Acoustic Analysis of Changes in Articulation Proficiency in Patients with Advanced Head and Neck Cancer Treated with Chemoradiotherapy

Abstract

Objectives:

Our aim was to characterize articulation proficiency and differences between tumor sites before and after chemoradiotherapy for advanced head and neck cancer with the help of acoustic measures. Our further goal was to improve objective speech measures and gain insight into muscle functioning before and after treatment.

Methods:

In 34 patients with laryngeal or hypopharyngeal, nasal or nasopharyngeal, or oral or oropharyngeal cancer, we acoustically analyzed nasality, vowel space, precision, and strength of articulation in 12 speech sounds (/α/, /i/, /u/, /p/, /s/, /z/, /l/, /t/, /tj/, /k/, /x/, /r/) before treatment and 10 weeks and 1 year after treatment. Outcomes were compared between assessment points and between tumor sites.

Results:

Nasality in nonlaryngeal sites was significantly reduced by treatment. Most affected in articulation were the oral or oropharyngeal cancer sites, followed by the nasal or nasopharyngeal sites. One year after treatment, vowel space had not recovered and consonant articulation had weakened. Laryngeal sites were less affected in articulation by tumor or treatment.

Conclusions:

Analyses of articulatory-acoustic features are a useful instrument for assessing articulation and speech quality objectively. Assessment of a number of sounds representing various articulation manners, places, and tongue shapes revealed patterns of speech deterioration after chemoradiotherapy. The results suggest that patients' speech could benefit from articulation exercises to address changes in muscle coordination and/or sensitivity and to counteract side effects and “underexercise” atrophy.

Keywords

acoustics articulation chemoradiotherapy head and neck cancer speech

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References

Givens

Karnell

Gupta

. Adverse events associated with concurrent chemoradiation therapy in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 2009;135:1209–17.

Lazarus

. Effects of chemoradiotherapy on tongue function in patients with head and neck cancer. Perspectives on Swallowing and Swallowing Disorders (Dysphagia) 2009;18:55–60.

Logemann

Pauloski

Rademaker

. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck 2008;30:148–58.

Kotz

Abraham

Beitler

Wadler

Smith

. Pharyngeal transport dysfunction consequent to an organ-sparing protocol. Arch Otolaryngol Head Neck Surg 1999;125:410–3.

Singer

Arraras

Baumann

. Quality of life in patients with head and neck cancer receiving targeted or multimodal therapy — Update of the EORTC QLQ-H&N35, Phase I. Head Neck 2013;35:1331–8.

Schuster

Stelzle

. Outcome measurements after oral cancer treatment: Speech and speech-related aspects — An overview. Oral Maxillofac Surg 2012;16:291–8.

Jacobi

van der Molen

Huiskens

van Rossum

Hilgers

. Voice and speech outcomes of chemoradiation for advanced head and neck cancer: A systematic review. Eur Arch Otorhinolaryngol 2010;267:1495–505.

Mlynarek

Rieger

Harris

. Methods of functional outcomes assessment following treatment of oral and oropharyngeal cancer: Review of the literature. J Otolaryngol Head Neck Surg 2008;37:2–10.

Kent

Kim

. Toward an acoustic typology of motor speech disorders. Clin Linguist Phon 2003;17:427–45.

10.

Rieger

Tang

Harris

. Survey of current functional outcomes assessment practices in patients with head and neck cancer: Initial project of the head and neck research network. J Otolaryngol Head Neck Surg 2010;39:523–31.

11.

Borggreven

Leeuw

I Verdonck-De

Langendijk

. Speech outcome after surgical treatment for oral and oropharyngeal cancer: A longitudinal assessment of patients reconstructed by a microvascular flap. Head Neck 2005;27:785–93.

12.

de Bruijn

ten Bosch

Kuik

. Objective acoustic-phonetic speech analysis in patients treated for oral or oropharyngeal cancer. Folia Phoniatr Logop 2009;61:180–7.

13.

Keuning

Wieneke

van Wijngaarden

Dejonckere

. The correlation between nasalance and a differentiated perceptual rating of speech in Dutch patients with velopharyngeal insufficiency. Cleft Palate Craniofac J 2002;39:277–84.

14.

Kissane

Patel

Baser

. Preliminary evaluation of the reliability and validity of the Shame and Stigma Scale in head and neck cancer. Head Neck 2013;35:172–83.

15.

Lallh

Rochet

, The effect of information on listeners' attitudes toward speakers with voice or resonance disorders. J Speech Lang Hear Res 2000;43:782–95.

16.

Dharmaperwira-Prins

. Dysartrie en verbale apraxie — DYVA-onderzoek. Pearson Assessment and Information, 2005.

17.

Boersma

Weenink

, (2012). Praat: Doing phonetics by computer [Computer Program]. Version 5.3.13, retrieved April 2012 from http://www.praat.org/.

18.

Stevens

. Acoustic phonetics. Cambridge, Mass: MIT Press, 2000.

19.

Jacobi

van der Molen

van Rossum

Hilgers

. Pre- and short-term posttreatment vocal functioning in patients with advanced head and neck cancer treated with concomitant chemoradiotherapy. In: Proceedings of Interspeech 2010, Makuhari, Japan, 2010:2582–5.

20.

van der Molen

van Rossum

Burkhead

Smeele

Rasch

Hilgers

. A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: Feasibility, compliance, and short-term effects. Dysphagia 2011;26:155–70.

21.

van der Molen

van Rossum

Jacobi

. Pre- and posttreatment voice and speech outcomes in patients with advanced head and neck cancer treated with chemoradiotherapy: Expert listeners' and patient's perception. J Voice 2012;26:e25–33.

22.

Marchal

. From speech physiology to linguistic phonetics. Hoboken, NJ: Wiley, 2009.

23.

Raphael

Borden

Harris

. Speech science primer. Physiology, acoustics, and perception of speech. 5th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2006.

24.

Stone

Lundberg

. Three-dimensional tongue surface shapes of English consonants and vowels. J Acoust Soc Am 1996;99:3728–37.

25.

Logemann

Pauloski

Rademaker

. Speech and swallow function after tonsil/base of tongue resection with primary closure. J Speech Hear Res 1993;36:918–26.

26.

Pittman

Bailey

. Genioglossus and intrinsic electromyographic activities in impeded and unimpeded protrusion tasks. J Neurophysiol 2009;101:276–82.

27.

Laaksonen

Rieger

Happonen

Harris

Seikaly

. Speech after radial forearm free flap reconstruction of the tongue: A longitudinal acoustic study of vowel and diphthong sounds. Clin Linguist Phon 2010;24:41–54.

28.

Palmer

Jaffe

McCulloch

Finnegan

Van Daele

Luschei

. Quantitative contributions of the muscles of the tongue, floor-of-mouth, jaw, and velum to tongue-to-palate pressure generation. J Speech Lang Hear Res 2008;51:828–35.

29.

Robbins

Butler

Daniels

. Swallowing and dysphagia rehabilitation: Translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res 2008;51:S276–S300.

30.

Stål

Marklund

Thornell

De Paul

Eriksson

. Fibre composition of human intrinsic tongue muscles. Cells Tissues Organs 2003;173:147–61.

31.

Miller

Watkin

Chen

. Muscle, adipose, and connective tissue variations in intrinsic musculature of the adult human tongue. J Speech Lang Hear Res 2002;45:51–65.

32.

Eisbruch

Schwartz

Rasch

. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: Which anatomic structures are affected and can they be spared by IMRT?. Int J Radiat Oncol Biol Phys 2004;60:1425–39.