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The self-reporting voice-related quality of life (V-RQOL) instrument has been viewed as a modular index of quality of life for speakers using tracheoesophageal, esophageal (ES), or electrolaryngeal speech. However, V-RQOL has never been studied with pneumatic artificial laryngeal (PA) individuals. This study attempted to quantify the self-assessed voice-related performance of PA and ES speakers in Taiwan via the V-RQOL questionnaire, and further to compare the results for PA and ES speakers. METHODS: V-RQOL was assessed in 79 PA and 25 ES speakers undergoing total laryngectomy without using tracheoesophageal puncture. Data were collected from members of Taiwan's Association of Laryngectomees. RESULTS: There was no significant difference between PA and ES participants in social-emotional, physical functioning and total scores, suggesting both may consider their quality of life comparable with each other. In ES participants, there was a significant effect of time after total laryngectomy in physical functioning and total scores. CONCLUSIONS: PA speakers did not exhibit more dissatisfaction or disability than ES speakers on 10 statements in the V-RQOL, but after total laryngectomy the ES have been shown to improve over time. Information on the experience of PA and ES speakers could be used by clinicians to inform patients of potential outcomes, and help them select suitable rehabilitation techniques.

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BACKGROUND: The Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL) are seldom administered to alaryngeal patients who use pneumatic artificial larynx (PAL) and esophageal speech (ES). As such, the specificity of VHI and 10-item VHI (VHI-10) for assessing voice-related changes in such patients is unclear. Accordingly, this study investigated the correlation between scores on the VHI, its shortened version (VHI-10), and the V-RQOL for Mandarin-speaking laryngectomees using PAL and ES, with the aim of establishing which of these instruments is suited to such patients. METHODS: The participants comprised 126 PAL and 26 ES patients from Taiwan who completed the Mandarin VHI and V-RQOL. Fifty-two of these alaryngeal participants then completed both those instruments a second time, between 8 and 64 days later. RESULTS: One item appearing in both the Mandarin long-form VHI and the VHI-10 was excluded because more than half the participants left it unanswered. The correlation of scores on the remaining 29 items on the former with the nine on the latter was high ( r = 0.968), while that between the former and V-RQOL scores was moderate ( r = -0.569), as was the correlation between short-form VHI and Mandarin V-RQOL scores ( r = -0.582). Structural equation modeling was then used as the basis for simplifying the Mandarin long-form VHI into a new 10-item VHI specifically for alaryngeal Mandarin speakers (MA-VHI-10), to eliminate the scoring effect of the original VHI's and VHI-10's work-related item. MA-VHI-10 scores were highly correlated with those on the Mandarin long-form VHI ( r = 0.983). CONCLUSION: The Mandarin versions of long-form VHI, short-form VHI, and MA-VHI-10 are interchangeable for a Mandarin-speaking alaryngeal population. However, neither of the former two instruments should be substituted for the V-RQOL.

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This study investigates three aspirated voiceless stop consonants and their unaspirated counterparts produced in Taiwan's Southern Min dialect by 10 laryngeal speakers (LA), 10 speakers with pneumatic artificial larynxes (PA), and 10 oesophageal speakers (ES). Listeners' perceptions of the accuracy of the three groups in producing these six stop consonants were also examined. Each of the voiceless stop consonants /p, pÊ°, t, tÊ°, k, kÊ°/, followed by the vowel /a/, was represented by a Southern Min character and appeared three times on a list in random order. Each character had a consonant-vowel syllable structure, and all were read with Tone 1 (high and level). Voice onset time (VOT) was measured for each stop consonant. A separate group of 20 listeners was then asked to identify the consonants produced by the LA, PA, and ES speakers. The VOT values of aspirated voiceless stop consonants from PA and ES were shorter than those from LA. Although PA and ES had aspiration contrast in their VOT values, perceived accuracy was low for PA (/pÊ°/: 16.3%; /tÊ°/: 13.5%; /kÊ°/: 22.8%) and ES (/pÊ°/: 33.7%; /tÊ°/: 25.9%; /kÊ°/: 31.9%). The mean percentages of correctly identified /pÊ°, tÊ°, kÊ°/ produced by PA were at chance level. In terms of VOT values, it is recommended that, when producing aspirated voiceless stop consonants, PA and ES elongate the duration between the release of the oral constriction and the onset of their vibratory sound source. Moreover, it is also recommended that further investigation into other phonetic properties that support stop contrast is needed.

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Purpose The Voice Handicap Index (VHI) questionnaire assesses the impact of total laryngectomy on voice-related quality of life. This study evaluates the Mandarin VHI, including its internal consistency, test-retest reliability, content validity, and differences in scores for Mandarin alaryngeal patients with pneumatic artificial laryngeal (PA) and esophageal (ES) speech. Method Translation and validation of the VHI questionnaire was performed through the forward-backward translation technique. This study used a sample of 78 PA and 23 ES participants from Taiwan who completed the Mandarin VHI. Forty-two of the alaryngeal participants completed the Mandarin VHI twice over a period of 7-63 days. Results The measurement of the internal consistency of the Mandarin VHI showed a high Cronbach's alpha coefficient for the total score (.975) and the functional (.930), physical (.939), and emotional (.938) subscales. Based on the results of the intraclass correlation coefficients, good test-retest reliability for the total and domain scores was found (intraclass correlation coefficient = .827-.863). Conclusion The Mandarin VHI was validated as an instrument with proper internal consistency and reliability, which supports the Mandarin VHI as a valid instrument for the self-evaluation of handicaps related to voice problems in PA and ES speakers.

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OBJECTIVE: For recurrent laryngeal cancers, trans-oral robotic surgery has been used to perform total laryngectomy, but limited cases had been reported without long-term outcome follow-up. This study aims at presenting the largest longitudinal retrospective cohort in a single tertiary referral medical center. METHODS: From November 2013 to August 2017, seven patients with recurrent laryngeal cancers without evidence of neck metastasis were selected to receive trans-oral robotic surgery-assisted TL without neck dissection. The para-operative details including the surgical success rates, surgical methods, resection extent, drainage tube placement, pharyngeal wound closure, console surgical time, pathologic findings and long-term complications were reviewed and described. The study end points include survival rates and preservation of swallowing function without tube feeding. RESULTS: Trans-oral robotic surgery-assisted total laryngectomy was successfully performed on all seven patients with mean surgical console time of 111 ± 66 min. Strap muscles and hyoid bone were resected like open surgery in six and five patients, respectively. For all the seven patients, there was no severe pharyngo-cutaneous fistula formation requiring repair in a second surgery, but tracheostoma stenosis was not uncommon (57%). Three patients received adjuvant chemotherapy/radiotherapy. After follow-up of 36.1 ± 15.8 months, two patients had neck recurrence, and one patient died 19 months after surgery, but the other five patients were alive without disease recurrence. The overall survival rate was 85.7% (6/7), and all patients had good swallowing function without tube feeding. CONCLUSIONS: Trans-oral robotic surgery-assisted total laryngectomy is a feasible approach for selected patients with recurrent laryngeal cancers. The oncologic and functional outcomes were satisfactory. Further larger cohort study is worthwhile to further elucidate the value of trans-oral robotic surgery-assisted total laryngectomy.

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Purpose: This study investigated the acoustic properties of 6 Taiwan Southern Min vowels produced by 10 laryngeal speakers (LA), 10 speakers with a pneumatic artificial larynx (PA), and 8 esophageal speakers (ES). Method: Each of the 6 monophthongs of Taiwan Southern Min (/i, e, a, ɔ, u, ə/) was represented by a Taiwan Southern Min character and appeared randomly on a list 3 times (6 Taiwan Southern Min characters × 3 repetitions = 18 tokens). Each Taiwan Southern Min character in this study has the same syllable structure, /V/, and all were read with tone 1 (high and level). Acoustic measurements of the 1st formant, 2nd formant, and 3rd formant were taken for each vowel. Then, vowel space areas (VSAs) enclosed by /i, a, u/ were calculated for each group of speakers. The Euclidean distance between vowels in the pairs /i, a/, /i, u/, and /a, u/ was also calculated and compared across the groups. Results: PA and ES have higher 1st or 2nd formant values than LA for each vowel. The distance is significantly shorter between vowels in the corner vowel pairs /i, a/ and /i, u/. PA and ES have a significantly smaller VSA compared with LA. Conclusions: In accordance with previous studies, alaryngeal speakers have higher formant frequency values than LA because they have a shortened vocal tract as a result of their total laryngectomy. Furthermore, the resonance frequencies are inversely related to the length of the vocal tract (on the basis of the assumption of the source filter theory). PA and ES have a smaller VSA and shorter distances between corner vowels compared with LA, which may be related to speech intelligibility. This hypothesis needs further support from future study.

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