伦巴底效应在改善咽喉语言中的作用外文文献

The use of the Lombard Effect in Improving Alaryngeal Speech Manwa L Ng Pokfulam Hong Kong Summary Objective The present study examined and compared the Lombard effect among laryngeal and alaryngeal speakers including esophageal tracheoesophageal pneumatic artifi cial laryngeal electrolaryngeal speakers of Cantonese The subsequent change in intelligibility was also examined Methods A total of 52 native Cantonese speaking laryngeal and alaryngeal speakers 10 laryngeal 8 laryngeal 13 electrolaryngeal 11 esophageal and 10 tracheoesophageal participated in a reading task involving three 10 syllable Cantonese sentences under 10 background conditions quiet 60 dB 65 dB 70 dB 75 dB 80 dB 85 dB 90 dB 95 dB and 100 dB white background noise Speech intelligibility associated with speaking conditions were evaluated by fi ve na ve Cantonese speakers Results Output intensity was signifi cantly increased in all speaker types under all nine noisy background condi tions when compared with the quiet condition However the amount of increase was different for different modes of phonation In addition signifi cant difference in speech intelligibility between laryngeal and alaryngeal speakers was found at all conditions but not among any alaryngeal speech Discussion and conclusion The Lombard refl ex is still present after total laryngectomy Yet different alaryngeal speech was associated with different amount of loudness change and subsequent improvement in intelligibility was not observed Key Words Lombard effect Cantonese Alaryngeal speech INTRODUCTION When other intervention options fail total laryngectomy is often used as a salvage surgery for late stage mainly stages 3 and 4 laryngeal cancer The procedure removes the entire pathological larynx during which the voice box is severed and the pharyngeal conduit is reconstructed 1 4With the loss of their phonatory apparatus laryngeal cancer survivors suffer the inability to speak again To regain verbal communication they have to learn to use an alternative speaking method This is why alaryngeal speech training constitutes an important part of postlaryngectomy rehabilitation To date four alaryng eal speaking methods are available which are grouped as internal and external depending on the new sound source External alaryngeal speech include speaking with an electrolar ynx EL electronic voice box and pneumatic artifi cial PA larynx while internal alaryngeal speech include esophageal SE and tracheoesophageal TE speech eg ref2 EL speech relies on a hand held battery operated device known as the EL to speak During EL speech the plastic membrane of the EL vibrates and the sound generated is transmitted into the vocal tract through neck tissue for reso nance In PA speech sound is generated by vibrating the elastic reed inside the hand held pneumatic device using air exhaled from the lungs in a way similar to plugging a thick rubber band Sound is then propagated in the vocal tract along a straw like tubing placed per orally for resonance and articulation of various speech sounds 2 3 Both SE and TE speech make use of the pharyngoesopha geal PE segment known as the neoglottis as the new sound source The PE segment is formed by muscle fi bers of the cri copharyngeus inferior pharyngeal constrictor and the upper esophagus 5To prepare for SE speech air is injected or inhaled into the upper esophagus When speaking air is expelled from the esophagus which sets the neoglottis into vibration Mean while in TE speech pulmonary air is directed into esophagus just underneath the neoglottis via a unidirectional prosthesis TE valve fi tted in the TE fi stula 5 With the use of a new sound source even superior alaryng eal speakers still lack a good control over the new phonatory apparatus for loudness and pitch control often resulting in a compromised voice quality and intelligibility regardless of type of alaryngeal speech Signifi cant acoustical and percep tual differences between different alaryngeal and laryngeal speech have been reported eg ref3 6 16 In particular vocal loudness associated with different alaryngeal speech has been found to differ from laryngeal speech For example SE speech has been reported to be approximately 6 10 dB softer than NL speech eg ref14 17 21 Comparable results were also found for Cantonese and Mandarin esophageal speak ers 7 10In addition EL speech exhibited a reduced loudness despite such loudness is dependent of the device Due to the absorptive nature of neck tissue loudness of EL speech never exceeds that of NL speech 10The reduced loudness in SE and EL has been attributed to the limited air reservoir in SE and the great attenuation of acoustic energy of neck tissue in EL speakers Meanwhile TE speakers were able to speak with a suffi ciently loud voice sometimes even louder than laryngeal speakers eg ref14 The difference in vocal loudness between Accepted for publication July 8 2019 Funding This study was supported by the Education Faculty Research Fund of the Faculty of Education University of Hong Kong 200007679 From the Speech Science Laboratory Division of Speech and Hearing Sciences University of Hong Kong Pokfulam Hong Kong Address correspondence and reprint requests to Manwa L Ng 759 Meng Wah Com plex University of Hong Kong Pokfulam Hong Kong E mail manwa hku hk Journal of Voice Vol 135 831 837 2 Ng M Kwok CLI Chow SFW Speech performance of adult Canton ese speaking laryngectomees using different types of alaryngeal phona tion J Voice 1997 11 338 344 3 Ng M Xiong MY Chinese alaryngeal speech rehabilitation and their acoustical characteristics a comprehensive review Rehabil Med 2015 25 44 49 4 Ward EC van As Brooks CJ Head and Neck Cancer Treatment Rehabilitation and Outcomes San Diego Plural Publishing 2007 5 Ng ML Aerodynamic characteristics associated with oesophageal and tracheoesophageal speech of Cantonese Int J Speech Lang Pathol 2011 13 137 144 6 Filter MD Hyman M Relationship of acoustic parameters and per ceptual ratings of 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