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This chapter presents a case study of a young patient, facing a series of surgeries and rehabilitation after an accident, who resists therapy from a provider with an electrolarynx.

An electrolarynx (EL) is a widely used device to mechanically generate excitation signals, making it possible for laryngectomees to produce EL speech without vocal fold vibrations. Although EL speech sounds relatively intelligible, is significantly less natural than normal speech owing to its mechanical excitation signals. To address this issue, a statistical voice conversion (VC) technique based on Gaussian mixture models (GMMs) has been applied to EL speech enhancement. In this technique, input EL speech is converted into target normal speech by converting spectral features of the EL speech into spectral and excitation parameters of normal speech using GMMs. Although this technique makes it possible to significantly improve the naturalness of EL speech, the enhanced EL speech is still far from the target normal speech. To improve the performance of statistical EL speech enhancement, in this paper, we propose an EL-to-speech conversion method based on CLDNNs consisting of convolutional layers, long short-term memory recurrent layers, and fully connected deep neural network layers. Three CLDNNs are trained, one to convert EL speech spectral features into spectral and band-aperiodicity parameters, one to convert them into unvoiced/voiced symbols, and one to convert them into continuous $F_{0}$ patterns. The experimental results demonstrate that the proposed method significantly outperforms the conventional method in terms of both objective evaluation metrics and subjective evaluation scores.

Advanced stage laryngeal cancer patients have to undergo larynx removal surgery. Laryngeal retraction is done by laryngeal surgery. After the surgery, the laryngeal patients will lose the vocal cords and thus lose the ability to produce permanent sound. For post-laryngectomy patients, sound rehabilitation is necessary to able to conduct communication in other ways. There are 3 (three) ways of sound rehabilitation, namely esophageal speech, tracheoesophageal and electrolarynx. Sound has two kinds of intonation, namely high and low intonation that are used to emphasize certain words within sentences. Intonation also consists of three types of intonation, namely: dynamic pressure (low strong), tone pressure (high), and tempo pressure. The result will be used as the parameter to determine the start and the end of the sound. Electrolarynx is one of the tools used by the patient to talk in post-laryngectomy. In the previous research, electrolarynx prototype development is still needed to be improved, so that the optimal results to help human to be able to speak could be achieved. This research will describe the design of intonation control in electrolarynx using electromyograph sensor to raise human voice intonation in larynx (no larynx) and mute (deaf or speech impaired) in order not to sound monotone.

We propose a mathematical model for voice aging that could be used in the design of an age-adapting Electrolarynx. Voice data from public figures, at the ages of 30, 40, 50 and 60 years old, were acquired from a YouTube corpus. The voice processing consisted of an extraction of 70 Mel-Frequency Cepstral Coefficients (MFCCs) and a computation of their statistical features. ANOVA F-tests were used to determine which of these features change with age. Significant differences between age groups were found only for the first 40 MFCCs. The aging model was then constructed using non-linear regression and an averaged quadratic polynomial fit on these coefficients. Model age-adapted voices were reconstructed from the young dataset speakers’ voices and compared to their voices at older ages. The model was validated by the correlation between speakers’ MFCCs at older ages and the model-aged MFCCs. The average correlation results were in the range of 0.62 to 0.93. The results imply that the first 40 MFCCs are more susceptible to age related changes and that the proposed model has the potential to enhance the Electrolarynx by providing age adaptation as the speaker grows older.

Vocal rehabilitation devices used by patients after Laryngectomy produce an unnatural sounding speech. Our study aims at increasing the quality of these synthetically generated voices by implementing human-like characteristics. A simplified source filter model, linear predictive coding coefficients and line spectral frequencies were used to model the vocal tract and manipulate the acoustic features of their resulting speech. Two different mapping functions were employed to convert between the features of synthetically generated voice and those of a human voice: A Gaussian mixture model and a linear regression model. The models were trained on a set of 50 human and 50 synthetic voice utterances. Both mapping functions yielded significant changes in the transformed synthetic voices and their spectra were similar to the human voices. The linear regression model mapping produced slightly better results compared to the Gaussian mixture model mapping. Listeners' tests confirmed this result, but indicated that voices re-synthesized from the transformed model coefficients, improved on the synthetic voice but still sounded unnatural. This may imply that the vocal tract model is lacking in information that produces the subjective perception of “artificial speech”. Future work will investigate an elaborate model which will include the speech production excitation and radiation signals and the transformation of their features. These models have the potential to improve the conversion of synthetically generated electrolarynx voice into human sounding one.

Dear Editor, The management of laryngeal cancer is focused on improvingsurvival while preserving function; nevertheless, total laryngectomy is often required for primary and recurrent disease. While total laryngectomy is undoubtedly an effective oncologicalsurgery, it profoundly alters speech, respiration and sense of smell and taste. Specifically, the loss of voicehas the impact on the psychosocial and economic consequencesfollowing laryngectomy.There are three methods of voice rehabilitation after totallaryngectomy: electrolarynx, oesophageal speech andtracheo-oesophageal (TE) speech. Historically, oesophagealspeech was the method of choice by which all otherswere compared, and patients who could not master oesophagealspeech used the electrolarynx. In 1969, Staffieri introduced a surgical voice restoration techniquecalled “phonatory neoglottis surgery”: this was a personaltechnique that allowed one-way air transit from the lungsto the hypopharynx or oesophagus through a fistula betweenthe trachea and the hypopharynx or oesophagus.In 1977, Amatsu with a different surgical technique thatincluded a posterior tracheal wall flap, namely the “Amatsutracheo-oesophageal shunt”, achieved similar results.Both authors addressed the issue of frequently occurringaspiration and the use of a trachea-oesophageal prosthesisplacement to manage failures. In 1972, Mozolewski firstdescribed a TE shunt prosthesis with a valve function. In1980, Singer and Blom proposed a simplified endoscopicmethod for voice restoration. They addressed the problemsof aspiration and stenosis (of the fistula) by meansof a valved prostheses placed inside the TE fistula. Thisprocedure was initially proposed as a secondary salvagetechnique for patients who failed oesophageal speech orthose who were displeased with the electrolarynx voice.Maves and Lingeman and Hamaker et al. were the firstto introduce TE puncture with voice prosthesis as a primarytechnique, performed at the time of laryngectomy.Nowadays, TEP with voice prosthesis is the gold standardfor voice rehabilitation after total laryngectomy.

An electrolarynx (EL) is one of the most popular voice rehabilitation technologies used after laryngectomy. However, most ELs generate monotonic EL speech, which has been shown to create a particular deficit in speech intelligibility, especially for Chinese Mandarin (Mandarin). Mandarin is a tonal language that makes lexical distinctions using variations in tone. Our purpose is to design an EL that can produce the four Mandarin tones, and to evaluate its performance. We designed a fundamental frequency (F0) control method for Mandarin EL speech and manufactured a touch-controlled electrolarynx (T-EL) prototype. Using monosyllables, disyllabic words, and frequently used phrases, we evaluated speech produced with a T-EL, as well as with monotone (M-EL) and variable-frequency modes (P-EL) of a commercially available TruTone EL. A male native Mandarin speaker with laryngectomy volunteered to be the speaker. Results show that the normal speech pitch contours of the four Mandarin tones were most closely matched by the characteristics produced with T-EL. The statistical accuracy of the T-EL’s tone and word perception was significantly higher than that of the other EL types. Moreover, the confusion matrix indicates that the listeners could correctly identify the tones of monosyllables and disyllabic words in T-EL speech. Accurate tone judgment can improve the intelligibility of EL speech in Mandarin. The mean opinion score was used to evaluate the listeners’ acceptability of EL speech. The scores of the T-EL and M-EL were very close, and the score of the P-EL was significantly lower than that of the other two ELs. However, the results from a single speaker cannot provide sufficient data to conclude which EL has a higher acceptability. The evaluation of multiple EL speakers with different EL types at difference levels of proficiency should be studied in future research.

Laryngectomees lose their voice box after surgery and adapt various methods to restore their voice, one of them being Electrolaryngeal speech. The Electrolarynx suffers from producing natural speech by generating mechanical form of speech with suppressed unvoiced features, device and environment noise. This paper tends to remove the echo noise, device noise and environmental noise thereby enhancing the Electrolaryngeal speech to be more intelligible by spectral mapping using Gaussian Mixture Model (GMM) and auditory masking. The low frequency noise is masked by the pre-emphasised speech signal by determining the absolute threshold of masking. The spectral mapping technique using GMM based voice conversion in association with the source-filter model improves the voice quality and prosody. The objective and subjective evaluation measures, depict the significant enhancement of electrolaryngeal speech compared to previous enhancement methods which removed only low frequency noise and failed to include voice quality.

Individuals who undergo laryngectomy as a radical treatment for laryngeal cancer lose their vocal cords and their voice; this also occurs with individuals suffering from amyotrophic lateral sclerosis when they are fitted with a respirator.

Electrolarynx (EL) is a speaking-aid device that helps laryngectomees who have their larynx removed to generate voice. However, the voice generated by EL is unnatural and unintelligible due to its flat pitch and strong vibration noise. Targeting these challenges, previous works show that the electrolaryngeal speech can be enhanced using Gaussian Mixture Model (GMM) based voice conversion (VC). Although effective in improving the naturalness, it degrades the intelligibility of the converted speech. To address this issue, we propose a hybrid approach using both Non-negative Matrix Factorization (NMF) and GMM methods. For better intelligibility, we apply the NMF to estimate the high quality spectral features. For better naturalness, we use the GMM with dynamic trajectory constraint to recover a smoothed F 0 . Additionally, to suppress the EL vibration noise, we include the 0th MCC coefficient in the GMM-based VC. The proposed method significantly increases the F 0 dynamic range, reduces vibration noise, and improves both speech naturalness and intelligibility. One hundred pairs of the normal and electrolaryngeal speech in daily mandarin are recorded as our evaluation data. Experimental results show that our proposed hybrid method reduces the mel-cepstral distortion by 7.1 dB and increases the F 0 correlation coefficient to 0.54.

Towards the development of a singing aid system for laryngectomees, we propose a method for converting electro-laryngeal (EL) speech produced by using an electrolarynx into more naturally sounding singing voices. Singing by using the electrolarynx is less flexible because the pitch of EL speech is determined by the source excitation signal mechanically produced by the electrolarynx, and therefore, it is necessary to embed melodies of songs to be sung in advance to the electrolarynx. In addition, sound quality of singing voices produced by the electrolarynx is severely degraded by an adverse effect of its mechanical excitation sounds emitted outside as noise. To address these problems, the proposed conversion method uses 1) pitch control by playing a musical instrument and 2) noise suppression. In the pitch control, pitch patterns of music sounds played simultaneously in singing with the electrolaryx are modified so that they have specific characteristics usually observed in singing voices, and then, the modified pitch patterns are used as the target pitch patterns in the conversion from EL speech into singing voices. In the noise suppression, spectral subtraction is used to suppress the leaked excitation sounds. The experimental results demonstrate that 1) naturalness of singing voices is significantly improved by the noise suppression and 2) the pitch pattern modification is not necessarily effective in the conversion from EL speech into singing voices.

Background Loss of voice is the consequence of laryngectomy most disturbing for the patient. As such, the notion of performing a laryngectomy has always been directly linked to the possibility of voice rehabilitation. The multitude of different technical and surgical approaches pays testimony to the problems associated with rehabilitation of speech and swallowing after laryngectomy. Methods Scientific online search engines and library facilities were used to search for recent publications and historical medical documents. Important works were identified and summarized. Results Four different categories of voice rehabilitation can be identified: external (electrical) devices, esophageal speech, and tracheoesophageal shunts either with or without fistula valves/voice prosthesis. During the past three decades, fistula valves/voice prostheses have become the state of the art, with some patients still using esophageal speech or external devices as a back-up method in case of prosthesis failure.

Patients after total laryngectomy lose their ability to speak. Electrolarynx is a commonly used electronic device that helps these patients to verbally communicate. However, existing electrolarynx systems do not provide pitch control function, which is critical in speech communication especially for tonal languages. This study investigated the surface electromyographic (sEMG) activity of extrinsic laryngeal muscles in producing speech sounds of different pitches by normal speakers. In particular, the sEMG signals for producing different lexical tones of Cantonese were extracted and analyzed. The experimental results on Cantonese tone production confirmed that the sEMG signal from sternocleidomastoid muscle can be used to differentiate high-pitch tones from low-pitch tones. This reveals the potential of developing pitch-controlled EL systems for laryngectomees who speak Cantonese and other tonal languages.

This study evaluated the effectiveness of visual feedback in facilitating pitch control using a pressure sensitive electrolarynx (EL). This proof-of-concept pilot study was a single-subject design that included two healthy adults (1 female aged 23;6 years old, and 1 male aged 67;0 years old). Both participants were provided with visual feedback over two consecutive weeks. Changes in pitch and force control accuracy over 4 hours were analyzed. The results demonstrated that both participants showed an improvement in force control accuracy from the first to the last training session. The results of this proof-of-concept study are a preliminary step towards the development of a clinical training protocol for the use of a pressure sensitive EL. Further, these results highlight the importance of developing a clinically relevant tool for the improvement of a laryngectomee’s quality of life postlaryngectomy.

The ability to speak and communicate with one's voice is a unique human characteristic and is fundamental to many activities of daily living, such as talking on the phone and speaking to loved ones. When the larynx is removed during a total laryngectomy (TL), loss of voice can lead to a devastating decrease in a patient's quality of life, and precipitate significant frustration over their inability to communicate with others effectively. Over the past 50 years there have been many advances in techniques of voice restoration after TL. Currently, there are three main methods of voice restoration: the electrolarynx, esophageal speech, and tracheoesophageal speech through a tracheoesophageal puncture (TEP) with voice prosthesis. Although TEP voice is the current gold standard for vocal rehabilitation, a significant minority of patients cannot use or obtain TEP speech for various reasons. As such, the electrolarynx is a viable and useful alternative for these patients. This article will focus on voice restoration using an electrolarynx with the following objectives: 1) To provide an understanding of the importance of voice restoration after total laryngectomy. 2) To discuss how the electrolarynx may be used to restore voice following total laryngectomy. 3) To outline some of the current electrolarynx devices available, including their mechanism of action and limitations. 4) To compare pros and cons of electrolaryngeal speech to TEP and esophageal speech.

A hands-free speech enhancement system for laryngectomies is proposed to improve the usability and the speech quality. The system has a small and right weight transducer, photo-reflector based lip movement level sensors, and a microphone. The sensor outputs are used for generating the transducer turn on/off signal. A simple performance test was conducted if the system can determine the utterance segments accurately, and the result showed good utterance detection performance. Also, we tested with five more subjects and confirmed that the proposed method was well performed even under the speaker-independent condition.

The present study aimed to identify a feasible treatment strategy for hypopharyngeal cancer (HPC) with non-extensive invasion of the thyroid and/or cricoid cartilage. Between June 2008 and December 2014, patients with previously untreated HPC invading cartilage who had received either open partial laryngectomy (OPL) with tube-free tracheostomy or total laryngectomy (TL) with permanent tracheostomy and an artificial larynx (pneumatic tube) were retrospectively reviewed. The patients with extensive cartilage invasion and those with inoperable or T4b disease were excluded for OPL. Outcomes and quality of life were compared between the two treatment modalities. A total of 44 patients were included. The survival rates, complications, and Dysphagia Score were compared between the two treatment modalities. The outcome of the Voice Handicap Index (P=0.032), understandability of speech (P

Speech is the best way to express the thoughts and feelings among the human beings. But for many reasons the sound produced by human beings becomes disordered voice and termed with many names based on the cause as stammering, dys-theria, apraxia and so on. In the above mentioned few examples, the voice becomes disordered because of the underperformance of body's organ. The larynx is removed in some human beings because of cancer. For them an artificial larynx transducer (ALT) is used to produce the sounds. The above all sounds are categorized as disordered voice and the sound produced by ALT is also called as Substitution voice. In this paper, a method is used to improve the quality of substitution voice produced by ALT. Algorithm is developed to estimate undesired audio components from the device output and remove the same using Non Linear Spectral Subtraction (NLSS) technique. Further, Fundamental (F0) contour and novel parameter F1 formant deviation of healthy speech (HE) and ALT speech are determined. The above two parameters are estimated and stored during the training phase of the system. In the test phase, the above mentioned parameters are estimated and they are used to scale down the database to reduce overall enhancement time. Next step is template matching done by mapping test data with training data using Dynamic Time Warping (DTW) Technique. The data base with least distance estimation is recognized as the utterance and the same is played back.

Organ loss due to late-stage cancer is a heavy burden on both the patient and the health care system. This letter describes a patient who received an artificial larynx to replace lost laryngeal functions and who underwent 16 months of follow-up.

Tone plays an important role in the speech perception for tonal languages. However, the monotonie speech of conventional electrolarynx (EL), which lacks of frequency variation, greatly decreased the intelligibility. For purpose of improving the speech quality of Mandarin Chinese (Mandarin). We designed a new type of EL that can produce the four types of tones in Mandarin, and evaluate its performance through a contrast experiment. A wheel-controlled pitch-adjustable EL was firstly designed and a prototype (W-EL) was manufactured. Then the speech produced by W-EL, and the speech produced by the monotone mode of the commercially available TruTone EL(M-EL), was evaluated objectively and subjectively. The results of objective evaluation showed that the pitch contour of the high-level (HL), middle-rising (MR), and falling-rising (FR) tones produced by W-EL most closely matched the natural speech characteristics of a native speaker. Meanwhile, statistical results showed that the accuracy of W-EL's tone perception and word perception was significantly higher than that of the M-EL. Nevertheless, there were no significant differences in acceptability among the two EL speech types.

In this chapter, the author discusses an artificial electro-larynx that can produce intonation and fluctuation of the larynx voice for speech disorders, especially for laryngectomees. In the design of the artificial larynx, he emphasizes that many hints were taken from the vocalization mechanism of a talking bird, the mynah. The author also introduces a voice synthesizer called “Let’s talk by a finger” for people with articulation disorders that make it hard to control their voice organs because of neuromuscular disease or speech apraxia. The synthesizer, which can produce any speech sound just by touching and stroking the touchpad of a mobile phone, was modeled after the vocalization mechanism of a ventriloquist who can produce any speech sound without moving his lips. Furthermore, evaluation methods are indicated for aids and treatment of speech organ disorders caused by a cleft palate and a reversed occlusion.

Cilj ovog diplomskog rada bio je procijeniti zadovoljstvo laringektomiranih osoba vlastitom postoperativnom komunikacijom koristeći hrvatski prijevod Self-Evaluation of Communication Experiences After Laryngectomy - SECEL upitnika samoprocjene. Također, željelo se uvidjeti postoje li razlike među spomenutim zadovoljstvom prvenstveno s obzirom na dominantan način alaringealnog govora, a potom i s obzirom na spol, dob pacijenta te vrijeme proteklo od same operacije. Ispitano je 40 osoba oba spola koje su pretrpjele kirurški zahvat totalne laringektomije. Od navedenih se ispitanika 24 njih služilo ezofagealnim govorom, 14 njih traheoezofagealnim govorom, a 4 elektrolarinksom. Ispitanicima je bio podijeljen hrvatski prijevod SECEL upitnika samoprocjene koji se sastojao od tri skale: Opća skala (četice 1-5), Okolinska skala (čestice 6-19) te Skala stavova (čestice 20-44). Ispitivanje se provodilo u više navrata u KBC-u "Zagreb" te u Klinici za tumore bolnice "Sestre milosrdnice". Ispitanici su za svaku od čestica SECEL-a morali odrediti u kojem omjeru ista prikazuje njihovo trenutno stanje (0= nikad, 1= ponekad, 2= često, 3= uvijek). Veći broj bodova predstavljao je ujedno i veće glasovno-govorne komunikacijske teškoće i nezadovoljstvo. Posljednja čestica (br.35) uspoređuje količinu govora prije i poslije operacije te jedina ima modificirani način bodovanja (manje/više/jednako) koji je isključen iz ukupne brojčane interpretacije rezultata. Ispitanici su se uspoređivali prema rezultatima na svakoj skali pojedinačno te na ukupnom rezultatu. Uvidom u rezultate, nije dobivena statistički značajna razlika između ispitanika koji koriste različite metode alaringealnog govora ni na jednoj od skala SECEL-a, kao ni na ukupnom rezultatu. Također je dokazano da ne postoji statistički značajna razlika među ispitanicima s obzirom na spol, dob te vrijeme proteklo od operacije. Općenito, ispitanici su postigli niske rezultate na SECEL-u, što upućuje na dobro rehabilitiran alaringealni govor i njegovo adekvatno korištenje u svakodnevnim situacijama., The aim of this master's paper was to assess the effect of total laryngectomy on everyday communication patterns, regarding mainly the dominant method of alaryngeal speech. Total number of participitians was 40, where 24 of them were using esophageal speech, 14 of them were using tracheoesophageal speech and 4 of them electrolarynx. Evaluation was performed in two Croatian hospitals using Croatian traduction of Self-Evaluation of Communication Experiences After Laryngectomy – SECEL questionnaire. Besides from the method of speech, comparison was also made regarding sex, age and time passed from total laryngectomy surgery. The SECEL questionnaire consisted of 35 questions divided into three subscales: General subscale (questions 1-5), Environment subscale (questions 6-19) and Attitude subscale (questions 20-34). For each of them patient had to decide how much it described his/hers current status (0= never, 1= sometimes, 2= often, 3= always). Larger total score represented greater communication difficulties and dissatisfaction. Last question (no. 35) compared total amount of speech before and after total laryngectomy (more/less/same), and because of that modified way of answering it was excluded from total score. A statistical analyses showed there is no statistically significant difference in communication satisfaction between three groups of participitians regarding the dominant method of alaryngeal speech. Furthermore, the results also showed no statistically significant difference in communication satisfaction regarding the sex, age and time passed from total laryngectomy surgery. That pattern was the same for each of three SECEL subscales, and for total SECEL score. On average, patients had a low total SECEL score, which implied that they had reached great level of proficiency in using alaryngeal speech and that they had been using it adequately in everyday situations.

This paper develops, simulates and experimentally evaluates a novel method based on non-contact low frequency (LF) ultrasound which can determine, from airborne reflection, whether the lips of a subject are open or closed. The method is capable of accurately distinguishing between open and closed lip states through the use of a low-complexity detection algorithm, and is highly robust to interfering audible noise. A novel voice activity detector is implemented and evaluated using the proposed method and shown to detect voice activity with high accuracy, even in the presence of high levels of background noise. The lip state detector is evaluated at a number of angles of incidence to the mouth and under various conditions of background noise. The underlying mouth state detection technique relies upon an inaudible LF ultrasonic excitation, generated in front of the face of a user, either reflecting back from their face as a simple echo in the closed mouth state or resonating inside the open mouth and vocal tract, affecting the spectral response of the reflected wave when the mouth is open. The difference between echo and resonance behaviours is used as the basis for automated lip opening detection, which implies determining whether the mouth is open or closed at the lips. Apart from this, potential applications include use in voice generation prosthesis for speech impaired patients, or as a hands-free control for electrolarynx and similar rehabilitation devices. It is also applicable to silent speech interfaces and may have use for speech authentication.

Purpose The purpose of this study was to determine listeners' ability to learn talker identity from speech produced with an electrolarynx, explore source and filter differentiation in talker identification, and describe acoustic-phonetic changes associated with electrolarynx use. Method Healthy adult control listeners learned to identify talkers from speech recordings produced using talkers' normal laryngeal vocal source or an electrolarynx. Listeners' abilities to identify talkers from the trained vocal source (Experiment 1) and generalize this knowledge to the untrained source (Experiment 2) were assessed. Acoustic-phonetic measurements of spectral differences between source mechanisms were performed. Additional listeners attempted to match recordings from different source mechanisms to a single talker (Experiment 3). Results Listeners successfully learned talker identity from electrolarynx speech but less accurately than from laryngeal speech. Listeners were unable to generalize talker identity to the untrained source mechanism. Electrolarynx use resulted in vowels with higher F1 frequencies compared with laryngeal speech. Listeners matched recordings from different sources to a single talker better than chance. Conclusions Electrolarynx speech, although lacking individual differences in voice quality, nevertheless conveys sufficient indexical information related to the vocal filter and articulation for listeners to identify individual talkers. Psychologically, perception of talker identity arises from a “gestalt” of the vocal source and filter.

The majority of laryngectomees use the electrolarynx as their primary mode of verbal communication after total laryngectomy surgery. However, the archetypal electrolarynx suffers from a monotonous tone and the inconvenience of requiring manual control. This paper presents the potential of pattern recognition to support electrolarynx use by predicting fundamental frequency (F0) and voicing state (VS) from surface EMG of the infrahyoid and suprahyoid muscles, as well as from a respiratory trace. In this study, surface EMG signals from the infrahyoid and suprahyoid muscle groups and respiratory trace were collected from 10 able-bodied, adult males (18–60 years old). Participants performed three kinds of vocal tasks – tones, legatos and phrases. Signal features were extracted from the EMG and respiratory trace, and a Support Vector Machine (SVM) classifier with radial basis function kernels was employed to predict F0 and voicing state. An average root mean squared error of 2.81 ± 0.6 semitones was achieved for the estimation of vocal frequency in the range of 90–360 Hz. An average cross-validation (CV) accuracy of 78.05 ± 6.3% was achieved for the prediction of voicing state from EMG and 65.24 ± 7.8% from the respiratory trace. The proposed method has the advantage of being non-invasive compared with studies that relied on intramuscular electrodes (invasive), while still maintaining an accuracy above chance. Pattern classification of neck-muscle surface EMG has merit in the prediction of fundamental frequency and voicing state during vocalization, encouraging further study of automatic pitch modulation for electrolarynges and silent speech interfaces.

Understanding the sound transmission of the neck tissue is necessary and important in areas such as vocal function evaluation and electrolarynx improvement. In this paper, a simple method using a reflectionless tube was proposed to measure the neck frequency response function (NFRF) of ten normal subjects (five males and five females) during Mandarin vowel production. The NFRFs across different subjects producing different vowels were measured at different neck positions and compared to confirm the effectiveness of the method, and determine the NFRF variations in normal subjects. The results showed that the proposed method offered an easy and effective way to obtain an accurate NFRF. For normal subjects, the neck tissue can be treated as a low-pass filter, with a maximum gain at 310 Hz and a roll-off at a slope of -8.4 dB/octave, flattening out above 2000 Hz. The measurement position on the neck did not influence the shape of the NFRF, but did change the overall gains of the NFRF. In addition, there was a significant gender difference in NFRFs at the low frequencies. Finally, some potential applications of this method and the results are suggested.

Background Most patients perceive total laryngectomy as a mutilation carrying with it a loss of physical and psychological integrity. Thus, an artificial larynx system that can replace the laryngeal functions would significantly improve the quality of life for the afflicted patients. Methods This report, with accompanying video, presents the first case in an ongoing clinical trial of laryngeal rehabilitation using an artificial larynx after total laryngectomy for squamous cell carcinoma, for an 8-month follow-up period. We depict the prosthesis' features, our 2-step surgical procedure, and the outcome. The prosthesis is formed of 2 parts: (1) a tracheal prosthesis with a porous titanium junction with trachea, which was implanted in the first step to ensure its colonization, and (2) a removable part composed of concentric valves that enable inhalation and exhalation. The second part was implanted endoscopically. The implant was monitored with a retrograde nasofibroscopy of the tracheal prosthesis lumen and CT scans over a course of 8 months. Results The patient's functioning in the relevant postoperative problem areas, such as swallowing, breathing, and smelling, has significantly improved. The patient was able to talk in a whispering fashion while the tracheostomy was temporarily closed. The implant's porous part was in the process of being colonized by the surrounding tissue and no fistulas were observed as evidenced by barium swallow. Conclusion As the current case shows, tracheotomy closure can be performed, and laryngeal functions are restored, by means of an implant. With further improvements, this system can alleviate the need for a permanent tracheostomy after total laryngectomy, while maintaining important larynx functions intact. © 2014 Wiley Periodicals, Inc. Head Neck 36: 1669–1673, 2014

Persons who have undergone a laryngectomy have a few options to partially restore speech but no completely satisfactory device. Even though the use of an electrolarynx (EL) is the easiest way for a patient to produce speech, it does not produce a natural tone and appearance is far from normal. Because of that and the fact that none of them are hands-free, the feasibility of using a motion sensor to replace a conventional EL user interface has been explored. A mobile device motion sensor with multi-agent platform has been used to investigate on/off and pitch frequency control capability. A very small battery operated ARM-based control unit has also been developed to evaluate the motion sensor based user-interface. This control unit is placed on the wrist and the vibration device against the throat using support bandage. Two different conversion methods were used for the forearm tilt angle to pitch frequency conversion: linear mapping method and F0 template-based method A perceptual evaluation has been performed with two well-trained normal speakers and ten subjects. The results of the evaluation study showed that both methods are able to produce better speech quality in terms of the naturalness.

To investigate voice-related quality of life in an effort to index self-assessed voice disability in speakers who use the electrolarynx and to determine the perceived level of influence of the electrolarynx on vocal communication.Prospective study.This study was conducted at a tertiary care facility.Forty laryngectomized adults (25 men, 15 women) who used the electrolarynx as a primary method of communication served as participants. The Voice-Related Quality of Life measure was administered and scored in standard fashion and descriptive data generated for physical, social-emotional, and total scores.Data indicate substantial variability in self-perceived quality of life specific to voice use; a wide range of physical, social-emotional, and total scores were observed. Only one-quarter of these participants rated themselves as having "poor/fair" voice-related quality of life.Our findings suggest that use of the electrolarynx as a postlaryngectomy method of verbal communication has a wide-ranging influence on self-perceived voice-related quality of life and that mean scores from prior studies may not accurately reflect the potential value of the electrolarynx. Communication disability related to electrolarynx use does in fact vary; however, it is not uniformly poor, and some may be highly proficient users. Consequently, the Voice-Related Quality of Life measure may also serve as a useful tool for clinical documentation of rehabilitation outcomes in those who use the electrolarynx as a postlaryngectomy method of speech.

The electrolarynx (EL) is a widely used device for alaryngeal communication, but the low quality seriously reduces the intelligibility of EL speech. To improve EL speech quality, a vowel-specific voice source based on visual information of lip shape and movements and artificial neural network (ANN) is implemented into an experimental EL (SGVS-EL) system in real time. Five volunteers (one laryngectomee and four normal speakers) participated in the experimental evaluation of the method and SGVS-EL system. Using ANN participants were able to perform high vowel precision with identification rates of >90% after the training. The results of voicing control indicated that all subjects using SGVS-EL could achieve good vowel control performance in real time, but still control errors frequently occurred at the voice initiation period. However, the control errors had no significantly impact on the perception of SGVS-EL speech. Intelligibility evaluation demonstrated that both the vowels and words produced using the SGVS-EL were more intelligible than vowels spoken with a commercial EL (by 30%) or words (by 18%), respectively. Using a controlled vowel-specific voice source was a feasible and effective way to improve EL speech quality with more intelligible words.

Larynx has a complex structure with joints and multiple functions. In order to study the artificial larynx and artificial auricle scaffold, a three-dimensional digital model of laryngeal joint is established in this paper using MIMICS with its biomechanical properties analyzed and calculated by using the finite element method. This model is based on the CT scanned images of 281 layers with an interlamellar spacing of 1.25 mm. The obtained data are denoised, segmented and smoothed before being loaded into MIMICS. By further optimizations, an accurate and complete 3D model can be obtained. Subsequently, a 3D FEM of the normal larynx joint is performed which allows observations from any dimensions and angles. Compared with natural laryngeal joint, this model has good geometric similarity and mechanically similar throat voicing functions.

Background/Objectives Mechanical prosthetic valve rehabili tation after total laryngectomy have a success rates of 90% in restoring voice. The effective speech is achieved better with mechanical voice prosthesis when compared to esophageal speech and electrolarynx. Candidal growth and tubal blockage are the commonest cause of peri and endotubal leakage causing prosthesis failure. Case report A 50-year-old male who had undergone wide field laryngectomy with primary tracheoesophageal puncture (TEP) with voice prosthesis 18 months back complained of blocked voice prosthesis and peritubal leakage. The tip of the cleaning brush which had blocked the opening was removed in the outpa tients under topical anesthesia and the peritubal block reduced. Conclusion Mechanical valve prosthesis rehabilitation after primary tracheoesophageal puncture is the standard voice rehabilitation of laryngectomized patients. Patient education regarding maintenance of the prosthesis and the care for the tracheostoma is important in reducing the complications. How to cite this article Halkud R, Shenoy AM, Sunil KC, Samskruthi M, Sarvadyna J, Biswas S, Chavan P, Siddappa KT, Shivappa A, Naik SM. Blocked voice Prosthesis: A Common Complication Reducing the Prosthesis Longevity. Int J Head Neck Surg 2014;5(2):66-71.

Background There is debate about the optimal voice restoration method and technique for patients who have undergone total laryngopharyngectomy, esophagectomy, and gastric pull-up. The purpose of this study was to report a series of patients who underwent awake, secondary tracheoesophageal puncture (TEP) after this procedure. Methods A retrospective chart review was performed at a tertiary referral center. All subjects who underwent TEP placement under transnasal esophagoscopy guidance between 2003 and 2013 were included. Results All patients underwent uncomplicated TEP in the clinic. At the time of last follow-up, all patients had functional TEP speech that they were using preferentially over an available electrolarynx. Conclusion In-office placement of secondary TEP using transnasal esophagoscopy is an efficient means of providing a conduit for voice prostheses in patients who have undergone laryngopharyngectomy with gastric pull up reconstruction. This procedure can be performed with minimal complications and with expectation of voice outcomes comparable to that seen with standard laryngectomy. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

The feasibility of using a motion sensor to replace a conventional electrolarynx(EL) user interface was explored. Forearm motion signals from MEMS accelerometer was used to provide on/off and prosody control. The small transducer was placed against the throat using support bandage. A battery operated ARM-based small control unit was developed and placed on the wrist. The control unit can convert the tilt angle into the pitch frequency. Speech generation was tested with various forearm movements, and then a simple and small action was chosen to control the device. A simple comparison study has been made with well-trained normal speakers. Results of the study showed that the prototype system was able to produce the pitch patterns similar to those in natural utterances.

Electrolarynx (EL) is a medical speech-recovery device designed for patients who have lost their original voice box due to laryngeal cancer. As a substitute for human larynx, the current commercial EL voice source cannot reconstruct natural EL speech under laryngectomy conditions. To eliminate the abnormal acoustic properties of EL speech, a supraglottal voice source with compensation of vocal tract characteristics was proposed and provided through an experimental EL(SGVS-EL) system. The acoustic analyses of simulated EL speech and reconstructed EL speech produced with different voice sources were performed in the normal subject and laryngectomee. The results indicated that the supraglottal voice source was successful in improving the acoustic properties of EL speech by enhancing low- frequency energy, correcting the shifted formants to normal range, and eliminating the visible spectral zeros. Both normal subject and laryngectomee also produced more natural vowels using SGVS-EL than commercial EL, even if the vocal tract parameter was substituted and the supraglottal voice source was biased to a certain degree. Therefore, supraglottal voice source is a feasible and effective approach to improving the acoustic quality of EL speech.

It brings the pain to the patients whether in spirit or on physiology when laryngeal cartilage is injured. The paper reviewed the previous methods of improving the pronunciation for laryngeal cartilage injury and patients whose larynxes have been cut off, and compared the advantages and disadvantages of various methods. On the basis of the studies on the artificial auricle scaffold, artificial spinal cord scaffold in our center, this paper puts forward a larynx injury repair methods with a personalized tissue engineering artificial larynx, namely taking the advantages of biological manufacturing and tissue engineering related technology to prepare laryngeal cartilage scaffolds, and then the stem cells could be cultured into the scaffold in vitro. After more study and test, this bio-manufactured larynx scaffold could be expected as one of the ideal repair methods for the larynx injury.

An electrolarynx is a speaking aid device to artificially generate excitation sounds to help laryngectomees produce electrolaryngeal (EL) speech. Although EL speech is quite intelligible, its naturalness significantly suffers from the unnatural fundamental frequency (F 0 ) patterns of the mechanical excitation sounds. To make it possible to produce more naturally sounding EL speech, we have proposed a method to automatically control F 0 patterns of the excitation sounds generated from the electrolarynx based on the statistical F 0 prediction, which predicts F 0 patterns from the produced EL speech in real-time. In our previous work, we have developed a prototype system by implementing the proposed real-time prediction method in an actual, physical electrolarynx, and through the use of the prototype system, we have found that improvements of the naturalness of EL speech yielded by the prototype system tend to be lower than that yielded by the batch-type prediction. In this paper, we examine negative impacts caused by latency of the real-time prediction on the F 0 prediction accuracy, and to alleviate them, we also propose two methods, 1) modeling of segmented continuous F 0 (CF 0 ) patterns and 2) prediction of forthcoming F 0 values. The experimental results demonstrate that 1) the conventional real-time prediction method needs a large delay to predict CF 0 patterns and 2) the proposed methods have positive impacts on the real-time prediction.

Tone is important in tonal languages, especially in Mandarin. However, there is presently no commercially available electrolarynx (EL) for laryngectomized Mandarin speakers. Moreover, few studies have focused on this area. Our purpose is to design an EL that produces the four Mandarin tones and to evaluate its performance. We designed a wheel-controlled pitch-adjustable EL and manufactured a prototype (Wheel-EL). Using monosyllables, disyllabic segments, and frequently used phrases, we evaluated speech produced by Wheel-EL and by monotone (M-TruTone) and variable-frequency modes (V-TruTone) of the commercially available TruTone EL. The pitch contours of the high-level (HL), middle-rising (MR), and falling-rising (FR) tones produced by Wheel-EL most closely matched the natural speech characteristics of a native speaker. However, redundant sounds were generated in the high-falling (HF) tone. The statistical accuracy of Wheel-EL’s tone and word perception was significantly higher than that of other EL types. However, no significant differences existed in acceptability among the three EL speech types. Wheel-EL produces better HL, MR, and FR tones in Mandarin than either M-TruTone or V-TruTone. Nevertheless, redundant sounds affect HF phonation. Accurate tone judgment can improve the intelligibility of EL speech in Mandarin but has no obvious effect on acceptability.

The present work was comprised of a series of experiments that investigated the application of clear speech (CS) in a group of electrolaryngeal (EL) speakers. Three experiments were conducted to assess the impact of CS on three important aspects of EL speech. More specifically, Experiment 1 sought to identify the impact of CS on EL speakers’ word and consonant intelligibility; Experiment 2 examined the influence of CS on the acoustic characteristics of words and vowels in EL speech; and finally, Experiment 3 sought to identify the influence of CS produced by EL speakers on auditory-perceptual ratings by naïve listeners. Results revealed that overall word and consonant intelligibility were minimally different when EL speakers used CS compared to their everyday, ‘habitual’ speech (HS) (Experiment 1). Secondly, EL speakers’ use of CS significantly increased word durations, but did not have a substantial impact on fundamental and formant frequency characteristics of vowels (Experiment 2). Finally, due to the productive changes associated with CS involving a slower rate of speech, over-articulation, and increased mouth-opening, listeners judged EL speech to be significantly less acceptable to listen to when compared to HS. However, no significant effect of speaking condition was noted on listeners’ comfort levels (Experiment 3). Overall, findings suggest that the acoustic deficits in EL speech might be too complex to derive further benefit from CS in the areas of speech intelligibility, the acoustic structure of EL speech and/or auditory-perceptual ratings of EL speakers. Clinical implications and future directions for research are discussed.

This study investigated the relationship between psychological well-being and different voice rehabilitation methods in total laryngectomy patients. The study enrolled 96 patients who underwent total laryngectomy. The patients were divided into three groups according to the voice rehabilitation method used: esophageal speech (24 patients); a tracheoesophageal fistula and Provox 2 voice prosthesis (57 patients); or an electrolarynx (15 patients). The participants were asked to complete the Turkish version of the Voice Handicap Index-10 (VHI-10) to assess voice problems. They were also asked to complete the Turkish version of the Perceived Stress Scale (PSS), and the Hospital Anxiety and Depression Scale (HADS). The test scores of the three groups were compared statistically. Patients who used esophageal speech had a mean VHI-10 score of 10.25 ± 3.22 versus 19.42 ± 5.56 and 17.60 ± 1.92 for the tracheoesophageal fistula and Provox 2 and electrolarynx groups respectively, reflecting better perception of their voice. They also had a PSS score of 11.38 ± 3.92, indicating that they felt less stressed in comparison with the tracheoesophageal fistula and Provox 2 and electrolarynx groups, which scored 18.84 ± 5.50 and 16.20 ± 3.49 respectively. The HADS scores of the groups were not different, indicating that the patients’ anxiety and depression status did not vary. Patients who used esophageal speech perceived less stress and were less handicapped by their voice.

In this paper, we have taken Electro-Larynx (EL) speech and have improved the speech quality, electro-larynx speech was improved in terms of naturalness and intelligibility by introducing variations in the F0-contour and template matching with correlation coefficient. Initially, we introduced two different speech signals, the first speech signal introduced was healthy speech signal and the second speech signal introduced was disordered speech signal. Here, the second speech signal, the disordered speech is taken as the EL speech. The fundamental frequency or pitch was extracted first from the two inputed speech signals, then the contour of each fundamental frequency was extracted from the two input speech signals. Using these extracted features of fundamental frequency the gender classification by K-means algorithm was instigated. The same process was implemented with F0 contour features which was extracted using K-NN algorithm. EL speech contains directly radiated electrolarynx noise (DREL). The noise was filtered out using spectral subtraction algorithm. Once DREL noise is removed from EL speech, the quality of the speech was greatly improved. Then EL enhanced speech signal is compared and mapped with healthy speech signal using template matching algorithm with the help of correlation coefficient, this improves the overall quality, that is the naturalness and intelligibity of the introduced disordered speech signal. This technique helps solve the major problem of speech faced by differently abled persons with larynx disorder.

If a novice practitioner encounters difficulties during laryngoscopy it is not the fault of the patient but “want of skill on the part of the operator.” The novice must practice “until he has fully mastered the use of the instrument, as it is not fair to make others suffer for his own clumsiness.” [1, p. 79]