded fashion using a validated 7-point scale. Additionally, the Voice Handicap Index-10 was administered as a validated patient self-reporting tool. Results Ten patients (7 male, 3 female) were included, all of whom preferentially used tracheoesophageal puncture for communication. These patients had abnormal median fundamental frequency of 250 (interquartile range (IQR) 214–265) Hz and a limited median vocal intensity of 65.8 (IQR 64.1–68.3) dB. Perceptual analysis (GRBAS) revealed a median ‘moderate’ degree of impairment [grade 2 (IQR 2–3), roughness 2 (IQR 2–3), breathiness 3 (IQR 2–3), asthenia 2 (IQR 1–2), strain 2 (IQR 1–2)] as did median intelligibility scores [median 5 (IQR 4–7)]. Most patients self-reported an abnormal voice handicap-10 [median 26.5 (IQR 22.8–35.0)]. Conclusion Secondary tracheoesophageal puncture is a safe and feasible option for voice rehabilitation after gastric pull-up. Although analyses demonstrated moderate subjective and objective impairment, tracheoesophageal puncture provided patients with a self-reported means of functional verbal communication and was their preferred method of communication. Graphical abstract

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“…De esta manera la faceta de evaluación artística de la voz se verá completada con procedimientos técnicos y científicos, como ya apuntamos en la introducción. En el futuro es nuestro propósito ampliar la base de cantantes y establecer comparaciones entre las pruebas objetivas y subjetivas, como ya ha hecho nuestro grupo con otros colectivos, como es el caso de los pacientes laringectomizados (Granda et al, 2016). No pretendemos extrapolar los datos obtenidos en este estudio como valores de referencia, por la limitación del tamaño muestral como ya hemos indicado de manera reiterada, pero sí ampliarlo en el futuro.…”

Section: Discussionunclassified

La voz en los cantantes líricos. Protocolo para su valoración clínica y acústica

Gutiérrez

Álvarez²,

Rodríguez³

et al. 2021

RLOG

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El objetivo de esta investigación es elaborar un protocolo clínico y acústico con diversas técnicas para evaluar la voz de los cantantes líricos. Se seleccionaron 18 cantantes líricos, que se consideraban sanos, clasificados como soprano, mezzosoprano, contralto, tenor, barítono y bajo. A todos se les realizó la anamnesis, el S-VHI y una serie de estudios aerodinámicos (TMF, índice s/e y cociente de fonación) y acústicos (F0, intensidad, HNR, Jitter, Shimmer, espectrograma, fonetograma y LTAS), así como una exploración clínica e instrumental estroboscópica. El 33% eran fumadores, siendo este hábito más frecuente en hombres. El S-VHI detectó 20 puntos sobre 144 posibles, puntuación relativamente alta de su grado de incapacidad. Casi la mitad obtuvieron valores fuera del rango de normalidad en el TMF, índice s/e y cociente de fonación. Las características acústicas de su voz y los rangos vocales y dinámicos estaban, en la mayoría de los casos, dentro de la normalidad. En el 55% se observó algún tipo de patología laríngea. Los cantantes deberían evitar el uso del tabaco, así como hacer revisiones frecuentes para detectar patologías laríngeas que pasan desapercibidas. Los valores aerodinámicos y acústicos muestran alteraciones con respecto a los valores normales de referencia. La presencia de vibrato y formante del cantante puede verse en el espectrograma y el LAST, así como el rango dinámico y vocal con el fonetograma. El uso del protocolo clínico y acústico proporciona importante información que completa la obtenida por el terapeuta vocal o el profesor de técnica vocal en el análisis perceptual de la voz profesional.

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La voz del laringectomizado: incapacidad, percepción y análisis acústico

Cited by 11 publications

References 11 publications

<p>Verbal performance of total laryngectomized patients rehabilitated with esophageal speech and tracheoesophageal speech: impacts on patient quality of life</p>

<p>Verbal performance of total laryngectomized patients rehabilitated with esophageal speech and tracheoesophageal speech: impacts on patient quality of life</p>

Prospective cohort study of voice outcomes following secondary tracheoesophageal puncture in gastric pull-up reconstruction after total laryngopharyngoesophagectomy

La voz en los cantantes líricos. Protocolo para su valoración clínica y acústica

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