• 음성과학
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• 제5권1호
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• pp.121-139
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• 1999

Our experimental subject was a laryngectomee who had undergone total laryngectomy with $PROVOX^{(R)}$ insertion, and learned esophageal speech after the surgery, so he could produce both $PROVOX^{(R)}$ voice and esophageal voice. With this subject's production of $PROVOX^{(R)}$ and esophageal voice, we are to compare the acoustic and aerodynamic characteristics of the two voices, under the same physical conditions of the same person. As a result, the fundamental frequency of esophageal voice was 137.2 Hz, and that of $PROVOX^{(R)}$ was 97.5 Hz. $PROVOX^{(R)}$ voice showed lower jitter, shimmer and NHR than esophageal voice, which means that $PROVOX^{(R)}$ voice showed better voice quality than esophageal voice. In spectrographic analysis, the formation of formants and pseudoformants were more distinct in esophageal voice and several temporal aspects of acoutic features such as VOT and closure duration were more similar with normal voice in $PROVOX^{(R)}$ voice. During the sentence utterance, esophageal voice showed longer pause or silence duration than $PROVOX^{(R)}$ voice. Maximum phonation time and mean flow rate of $PROVOX^{(R)}$ voice were much longer and larger than esophageal voice, but mean and range of sound pressure level, subglottic pressure and voice efficiency were similar in the two voices. Glottal resistance of esophageal voice was much larger than $PROVOX^{(R)}$ voice which showed still larger glottal resistance than normal voice.

• 대한후두음성언어의학회지
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• 제9권1호
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• pp.5-10
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• 1998

Voice rehabilitation is very important concerning in laryngectomees. Esophageal speech is a common and widely used method of voice restoration. But, until now there is no reliable data which shows the aerodynamic characteristics of esophageal speech. In order to evaluate the vocal quality of normal laryngeal and esophageal speech, several aerodynamic parameters were measured in 13 adults with normal laryngeal voice and 2 excellent esophageal speakers using Aerophone II voice function analyzer. The examined parameters were maximal flow rate, mean airflow rate, subglottic pressure, vocal efficiency, glottic resistance, maximal phonation time and mean sound pressure level. In vocal efficiency, there is no difference between two groups, but in other parameters, marked differences were showed in esophageal speakers, especially mean resistance. Results indicates that esophageal speakers make the efficient voices with poor aerodynamic condition, comparing with normal laryngeal speakers.

• 대한후두음성언어의학회지
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• 제13권2호
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• pp.155-163
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• 2002

Background and Objectives : Esophageal voice, Silicone voice Prosthesis with tracheo-esophageal (T-E) puncture have been used as vocal rehabilitation methods for postlaryngectomy. However, long-term follow-up in the voice rehabilitation in the total laryngectomees has not been reported. The purpose of this study is to analyze practice of postlaryngectomy voice rehabilitation and to find the effective voice rehabilitation. Materials and Methods : From Jan 1992 until June 2002, 75 patients underwent a total laryngectomy at Yongdong Severance Hospital. We retrospectively studied voice rehabilitation methods commonly used, acquisition levels of esophageal speech, patients satisfaction scale (5 rating scale) according to the methods in 33 of them (40 died, 2 unavailable) by using charts review, telephone interview. Results : T-E speech is most commonly used by 14 patients (42.4%) : A tracheo-esophageal procedure (primary or secondary puncture) by 21 : and 8 patients removed Provox. 1 patient had no voice rehabilitation. 7 patients (21.2%) have used esophageal speech : 4 patients of them have used it after removing Provox. Electrolarynx has been used with other voice rehabilitation methods : 4 patients have only used this method and 3 patients with T-E speech, 1 patient with esophageal speech. However, 6 patients (18%) remained without a substitute voice rehabilitation. In the satisfaction with speech and management of voice rehabilitation methods, patients using esophageal speech were most satisfied (4.1), patients with T-E speech were unsatisfied (2.3). Regarding with the acquisition level of esophageal speech in 33 patients, 22 patients (66.6%) failed without functional speech. Conclusion : To increase patients satisfaction and to achieve successful voice rehabilitation after total laryngectomy, preoperative counseling, pretesting, appropriate patient selection of each method and team decision-making and postoperative voice therapy must be considered.

• 대한후두음성언어의학회지
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• 제19권1호
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• pp.28-30
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• 2008

The problem of voice restoration after total laryngectomy has existed ever since Billroth's first total laryngectomy in 1873. Since then, all the efforts to restore the voice was tried to divert the tracheal air to the pharynx to produce voice, which became the tracheo-esophageal shunt voice currently used. With the intact pharyngoesophagus, however, there are two basic options for speech rehabilitation : the artificial larynx and esophageal voice. The artificial larynx is an electrically driven buzzer or a sound transducer and its most common type is placed against a supple point on patient's neck and introduces a mechanical sound into the tissues and air spaces of the neck. This sound, emanating form the mouth, is articulated by the intact structures of the remaining vocal tract as understandable speech. Esophageal voice is a commonly recommended method for alaryngeal speech rehabilitation, which can be successfully done by regurgitating the air stored in the esophagus. Successful esophageal voice is preferable to the artificial larynx but, most patients usually adapt only one of those methods according to their needs and feasibility to learn.

• 말소리와 음성과학
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• 제6권2호
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• pp.115-121
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• 2014

This paper investigates the relationship between acoustic characteristics and voice handicap index for 29 males with esophageal speakers. Acoustic characteristics were measured by using a sustained vowel /a/ three times. The stable vocalization for 2 seconds was analyzed by MDVP program. Specifically, relationships between four VHI scores (total, functional, physical, and emotional) and three acoustic characteristics (jitter, shimmer, and NHR) were investigated using the Pearson correlation coefficient. As results, we found no relationship between NHR and VHI scores. However, both jitter and shimmer had statistically significant correlations with all four VHI scores. This research will contribute to establishing a baseline related to speech characteristics in voice rehabilitation with esophageal speakers. Further research could be done to examine the overall quality of life survey, which is widely used as a subjective measure about voice for patients with esophageal speakers.

• 말소리와 음성과학
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• 제6권2호
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• pp.47-54
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• 2014

The purpose of this study was to analyze spectral versus cepstral measurements in esophageal speakers. The comparison between the measurements in thirteen male esophageal speakers was compared with the control group of thirteen normal speakers using the sustained vowel /a/. The main results can be summarized as below: (a) the CPP and L/H ratio of the esophageal group were significantly lower than those of the control group (b) the CPP was significantly correlated with the spectral parameters such as jitter, shimmer, NHR and VTI, and (c) the ROC analysis showed that the threshold of 10.25dB for the CPP achieved a good classification for esophageal speakers, with 100% perfect sensitivity and specificity. Thus, it was known that cepstral-based acoustic measures such as CPP, may be more reliable predictors than other spectral-based acoustic measures such as jitter and shimmer. And it was found that cepstral-based acoustic measures were effective in distinguishing esophageal voice quality from normal voice quality. This research will contribute to establishing a baseline related to speech characteristics in voice rehabilitation with laryngectomees.

• 대한후두음성언어의학회지
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• 제3권1호
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• pp.6-12
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• 1989

Methods of voice rehabilitation in laryngectomees include training of esophageal speech, use of electrolarynx and pneumatic speech aid and surgical methods, etc. In this paper, we introduce the experimental model of obturator-type electrolarynx which has several advantages for use such as ease of learning, no disagreeable appearance, and both hands not being occupied. We compared it to normal voice and other voice rehabilitation methods such as esophageal voice, japanese pneumatic speech aid and cervical electrolarynx in intelligibility and sonagraphic evaluation. The results are as follows; 1) Obturator-type electrolarynx exhibited the lowest intelligibility. 2) In sonagraphic evaluation, the spectrogram produced by the obturator-type electrolarynx was the most different from those of normal voice.

• 대한음성학회:학술대회논문집
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• 대한음성학회 2003년도 10월 학술대회지
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• pp.133-137
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• 2003

The purpose of this study was to provide acoustic data on the voice of the laryngectomized patients for more scientific and efficient voice rehabilitation. The phonation of prolonged /a/ of 9 electronic artificial larynx(AL) users, 5 esophageal(EP) speech users, and 2 tracheo-esophageal(TEP) voice users were recorded and analyzed using Multi-Speech. Habitual f0, mean f0, sd f0, max f0, min f0, jitter, shimmer, and NHR were compared among groups of subjects using t-test. The EP and TEP groups exhibited higher f0 compared to the AL group. The AL and TEP groups showed more stable f0 than the EP group. In addition, the quality of TEP and EP voices were comparatively better in terms of jitter, shimmer, and NHR.

• 대한후두음성언어의학회지
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• 제12권2호
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• pp.152-157
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• 2001

Background : Electrolarynx, Esophageal voice, and Silicone voice prosthesis with tracheoesophageal(T-E) fistula have been used as vocal rehabilitating methods for the post-laryngectomized patients. Prosthetic rehabilitation of voice after total laryngectomy has gained wide acceptance and has become a common practice in many clinics since the pioneering works of Singer and Blom In 1979. Since the introduction of tracheo-esophageal puncture and application of Blom Singer$\circledR$ voice prosthesis in 1980, several reliable voice prostheses have been developed and are successfully being used. Objectives : Even though quality of voice produced by Silicone voice prosthesis with T-E fistula is superior to other modalities, it still has some disadvantages. We devised a new cannulatyped silicone voice prosthesis. Methods : 1) Devising a new prototype of cannula-typed silicone voice prosthesis. 2) Application of the prototype using canine animal model(laryngectormized dog) and fitting trial on human patient whose previously inserted Silicone voice prosthesis is not functioning due to presumed fungal infection. Discussion : Final form of prototype was made after several times of major and minor modifications. Insertion of the newly developed Cannula-typed Silicone voice prosthesis on canine animal model and human trial were done without any difficulty. There were no serious leakage of saliva or food during swallowing. Conclusion : The newly developed Cannula-typed Silicone voice prosthesis(So-Mang$\circledR$) and the modified replacement method will further improve the results of post-laryngectomized prosthetic voice rehabilitation. Long-term animal study and human trial are planned in the near future.

• 대한후두음성언어의학회지
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• 제9권2호
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• pp.142-146
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• 1998

Background : It has been established that the fundamental frequency(Fo) of the vowels varies systemically as a function of vowel height. Specifically, high vowels have a higher Fo than low vowels. Two major explanations or hypotheses dominate contemporary accounts of fired to explain the mechanisms underlying intrinsic variation in vowel Fo, source-tract coupling hypothesis and tongue-pull hypothesis. Objectives : Total laryngectomy surgery necessiates removal of all structures between the hyoid bone and the tracheal rings. Therefore, the assumption that no direct interconnection exists between the tongue and pharyngoesophageal segment that would mediate systematic variation in vowel Fo appears quite reasonable. If tongue-pull hypothesis is correct, systemic differences in Fo between high versus low vowels produced by esophageal speakers would not Or expected. We analyzed the Fo in the vowels of esophageal voice. Materials and method : The subjects were 11 cases of laryngectomee patients with fluent esophageal voice. The five essential vowels were recorded and analyzed with computer speech analysis system(Computerized Speech Lab). The Fo was measured using acoustic waveform, automatically and manually, and narrow band spectral analysis. Results : The results of this study reveal that intrinsic variation in vowel Fo is clearly evident in esophageal speech. By analysis using acoustic waveform automatically, the signals were too irregular to measure the Fo precisely. So the data from automatic analysis of acoustic waveform is not logical. But the Fo by measuring with manually calculated acoustic waveform or narrowband spectral analysis resulted in acceptable results. These results were interpreted to support neither the source-tract coupling nor the tongue-pull hypotheses and led us to offer an alternative explanation to account for intrinsic variation of Fo.