The effect of noise on relationships between speech intelligibility and self-report measures in tracheoesophageal speakers

Thesis (Master's)--University of Washington, 2014As clinicians and researchers, it is our ultimate goal to improve our patients' quality of life. This goal is achieved through reliable measurements such as speech intelligibility, which is a standard assessment of a patient's impairment level. Attempts to correlate this measurement with a patient's daily communication outside the clinic have been weak or uncertain. In this study we explore the correlation between speech intelligibility and self-report measures in a population of head and neck cancer patients, alaryngeal tracheoesophageal speakers (TEP). Participants: 24 individuals using TEP, 66 naïve listeners who performed intelligibility ratings of the speakers in quiet and in noise. The strength of these relationships was compared across the quiet and noise conditions. There was a weak correlation (r =0.201 and r= 0.003) between speech intelligibility in quiet and self-report measures. A slightly stronger correlation (r = 0.435 and r=0.311) was found between speech intelligibility in noise and self-report measures. The results of the study suggest that intelligibility in noise is a better predictor of self-rated communication function than intelligibility in quiet

Does Knowledge of Diagnosis Affect Inexperienced Listeners’ Judgments of Spasmodic Dysphonia

Objectives: Adductor spasmodic dysphonia (ADSD) is a laryngeal dystonia characterized by an effortful voice quality in purposeful speech. Beyond changes in voice, one study showed that unfamiliar communication partners perceive ADSD speakers as significantly older, less confident, and more tearful than control speakers. To address communication breakdowns, one strategy that ADSD speakers often employ includes disclosure of their condition (i.e., I have a voice problem called spasmodic dysphonia). Yet, it is unknown whether knowledge of a diagnostic condition negatively or positively affects listeners’ perceptions about that speaker. The purpose of this study is to determine whether knowledge of diagnosis affects inexperienced listeners’ judgments of perceived effort, confidence, and tearfulness in speakers with ADSD when compared to controls. Study Design: Experimental. Methods: Twenty speakers with ADSD and 20 age-and sex-matched controls provided speech recordings of the Rainbow Passage. Thirty inexperienced listeners were randomly assigned to two groups. Group 1 evaluated speech samples without diagnostic information; Group 2 was provided with diagnostic information (no vocal complaints vs. voice problem called ADSD)for each speaker. Listeners evaluated speech samples for speech effort, confidence, and tearfulness using 100 mm visual analog scales. Results: Data collection is ongoing; listeners in Group 1 have completed the task. Group means of listeners’ judgments will be calculated across conditions. A series of 2 x 2 ANOVAs will be completed to determine whether there is an effect of group (ADSD vs. control) or condition (no knowledge vs. knowledge) on listeners’ judgments. It is hypothesized that knowledge of diagnosis may bias listeners’ judgments positively for controls, and negatively for ADSD speakers (i.e., known as an expectancy effect). Conclusions: Results will reveal whether inexperienced listeners’ judgments may be affected by knowledge of a person’s condition, as in a disclosure scenario. Results have implications for counselling individuals with ADSD

Inexperienced Listener Impressions of Speakers with Spasmodic Dysphonia

Objectives/Hypothesis: Adductor spasmodic dysphonia (ADSD) is characterized by uncontrolled spasms of intrinsic laryngeal muscles. Patients with ADSD report difficulties related to employment and reduced psychosocial well-being. No study has investigated how the speech produced by ADSD patients may also influence listeners’ attitudes about these speakers. The objectives of this study are to determine 1) if listeners’ attitudes toward speakers with ADSD differ from attitudes towards healthy control speakers; and 2) whether listeners’ attitudes towards speakers with ADSD are related to perceived strain or patient-rated vocal effort and voice-related quality of life. Study Design: Experimental/Correlational Methods: Twenty speakers with ADSD and 20 healthy age-and sex-matched controls provided speech recordings. ADSD speakers also completed the VHI and self-rated vocal effort. 40 inexperienced listeners will make judgments of speech samples for strain using visual analog scales and provide judgments of age, employability, confidence, and emotional stability using semantic differential scales. Results: Group means of listeners’ judgments will be calculated across conditions. Multiple t-tests (Bonferroni corrections) will determine whether differences exist between control and ADSD speakers. Hypothesis: Listeners will judge those with ADSD more negatively and with increased strain. Additional linear regression analyses will be performed to determine if less favorable ratings made by listeners correlate with strain, patient-rated effort, and VHI scores Conclusions: Results will reveal whether inexperienced listeners’ attitudes of those with ADSD differ from severity of speech and whether oft-reported psychosocial and employment difficulties relate to negative attitudes. Implications for counselling and education will be discussed

Does Knowledge of Diagnosis Affect Inexperienced Listeners’ Judgments of Spasmodic Dysphonia

Objectives: Adductor spasmodic dysphonia (ADSD) is a laryngeal dystonia characterized by an effortful voice quality in purposeful speech. Beyond changes in voice, one study showed that unfamiliar communication partners perceive ADSD speakers as significantly older, less confident, and more tearful than control speakers. To address communication breakdowns, one strategy that ADSD speakers often employ includes disclosure of their condition (i.e., I have a voice problem called spasmodic dysphonia). Yet, it is unknown whether knowledge of a diagnostic condition negatively or positively affects listeners’ perceptions about that speaker. The purpose of this study is to determine whether knowledge of diagnosis affects inexperienced listeners’ judgments of perceived effort, confidence, and tearfulness in speakers with ADSD when compared to controls. Study Design: Experimental. Methods: Twenty speakers with ADSD and 20 age-and sex-matched controls provided speech recordings of the Rainbow Passage. Thirty inexperienced listeners were randomly assigned to two groups. Group 1 evaluated speech samples without diagnostic information; Group 2 was provided with diagnostic information (no vocal complaints vs. voice problem called ADSD)for each speaker. Listeners evaluated speech samples for speech effort, confidence, and tearfulness using 100 mm visual analog scales. Results: Data collection is ongoing; listeners in Group 1 have completed the task. Group means of listeners’ judgments will be calculated across conditions. A series of 2 x 2 ANOVAs will be completed to determine whether there is an effect of group (ADSD vs. control) or condition (no knowledge vs. knowledge) on listeners’ judgments. It is hypothesized that knowledge of diagnosis may bias listeners’ judgments positively for controls, and negatively for ADSD speakers (i.e., known as an expectancy effect). Conclusions: Results will reveal whether inexperienced listeners’ judgments may be affected by knowledge of a person’s condition, as in a disclosure scenario. Results have implications for counselling individuals with ADSD

Inexperienced Listener Impressions of Speakers with Spasmodic Dysphonia

Objectives/Hypothesis: Adductor spasmodic dysphonia (ADSD) is characterized by uncontrolled spasms of intrinsic laryngeal muscles. Patients with ADSD report difficulties related to employment and reduced psychosocial well-being. No study has investigated how the speech produced by ADSD patients may also influence listeners’ attitudes about these speakers. The objectives of this study are to determine 1) if listeners’ attitudes toward speakers with ADSD differ from attitudes towards healthy control speakers; and 2) whether listeners’ attitudes towards speakers with ADSD are related to perceived strain or patient-rated vocal effort and voice-related quality of life. Study Design: Experimental/Correlational Methods: Twenty speakers with ADSD and 20 healthy age-and sex-matched controls provided speech recordings. ADSD speakers also completed the VHI and self-rated vocal effort. 40 inexperienced listeners will make judgments of speech samples for strain using visual analog scales and provide judgments of age, employability, confidence, and emotional stability using semantic differential scales. Results: Group means of listeners’ judgments will be calculated across conditions. Multiple t-tests (Bonferroni corrections) will determine whether differences exist between control and ADSD speakers. Hypothesis: Listeners will judge those with ADSD more negatively and with increased strain. Additional linear regression analyses will be performed to determine if less favorable ratings made by listeners correlate with strain, patient-rated effort, and VHI scores Conclusions: Results will reveal whether inexperienced listeners’ attitudes of those with ADSD differ from severity of speech and whether oft-reported psychosocial and employment difficulties relate to negative attitudes. Implications for counselling and education will be discussed

Auditory-perceptual speech outcomes and quality of life after total laryngectomy

Background: Total laryngectomy (TL) results in challenges to communication, airway, and swallowing. Consequently, individuals often report a pronounced impact on quality of life (QOL). After TL, QOL outcomes are typically measured using cancer-specific and discipline-specific scales. Cancer-specific measures investigate the influence of head and neck cancer symptoms on QOL, while discipline-specific scales examine how a specific area (e.g., voice quality) affects QOL. Other common outcome measures after TL include a listener’s impressions of speech intelligibility or acceptability. A few previous studies have shown weak relationships between perceptions of speech intelligibility/acceptability with patient-reported QOL. However, the degree to which these perceptual variables generally influence QOL is largely unknown. Objectives: a) To determine relationships between speech intelligibility, speech acceptability and a patient’s self-reported QOL, and; b) To determine whether relationships are stronger when QOL is measured by a discipline-specific QOL scale (e.g., Voice Handicap Index-10; VHI-10) or a head and neck cancer-specific QOL scale (e.g., University of Washington Quality of Life; UW-QOL)? Methods: Twenty individuals (16 males, 4 females) who underwent TL (n=6 electrolaryngeal speakers; n=12 tracheoesophageal speakers; n=2 esophageal speakers) completed a disease-specific QOL scale (UW-QOL; Hassan & Weymuller, 1993; Rogers et al., 2002) and a discipline-specific QOL scale (VHI-10; Rosen et al., 2004). Individuals recorded 6 sentences of increasing length (5-15 words) from the Sentence Intelligibility Test (SIT; Yorkston et al., 1996) and a reading passage. Twenty-one inexperienced listeners each transcribed 6 sentences for 3 speakers using the SIT protocol. Each speaker’s intelligibility was based on the average score across 3 listeners. Listeners also judged speech acceptability for the 20 speakers using 100 mm visual analog scales. Twenty percent of the samples were repeated to determine intra-rater reliability (r = .71); intraclass correlation coefficients were calculated as a measure of interrater reliability (ICC = .97, speech acceptability). To determine the relationship between speech intelligibility or speech acceptability with QOL (UW-QOL; VHI-10), correlational analyses were performed. Results: Listeners judged tracheoesophageal and esophageal speakers significantly more acceptable than electrolaryngeal speakers (p \u3c .01). Intelligibility and QOL were not significantly differentiated by speaker type. In addition, listeners’ ratings of speech acceptability were only moderately related to intelligibility (r = .41). Relationships were weak to moderate between ratings of speech and QOL scores, with speech acceptability tending to be a stronger predictor of QOL than intelligibility. The speech sub-score on the UW-QOL related most strongly (r = .507) to speech acceptability (see table 1). Conclusions: Alaryngeal speakers exhibited a wide range of speech acceptability and intelligibility, although these dimensions were not strongly related. These results suggest that while listeners may be able to understand an alaryngeal speaker, being understood is not sufficient to render the speech “acceptable” to listeners. Results also revealed that listeners’ judgments of speech are not necessarily predictive of the speakers’ own perceptions of health-related or voice-related QOL. Overall, results suggest that listener-rated and patient-reported measures are complimentary after TL