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Types of laryngectomy ?? .

Laryngectomy Partial Total Hemilaryngec tomy Supraglottic supracricoid Subtotal Cordectomy .




Artificial/el ectromech anical





Transoral Intraoral


•Consonant Injection •Injection Method •Inhalation Method •Swallowing

Prosthesis .

Must have 2cm or greater tracheostoma Must pass esophageal insufflation test Requires SLP to remove/replace Less maintenance required Must have 2cm or greater tracheostoma Must pass esophageal insufflation test . cleaning. etc.Non-Indwelling Prosthesis: Must be removed every 3-4 days Indwelling Prosthesis: Can stay in place for 3-6 months Patient can change prosthesis independently More education is required for removal.


VOT. speech Intensity Perturbations Range Temporal aspects . Rise Time. LTAS Prosody in alaryngeal speech . Fall Time in phonation. Pause time and Total duration Spectral aspects – Format structures. Vowel duration. Rate of speech.Overview: F0 in phonation. MPD.

.Fundamental Frequency (Fo) Electrolarynx/ Artificial Larynx: • Most of have the mechanical speech aids are •Some a variable frequency electronic and have a manually adjustment. • Because Fo is determined by the electronic design of the • These are typically set to specific a low pitch for a instrument. tocharacteristics a higher valueof for a female produced with the electro larynx. adjustable fundamental frequency. voice (about 200 Hz). little data have been reported male voice (about 100 Hz) and. where on the Fo speech possible.

whereas the female esophageal voice is about 2 octaves lower than normal. • Better esophageal speakers tend to produce somewhat higher Fos whereas poorer speakers may produce somewhat lower Fos.Esophageal Speech: • The F0 of the esophageal voice is typically about 1 octave lower than the average laryngeal Fo of a male voice. .

esophageal speakers exhibit greater variability than normal speakers.Slavin and Ferrand (1995) grouped according to their average Fo and variability characteristics 26 esophageal speakers Most of them had difficulty controlling their Fo during dynamic speech. .

. but there is little evidence to support this hypothesis.Some authors believe the Fo of esophageal voice depends on the exact location of the vibrating segment.

• Ranges from 29. .37Hz (Perry & Tikofsky. This is due to the morphology of PE segment in females which is smaller and thinner.50 (Horri. 1965) to 86.• Weinberg (1980) normal pattern of high Fo with high vowels • higher Fo in females than males. 1982).

43 34.10 4. 1984 16 15 M F 64.F0 characteristics of Esophageal Speech (Reading Task): Study Damste. 1967 Wienberg & Bennet.00 21.65 4.74 86.50 62. 1959) N 20 6 Sex M M Mean 67.23 .80 Range - Shipp.D 4.80 S.98 3.25 15 M 77. 1972 Robbins et al.94 16. 1958 Snidecor & Curry.

pharyngoesophageal segment .

serves as the neoglottis and enables production of esophageal voice .The total laryngectomy procedure produces a defect in the hypopharynx that must be reconstructed to form the pharyngoesophageal segment (PES) This tubular shaped region. composed largely of skeletal muscle tissue.

C5 and C6 Spasticity or hypertonicity results in poor speech Air flows through the PE segment causing it to vibrate .Extends over C4.


followed in increasing order by the good.the shortest visible vibratory segment.Morphology at Rest Length • The excellent TEP speakers. fair and poor speaking groups These differences are generally very small Length of the PES is a significant contributor to TEP speech proficiency .

Thickness Multilayered and/or mucosally redundant structure Excellent. and fair groups. Poor speaking group exhibit mildly to moderately thickness .very thin and very thick extremes. good.

and pitch and loudness dyscontrol. greater dysfluency. lack of synchronous mucosal vibratory activity caused by thickened PES mucosa .• Subjects with thicker vibratory segments generally produce more hoarse-harshstrained vocal quality. PES thickness voice and speech proficiency.

Biomechanics During Phonation Vibratory rhythmicity • Dyssynchronous PES vibratory patterns • Positive correlation between the synchrony of PES vibrations and the associated level of TEP speech proficiency .

Vibratory stiffness • Exhibits at least some degree of vibratory stiffness Excellent good fair poor .

communication efficiency decreases .PES spasmodic hypertonic vibratory activity speech proficiency. • As the pathophysiologic signs increase in severity.

good and fair groupsmoderately retarded mucosal waves more severe disturbances observed in the poor group .Mucosal waves excellent.

A relatively strong interrelationships TEP speech proficiency PES mucosal wave integrity. .strong positive correlation degree of perceived PES spasms or hypertonicity mucosal wave abnormalities.

moderate degrees of PES muscular control poor group.mild degree o f PES muscular control . good. and fair groups.Muscular control The speakers in the excellent.

. • The variability of Fo is also somewhat less than esophageal speakers.Tracheoesophageal Speech: • Tracheoesophageal speakers tend to produce Fos that are closer to normal laryngeal speakers. but individual speakers may show considerable variation. at least for male speakers.

For these 10 subjects.• Juarbe et.40 (Kyatta. . 1964) to 100 (Zanoff et al.. 1990).al (1989) collected data from 10 subjects with flap reconstruction. the range in Fo was the most limited. • F0 Ranges from 50.

. Length and elasticity of the PE segment is not constant and adjustable as in normals. As noted above the Fo of TEP is commonly aperiodic.Weinberg (1980) Higher Fo in TEP compared to esophageal speech due to pulmonary air supply. Damste (1958) quoted reasons for this aperiodicity Due to variation in subneoglottic pressure.

73 4. 1990 N 15 Sex M Mean 101.46 10 F 108. 1985 M M 64.91 16. 1972 Merwin et al.00 22. et al. 1987 Wienberg & Bennet.98 .Fo characteristics of TE Speech (Reading Task): Study Robbins.68 - Moon & 16 Wienberg.80 - - .D 3. 1984 Trudeau & Qi.6 2.74 72.44 5 8 M 83.70 S.56 Range 37.

. TEP and EP individuals: (Robbins.Comparison of Fundamental Frequency characteristics in normal. 1984). et al.

Vocal Intensity Electrolarynx/ Artificial Larynx: Users of an electro This level is typical larynx can produce of normal laryngeal average intensity speakers during levels during speech ordinary ranging between 75 conversation or and 85 dB reading. .

There is some evidence for a reduced intensity range for users of electro larynges. the intensity of the electronic vibrator is largely determined by the design of the instrument. As was the case for Fo. .

Intensity characteristics of individuals with Electrolarynx
Study N Sex Mean S.D Range

Hymen, 1955




Weiss & 5 Komshian, 1979





Esophageal Speech:
The intensity of esophageal speech is more variable and somewhat lower in overall loudness than normal.

The range of voice intensity that esophageal speakers are able to produce is much less than the intensity range of normal laryngeal speakers (about 10 dB vs. 30 dB).

Intensity characteristics of individuals with Esophageal Speech:
Study Hymen, 1955 N 7 Sex M Mean 73.00 S.D 11.00 Range

Snidecor & Isshiki, 1965 Hoops & Noll, 1969 Baggs & Pine, 1983













8.96 (Recorded in mm from a graphic level recording. Not converted to dB). 59.30



Robbins et al, 1984





Tracheoesophageal Speech: • The intensity of tracheoesophageal speech appears to be only slightly less than the levels produced by laryngeal speakers. . • Some tracheoesophageal speakers habitually produce greater than normal intensity levels. • Variation of intensity may be somewhat greater than normal speakers.

esophageal and normal speech under identical sets of conditions. • In terms of vocal intensity laryngeal speech occupied the middle ground. being on the average 10 dB more intense than the esophageal speech and 10 dB less intense than the TE speech in oral reading and sustained vowel phonation.• Robbins et al (1984) compared TE. .

Intensity characteristics of individuals with TEP: Study N Sex Mean S.22 15.40 2.10 13.00 Baggs & Pine. 1984 15 M 79. et al. 1990 10 F 70.80 8. 1983 5 M 19.8 Trudeau & Qi.50 29.56 3.69 .D Range Robbins.

. Singer (1983) Esophageal speaker and Considerable lower TEP speaker. Results of vocal Larger intensity in TEP between speakers. intensity with TE speaker. Due to greater and TE intraoral pressure.Author Baggs and Pine (1983) Method Comparison intensity Esophageal speakers. Blood (1984) Laryngeal and TEP Higher intensity with TEP speakers.

4dBSPL Vowel Esophageal: 79. N: 72.6 dBSPL . esophageal.3 dBSPL Esophageal and TE Esophageal: 35.7 dBSPL Veena.5 dBSPL TE: 32.D (1998) TE: 65 dBSPL 5 each normals. Sustained vowels: TEP N: 76.3 dBSPL Debruyne (1994) 12 TE. TE: 88 dBSPL Paragraph reading: N: 69.3 dBSPL Esophageal: 59. Eso: 74 dBSPL Paragraph reading.Robbins et al (1984) 15 normals.K. 12 Esophageal TEP: 79.9 dBSPL sustained vowels.

Comparison of Intensity characteristics in normal. et al. 1984). . TEP and EP individuals: (Robbins.

relative average perturbation (RAP). and directional perturbation. jitter ratio. .Perturbation Measures Frequency perturbation (jitter) reflects the frequency stability of the vocal folds. jitter factor. mean period difference.

alaryngeal • This ratio is then in multiplied by 100 to yield a sp percentage measurement.ratio of the average period directional Jitter ratio difference and the average period.number of sign changes of the period differences divided by the total frequency perturbation number of periods. .• Jitter ratio . jitter • Directional jitter .

. • However.Electrolarynx/ Artificial Larynx: • No reported studies of frequency perturbation in speakers using an electro larynx. jitter expected to be directly related to the stability of the electronic circuit producing the tone • would not reflect the speech characteristics of the speaker.

.Esophageal Speech: Esophageal speech more unstable than normal laryngeal speech .as reflected in much larger jitter ratios. Directional jitter is about the same magnitude as normal speakers.

62 to 5.1% Smith et al (1978) 9 esophageal phonation /a/ Jitter: 0.13 msec Jitter ratio: 95:47 .Author Hoops and Noll (1969) Method 22 esophageal rainbow passage Results Jitter(%): 41.

.Tracheoesophageal Speech: • The data on jitter characteristics of tracheoesophageal speakers are unclear. whereas another reports a much higher than normal value. • One study reports a jitter ratio very similar to normal speakers.

. that is.Jitter values to be similar to those of esophageal speakers as both groups of speakers use the same anatomical system as the vibrator. the PE segment.

14 0.6 Hz 10.59 Esophageal 18.03 7.5 Hz Jitter and shimmer of TE is more similar to normal speakers than esophageal .47 30 1.82 60 2. al (1982) Kinshi and Amatsu (1986) Trudeau and Qi (1990) Pindzola and Cain (1989) Measure % jitter Mean jitter Jitter ratio Mean jitter Jitter ratio Directional jitter Jitter % Laryngeal 0.7 4.2 Hz 14 Hz - 13.3 Hz 14.77 0.07 10 TE 5.78 msec 134.Author Robbins et.25 0.8 63.65 Rajashekar (1990) Single case Rajashekar (1991) 20 TE and Esophageal speakers Bertino et al (1996) Extent of fluctuation Speed of fluctuation extent of fluctuation speed of fluctuation - 19 Hz 36 Hz 9.4 Hz 16.

Larger jitter in females for TE speakers attributed to their higher Fo and small VC.In TE speech more regular pattern in jitter values due to expiratory airflow which is more efficient driving force than the small ejections of air out of esophagus. .

jitter ratio elapsed time between laryngectomy and voice recording Trudeau and Qi (1990) .

particularly as the surgery transplants other tissue into the area of the PE segment.These combined findings seem to indicate the type of surgery. . affects the acoustical nature of speech produced by the puncture.

is the number of changes of sign between adjacent periods divided by the total number of period differences. like directional jitter.Amplitude perturbation (Shimmer) • index of the stability of a sound source • The average difference in amplitude between adjacent cycles of vibration (dB) • Directional shimmer. . again multiplied by 100.

Electro larynx • reflect the electronic design and construction of the instrument and not the inherent anatomical or physiological capabilities of the speaker. . Esophageal speakers • Shimmer of is greater than normal whereas directional shimmer is very similar to normal speakers Tracheoesophageal • Both shimmer and directional shimmer are greater than normal speakers.

8 dB 28.15 1.Author Robbins (1982) Robbins (1984) Rajashekar (1991) Method Shimmer ratio Task /a/ Laryngeal 0. .55 0.3 dB TE 10.90 Mean shimmer /a/ 20 TE.80 Esophageal 24.4 dB 3.43 0.8 dB 3. 20 Esophageal 6.3 dB Extent of fluctuation Speed of fluctuation Pauloski et Lower shimmer in TE speakers who wore low pressure al (1989) prosthesis and spoke by digital occlusion.

Temporal Characteristics Temporal measurements reported on alaryngeal speech words per minute (wpm) syllables per second total duration of reading words or syllables per air charge .

used as a measure of pause time. or the maximum time a speaker can sustain a vowel. percentage of silence during reading aloud. .wpm as a measure of speech rate. total vowel duration.

.To a large extent. all of these measures reflect the speaker’s ability to control the regressive air stream. For the esophageal speaker. they also reflect the ability to quickly recharge the esophagus with sufficient air.

• For users of an electro larynx. volumes present  in the esophagus TE speakers  full pulmonary air supply . phonation time is dependent on the vibrator Esophageal speaker on the speaker’s • Silence is dependent Small air facility with the on/off button.

. 1959). • Normal speakers can produce about 13 words per breath of air. ages most appropriate for comparison with laryngectomies) is about 173 wpm. which averages to about 4 seconds in duration (Snidecor & Curry. • Rates much less than 140 wpm are usually perceived as slow and rates above 185 wpm are perceived as fast (Franke. 1939).• The reading rate of normal adults speakers (between 40 and 70 years of age.

. 1979). Weiss & Yeni-Komshian. 1985.• Reading rates are slower when using an electro larynx compared to normal phonation or to tracheoesophageal speech (Merwin et al. • We might expect longer reading times for electro larynx users because of the need to produce more precise articulation to maintain an acceptable level of intelligibility.

• Rates between 100-115 wpm appear typical for these speakers.Esophageal speakers read slower than normal laryngeal speakers. which is about 60-70% of the rate of normal speakers. Esophageal speakers generally spend about 30-45% of their reading time in silence. • These abnormally long silent periods reflect the more frequent need to recharge air supply. .

Better esophageal speakers have much shorter periods of silence more rapid air intake with less interruption of speech flow. typically less than 6 seconds (vs. . 15-20 seconds for normal speakers). small volume of air in the esophagus. A much shorter sustained duration of “phonation” than normal speakers.

These speakers spend bout 10-30% of their time in silence The ability to use full pulmonary air supply to drive the PE segment.Tracheoesophageal speakers read at a slower rate than normal speakers but faster than esophageal speakers. Tracheoesophageal speakers also can produce long phonation durations (about 12 seconds) for the same reason . difficulty in controlling the PE segment and the need to articulate precisely.

TE speakers (97-136 wpm) esophageal speakers (110-115 wpm) laryngeal speakers (166 wpm) .

Studies on Esophageal speech: Author Snidecor and Curry (1960) Filter and Hyman (1975) Sanyogeetha (1993) Results Eso: group average of 113 wpm 2.5 syllables per second for good Esophageal speaker Rate of speech was less in Esophageal compared to normals .

High rate of speech with low pressure prosthesis 2. Pauloski et al.6 to 3. Sedory (1989) TE Fast rate of speech ranging from 2. (1989) Method 4 TE TE Duck-bill Vs Lowpressure TE Results 97-136 wpm.Studies done on TE speakers: Author Singer (1983).6 syllables per second in TE speakers .86 syllables/seconds Sedory et al (1989) Robbins (1984).

43 1.1 wpm.5 wpm 5. per second 3.8 wpm.5 wpm. 99. Eso and TE 182.Rate of speech across groups: Author Method Laryngeal Esophageal TE Baggs and Sentences Pine (1983) Robbins et Rainbow al (1984) passage Veena K. normals.7 wpm. 132. 117.85 syllables syllables per second. 127.44 syllable per second .D 5 each (1998).4 wpm 172.

TEP and EP individuals: (Robbins.Comparison of WPM in normal. et al. 1984) .

Other temporal characteristics: RT-FT in phonation Pause time VOT MPD Total duration .

VOT physical characteristics of neoglottis myoelastic motor control properties responsible for VOT in alaryngeal speech .

Esophageal and TE speakers Normals and TE speakers Santhosh Kumar (1993) Greater VOT in TE than normals (contrasts with Robbins et al) . Esophageal speakers Esophageal and TE speakers Results Reduced VOT in alaryngeal speakers Weinberg (1982) Esophageal speakers are far less consistent than normals in effective variations in timing of voicing onset Longer VOT Laryngeal>TE>Esophage al Robbins.Author Klor and Milanti (1980) Method VOT for pre-vocalic stop consonants Laryngeal. Chrinstensen and Kempstar (1986) VOT in voiceless consosnants Normals.

Weinberg and Alfonso (1978) VOT in a large number of consonants Average VOT associated with prevocalic voiceless stops of Esophageal was significantly shorter than normal . Chrinstensen. Slightly shorter VOT for TE for/b/ /d/ /g/ and /dh/ compared to normals in both initial and medial positions. Marshall (1974) Esophageal Listeners misidentified consonant voicing contrasts in Esophageal. Mann and Schultz (1967).Author Venkatraj Ajthal (1997) Method Normals & TE Results VOT for /p/ /t/ /k/ and /th/ was longer in TE than normals in both initial and final positions. Sacco. He attributed this as a cause for reduced intelligibility.

(1990). Falling time in phonation Author Rajashekar et al. TE showed longer FT than normals on/i/ and /u/ whereas normals showed longer FT in /a/.2. Santhosh Kumar (1993) Normals and TE speakers . Rising time. Attributed to more pressure required to initiate and sustain phonation in TE speakers RT shorter than normals. Method TE Results Greater RT and FT in TE.

TE: 12 secs. Esophageal: 6 secs Lower mean MPD in TE compared to normals. Fisher. however. Blom and Singer (1984) Santhosh Kumar (1993). Results Longer PD in TE compared to Esophageal. Robbins. MPD in TE was shorter than normals Attributed reduced MPD in TE to High airflow rates Poor digital occlusion of the stoma Poor MPD in Esophageal to limited air supply MPD: Laryngeal: 22 secs. MPD Author Baggs and Pine (1983) Robbins (1984).3. .

1984). TEP and EP individuals (Robbins. et al. .Comparison of MPD in normal.

10 vowels Esophageal. Chrinstensen and Kempstar (1986). Method VD Results Longer VD in voiced for Esophageal as against the voiceless in normals Normals had shorter VD. Sanyogeetha (1993 Normal and Esophageal . Alryngeal speaker uses longer VD as a compensatory strategy to increase intelligibility of speech Esophageal had longer VD than normals for /a/ /o/ and /u/. Esophageal intermediate and the TE longest.4. Vowel duration: Author Christensen and Weinberg (1976) Robbins. shorter VD for /u/ /a/ normals and Esophageal 15 each normals. Hariprasad (1992). Esophageal and TE.

Longer VD in TE speakers attributed to: • Pulmonary air as a driving source. . producing slower decay in PE segment vibration. • Greater air pressure and sustained flow rates driving the neoglottis.

Results TE used longer WD compared to normals.5. This is attributed to lack of efficient timing control in initiation and termination of voice in Te speakers and also changes in articulatory behavior secondary to laryngectomy. Word reading task. Word duration: Author Venkataraj Aithal (1997) Method Laryngeal and TE speakers. .

• Better Esophageal speakers-shorter PT.Pause time: • Esophageal: 30-40% in silence.89 Robbins et al Rainbow (1984) passage .65 0. • TE: 10-30% Author Method Laryngeal 0.62 Esophageal TE 0.

Spectral aspects: Esophageal: Weinberg (1982): elevated formant frequency. Sindecore (1968): irregular striations. .

/o/. /e/ Hariprasad (1992). F2. /u/. Normals and Esophageal Space between formants increase. speech intelligibility increases . Esophageal Results Higher except /o/. /u/ in Mean F1. and F3 for Esophageal vowels /a/. /i/.Author Sanyogeetha (1993) Method Normals.

F2 and F3 Normals and TE Alaryngeal voice had weaker Fo than F1 .TE Author Method Results Wider space between formants reduced F3 Christensen and vowels Weinberg (1976) Santhosh (1993) Kumar /a/ /i/ /u/ /e/ /o/ VenkatrajAithal (1997) Hammberg and Nord (1989) 10 vowels Higher Fo.

Prosody in alaryngeal speech Intonation and stress: Weinberg (1980): • TE were able to control Fo duration. . • Intonation and stress as like normals but change in frequency is discontinous.

TE and Eso-produce stress syllable but not on the same syllable. . Intonation contrasts were seen in laryngeal. TE and Eso but Electro-larynx-not able to achieve these intonation distinctions.