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Objective: 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. Methods: 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. Results: 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. Conclusion: 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. Level of Evidence: Step 4. [ABSTRACT FROM AUTHOR]

Abstract Objective 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. Methods 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. Results 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. Conclusion 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. Level of Evidence Step 4.

Objective: The current work aims to design and develop an automatically controlled wearable electrolarynx, a voice substitution device for laryngeal carcinoma survivals. Methods: 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. Results: 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. Conclusions: The assessment of the wearable and automatically controlled electrolarynx provides hands-free speech and easy control over the device.

The conventional electrolarynx (EL) restores the voice of people who have lost their voice, however, its voice sounds like a robot and it occupies user's one hand. Therefore, we developed a hands‐free wearable electrolarynx that improves the voice quality with the LPC residual wave as the vibration sound. Our device was able to reproduce sounds below 500 Hz, which is close to the fundamental frequency, but from 1700 Hz to 4000 Hz, the conventional EL continuously showed a frequency response closer to the spectrum of the user's vocal sound than our device. Thus, the periodic sound of the fundamental frequency band was found to be closer to human speech than individuality or sound quality. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: The current work aims to design and develop an automatically controlled wearable electrolarynx, a voice substitution device for laryngeal carcinoma survivals. Methods: 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. Results: 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. Conclusions: The assessment of the wearable and automatically controlled electrolarynx provides hands-free speech and easy control over the device. [ABSTRACT FROM AUTHOR]

The larynx is an organ in the human respiratory system that forms the basis of the speech production system. An electrolarynx is a device used by most laryngectomees to regain their verbal communication. Our objective was to design an electrolarynx with increased energy efficiency by modifying the driving source. Initially, we designed the electrolarynx to accommodate various driving signals. We then compared the voice output obtained by different input signals for quality and measured energy consumption using a digital multimeter. When compared to existing methods, the proposed driving source was found to be 11.1% more energy efficient. Voice quality was also better than the traditional driving source by 31.6%.

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. [ABSTRACT FROM AUTHOR]

Patients who have lost vocal cord function due to laryngeal cancer or laryngeal injury are incapable of speech because it is impossible to generate the laryngeal tone from which the voice originates. For such patients, various speech production substitutes have been devised and put into practical use. The electrolarynx is one of these speech production substitutes and it can be used with relative ease. However, the sound is sometimes difficult to hear and its quality is monotonous. Therefore, focusing on the control method to improve the articulation of the electrolarynx, we have proposed an electrolarynx controlled by myoelectric signals of the neck. The sternohyoid muscle, which is located in the superficial layer of the neck, was the source of the myoelectric signals. This muscle is active during speech, and its activity increases mainly at the time of speech in a low voice. We succeeded in detecting the surface myoelectric signals of the sternohyoid muscle and performing on/off control of the electrolarynx by signal processing. This report includes the derivation of a control function for converting into a control signal of the fundamental frequency of the electrolarynx from the relationship between the myoelectric signals and the fundamental frequency of the voice. This report also includes an evaluation of the controllability of the electrolarynx by comparing the obtained control signal with the user's intention. Regarding the control of the fundamental frequency, we have proposed a method of control in three stages – high, medium, and low – and a method of control in two stages – high and low – and compared their performances. The results of the three-stage control indicated that the use of the logarithm as a control function for converting the myoelectric signals into the fundamental frequency of the electrolarynx succeeded in the control at an accuracy of 90% or more by changing the pitch of the generated sound depending on the subjects. It was also indicated that the error rate was as low as less than 20%, while maintaining a constant sound. This makes it clear that the use of the logarithm as a control function gives the highest controllability. The two-stage control exhibits a very high control success rate exceeding 90%, regardless of the type of control function; in particular, the control function using the logarithm exhibits a control success rate exceeding 95%. These results indicate that the electrolarynx control function obtained using the logarithmic function has excellent controllability. [ABSTRACT FROM AUTHOR]

The larynx is an organ in the human respiratory system that forms the basis of the speech production system. An electrolarynx is a device used by most laryngectomees to regain their verbal communication. Our objective was to design an electrolarynx with increased energy efficiency by modifying the driving source. Initially, we designed the electrolarynx to accommodate various driving signals. We then compared the voice output obtained by different input signals for quality and measured energy consumption using a digital multimeter. When compared to existing methods, the proposed driving source was found to be 11.1% more energy efficient. Voice quality was also better than the traditional driving source by 31.6%. [ABSTRACT FROM AUTHOR]

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Modern methods of speech rehabilitation after a total laryngectomy have come to a great success by giving the patients a possibility to establish an intelligible and functional speech after an adequate rehabilitation treatment. The aim of this paper was to examine speech intelligibility of laryngectomized patients who use different types of vocal communication: esophageal speech, speech with tracheoesophageal prosthesis and speech with electronic laringeal prosthesis. The research was conducted on a sample of 125 laryngectomized patients of both sexes, between 48 and 85 years of age. For the subjective assessment of speech intelligibility, we used the phonetically balanced text. In the paper we used the descriptive statistics methods (the arithmetic mean with standard deviation, as well as minimum and maximum). The differences between the groups were determined by the t-test for independent samples. Pirson's correlation coefficient was used to examine the correlation between the two variables. The examinees are statistically different by the results achieved on the speech intelligibility test. The esophageal patients have the highest scores (1.13±0.86), while the patients with the vocal prosthesis and patients who use electrolarynx have similar scores (0.14±0.35; 0.15±0.36). The differences of the analyzed values were statistically significant (p

The larynx is a flexible part in the respiratory tract, a source of vibration during verbal communications. An electrolarynx or artificial larynx is a common device adopted by the laryngectomee to restore the speech. The objective of this paper is to design a low power electrolarynx using modified glottal source and perform an objective and subjective analysis of the vowel quality. In the first part, an electrolarynx circuit is designed which can drive different types of input signals. In the second part, a driving source is designed by pre-filtering the effect of neck surface. The power consumption of the prototype is measured and compared with the conventional type of electrolarynx. The vowel qualities are compared with that of normal vowels produced by a volunteer. We have found out that the glottal modified wave can reduce the power supply requirement of the electrolarynx. Loudness, quality factor and position of the formants are used as measures of quality for vowels produced by the present approach and found to be better (or comparable) than the traditional electrolarynx. When compared to existing method, the electrolarynx with glottal modified wave is power efficient and has a potential in forming a wearable device. It also has better vowel quality than the one with the conventional driving signal. [ABSTRACT FROM AUTHOR]

Highlights • Electrolaryngeal speakers reduce their speaking rate while using clear speech. • Clear speech does not negatively influence listener comfort. • Listeners perceive electrolaryngeal speech to be less acceptable in clear speech. • Clinical considerations warrant subjective and objective indices. Abstract Purpose To determine the influence of clear speech on auditory-perceptual judgments of speech acceptability and listener comfort for electrolaryngeal speech. Method 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. Results 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. Conclusions 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. [ABSTRACT FROM AUTHOR]

Hypopharyngeal carcinoma is one of the common head and neck cancers and also more common in men in India. Understanding of the role of the speech-language pathologist (SLP) in the area of assessment and management of this condition is limited. This is a case report of an adult male with recurrent squamous cell carcinoma of hypopharynx, spread to larynx and esophagus. Following total laryngopharyngoesophagectomy (TLPE) with gastric transposition, the patient was aphonic. This case report focuses on the voice restoration options available, that SLP needs to be aware right during pre-operative counselling and his/her role in rehabilitating TLPE patient with gastric transposition reconstruction. [ABSTRACT FROM AUTHOR]

Purpose 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. Methods 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. Results 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. Conclusions 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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.

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. [ABSTRACT FROM AUTHOR]

Computational speech reconstruction algorithms have the ultimate aim of returning natural sounding speech to aphonic and dysphonic patients as well as those who can only whisper. In particular, individuals who have lost glottis function due to disease or surgery, retain the power of vocal tract modulation to some degree but they are unable to speak anything more than hoarse whispers without prosthetic aid. While whispering can be seen as a natural and secondary aspect of speech communications for most people, it becomes the primary mechanism of communications for those who have impaired voice production mechanisms, such as laryngectomees. In this paper, by considering the current limitations of speech reconstruction methods, a novel algorithm for converting whispers to normal speech is proposed and the efficiency of the algorithm is explored. The algorithm relies upon cascading mapping models and makes use of artificially generated whispers (called whisperised speech) to regenerate natural phonated speech from whispers. Using a training-based approach, the mapping models exploit whisperised speech to overcome frame to frame time alignment problems that are inherent in the speech reconstruction process. This algorithm effectively regenerates missing information in the conventional frameworks of phonated speech reconstruction, and is able to outperform the current state-of-the-art regeneration methods using both subjective and objective criteria. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Although the electrolarynx (EL) provides an important means of voice reconstruction for patients who lose their vocal cords by laryngectomies, the radiated noise and additive environment noise reduce the intelligibility of the resulting EL speech. This paper proposes an improved spectrum subtract algorithm by taking into account the non-uniform effect of colored noise on the spectrum of EL speech. Since the over-subtraction factor of each frequency band can be adjusted in the enhancement process, a better noise reduction effect was obtained and the perceptually annoying musical noise was efficiently reduced, as compared to other standard speech enhancement algorithms.

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., Competing Interests: Disclosure The authors have no commercial or financial conflicts of interest; no funding sources were used for this article., (Copyright © 2022 Elsevier Inc. All rights reserved.)

An electrolarynx (EL) is a valuable rehabilitative option for individuals who have undergone laryngectomy, but current monotone ELs do not support controlled variations in fundamental frequency for producing tonal languages. The present study examined the production and perception of Mandarin Chinese using a customized hand-held EL driven by computer software to generate tonal distinctions (tonal EL). Four native Mandarin speakers were trained to articulate their speech coincidentally with preprogrammed tonal patterns in order to produce mono- and di-syllabic words with a monotone EL and tonal EL. Three native Mandarin speakers later transcribed and rated the speech samples for intelligibility and acceptability. Results indicated that words produced using the tonal EL were significantly more intelligible and acceptable than those produced using the monotone EL. [ABSTRACT FROM AUTHOR]