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

Document Type

Conference Presentation

Conference Title/Conference Publication

8th International Conference on Head and Neck Cancer


American Head and Neck Society


Toronto, Ontario, Canada

Conference Dates

July 21, 2012 - July 25, 2012

Date of Presentation



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 < .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.

This document is currently not available here.