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Outcome measurements after oral cancer treatment: speech and speech-related aspects—an overview

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Abstract

Introduction

Oral cancer and its surgical treatment impair speech quality by an alteration of the vocal tract. Local size and stage of the tumour as well as surgical and adjuvant treatment modalities have an impact on the functional outcome of patients' speech rehabilitation. It was the aim of this overview to specifiy speech and speech-related aspects as well as to delineate measurement methods of speech outcome in patients with oral cancer by a review of the literature.

Methods

The review is based on a Medline Search on “speech”, “cancer”, “oral cancer”, “malignoma mouth”, “intelligibility”, “formant”, “ultrasound”.

Discussion

In particular, speech intelligibility is inevitable for the social interaction of patients which is highly correlated with the patient's quality of life. However, speech outcome measurement shows a variety of methods without an international standardisation. Additionally, several co-aspects of speech production have to be considered: tongue mobility, voice production, velopharyngeal closure and neural coordination are important influencing factors. Speech assessment is traditionally performed by perceptual methods on a subjective or semi-subjective base. More objective, technical-based methods of speech evaluation are in development and under research.

Purpose

It was the aim of this overview to specify speech and speech-related aspects as well as to delineate measurement methods of speech outcome in patients with oral cancer by a review of the current literature.

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References

  1. Michi K (2003) Functional evaluation of cancer surgery in oral and maxillofacial region: speech function. Int J Clin Oncol 8(1):1–17

    Article  PubMed  Google Scholar 

  2. de Bruijn MJ, ten Bosch L, Kuik DJ, Quené H, Langendijk JA, Leemans CR, Verdonck-de Leeuw IM (2009) Objective acoustic-phonetic speech analysis in patients treated for oral or oropharyngeal cancer. Folia Phoniatr Logop 61(3):180–187

    Article  PubMed  Google Scholar 

  3. Stelzle F, Maier A, Nöth E, Bocklet T, Knipfer C, Schuster M, Neukam FW, Nkenke E (2011) Automatic quantification of speech intelligibility in patients after treatment for oral squamous cell carcinoma. J Oral Maxillofac Surg 69(5):1493–1500

    Article  PubMed  Google Scholar 

  4. Mlynarek AM, Rieger JM, Harris JR et al (2008) Methods of functional outcomes assessment following treatment of oral and oropharyngeal cancer: review of the literature. J Otolaryngol Head Neck Surg 37:2–10

    PubMed  Google Scholar 

  5. Sell D, Grunwell P, Mildinhall S, Murphy T, Cornisch TA, Bearn D, Shaw WC, Murray JJ, Williams AC, Sandy JR (2001) Cleft lip and palate care in the United Kingdom—the Clinical Standards Advisory Group (CSAG) Study. Part 3: speech outcomes. Cleft Palate Craniofac J 38:30–37

    Article  PubMed  CAS  Google Scholar 

  6. Henningsson G, Kuehn DP, Sell D, Sweeney T, Trost-Cardamone JE, Whitehill T (2007) Speech Parameters Group (2008). Universal parameters for reporting speech outcome in individuals with cleft palate. Cleft Palate Craniofac J 45:1–17

    Google Scholar 

  7. Weismer G, Liss JM (1991) Age and speech motor control. In: Ripich D (ed) Handbook of aging and communication. Pro-Ed, Austin, pp 205–226

    Google Scholar 

  8. Linville SE (1996) The sound of senescence. J Voice 10:190–200

    Article  PubMed  CAS  Google Scholar 

  9. Wohlert AB, Smith A (1998) Spatiotemporal stability of lip movements in older adult speakers. J Speech Lang Hear Res 41:41–50

    PubMed  CAS  Google Scholar 

  10. Stelzle F, Ugrinovic B, Knipfer C, Bocklet T, Nöth E, Schuster M, Eitner S, Seiss M, Nkenke E (2010) Automatic, computer-based speech assessment on edentulous patients with and without complete dentures—preliminary results. Oral Rehabil 37(3):209–216

    Article  CAS  Google Scholar 

  11. Lamas Azevedo LF, Zenha H, Rios L, Cunha C, Costa H (2010) Dorsalis pedis free flap in oromandibular reconstruction. Eur J Plast Surg 33:355–359

    Article  Google Scholar 

  12. Windrich M, Maier A, Kohler R, Nöth E, Nkenke E, Eysholdt U, Schuster M (2008) Automatic quantification of speech intelligibility of adults with oral squamous cell carcinoma. Folia Phoniatr Logop 60(3):151–156

    Article  PubMed  CAS  Google Scholar 

  13. Schuster M, Maier A, Haderlein T, Nkenke E, Wohlleben U, Rosanowski F, Eysholdt U, Nöth E (2006) Evaluation of speech intelligibility for children with cleft lip and palate by means of automatic speech recognition. Int J Pediatr Otorhinolaryngol 70(10):1741–1747

    Article  PubMed  Google Scholar 

  14. Schuster M, Maier A, Bocklet T, Nkenke E, Holst A, Eysholdt U, Stelzle F (2012) Automatically evaluated degree of intelligibility of children with different cleft type from preschool and elementary school. Int J Pediatr Otorhinolaryngol 76(3):362–369

    Article  PubMed  Google Scholar 

  15. Michiwaki Y, Schmelzeisen R, Hacki T, Michi K (1992) Articulatory function in glossectomized patients with immediate reconstruction using a free jejunum flap. J Craniomaxillofac Surg 20(5):203–210

    Article  PubMed  CAS  Google Scholar 

  16. Schmelzeisen R, Ptok M, Schönweiler R, Hacki T, Neukam FW (1996) Wiederherstellung der Sprech- und Kaufunktion nach ausgedehnten Tumorresektionen im Kiefer-Gesichtsbereich. Laryngol Rhinol Otol 75:231–238

    Article  CAS  Google Scholar 

  17. Schonweiler R, Altenbernd C, Schmelzeisen R et al (1996) Articulatory capacity and intelligibility of speech of patients with carcinomas of the mouth cavity. A comparison of pre- and postoperative results of various reconstruction techniques. HNO 44:634–639

    Article  PubMed  CAS  Google Scholar 

  18. Seikaly H, Maharaj M, Rieger J, Harris J (2005) Functional outcomes after primary mandibular resection and reconstruction with the fibular free flap. J Otolaryngol 34:25–28

    Article  PubMed  Google Scholar 

  19. Uwiera T, Seikaly H, Rieger J, Chau J, Harris JR (2004) Functional outcomes after hemiglossectomy and reconstruction with a bilobed radial forearm free flap. J Otolaryngol 33(6):356–359

    Article  PubMed  Google Scholar 

  20. Panchal J, Potterton AJ, Scanlon E et al (1996) An objective assessment of speech and swallowing following free flap reconstruction for oral cavity cancers. Br J Plast Surg 49:363–369

    Article  PubMed  CAS  Google Scholar 

  21. Archontaki M, Athanasiou A, Stavrianos SD, Korkolis DP, Faratzis G, Papadopoulou F, Kokkalis G, Rapidis AD (2010) Functional results of speech and swallowing after oral microvascular free flap reconstruction. Eur Arch Otorhinolaryngol 267:1771–1777

    Article  PubMed  Google Scholar 

  22. Mady K, Sader R, Hoole PH, Horch HH (2003) Speech evaluation and swallowing ability after intra-oral cancer. Clin Linguist Phon 17:411–420

    Article  PubMed  CAS  Google Scholar 

  23. Wächter R, Diz Dios P (1993) Einfluss von Adaptions- und Kompensationsmechanismen auf die postoperative Funktion bei Patienten mit Mundhöhlentumoren. Laryngol Rhinol Otol 72:333–337

    Article  Google Scholar 

  24. Diz Dios P, Fernandez Feijoo J, Castro Ferreiro M, Alvarez Alvarez J (1994) Functional consequences of partial glossectomy. J Oral Maxillofac Surg 52:12–14

    Article  PubMed  CAS  Google Scholar 

  25. Paal S, Reulbach U, Strobel-Schwarthoff K, Nkenke E, Schuster M (2005) Evaluation of speech disorders in children with cleft lip and palate. J Orofac Orthop 66(4):27–278

    Article  Google Scholar 

  26. Hsiao HT, Leu YS, Lin CC (2002) Primary closure versus radial forearm flap reconstruction after hemiglossectomy: functional assessment of swallowing and speech. Ann Plast Surg 49:612–616

    Article  PubMed  Google Scholar 

  27. Knuutila H, Pukander J, Määttä T, Pakarinen L, Vilkman E (1999) Speech articulation after subtotal glossectomy and reconstruction with a myocutaneous flap. Acta Otolaryngol 119(5):621–626

    Article  Google Scholar 

  28. Pauloski BR, Logemann JA, Rademaker AW, McConnel FM, Heiser MA, Cardinale S, Shedd D, Lewin J, Baker SR, Graner D et al (1993) Speech and swallowing function after anterior tongue and floor of mouth resection with distal flap reconstruction. J Speech Hear Res 36(2):267–276

    PubMed  CAS  Google Scholar 

  29. Bosman LJ, Fabert JMW, Pruyn JFA, Schmit Jongbloed-ter Pelwijk MA, de Boer MF, Van den Borne HW, de Jong PC, Ryckman RM (1991) Judging speech communication effectiveness in oral cancer patients. J Commun Disord 24:40–50

    Article  PubMed  CAS  Google Scholar 

  30. Brown JS, Zuydam AC, Jones DC, Rogers SN, Vaughan ED (1997) Functional outcome in palate reconstruction using a radial forearm free flap in conjunction with a superiorly based pharyngeal flap. Head Neck 19:524–534

    Article  PubMed  CAS  Google Scholar 

  31. Schiavetti N (1992) Scaling procedures for the measurement of speech intelligibility. In: Intelligibility in speech disorders: theory, measurement and management. Philadelphia: John Benjamins, 11–34

  32. Nishigawa G, Natsuaki N, Maruo Y, Okamoto M, Minagi S (2003) Galvanic skin response of oral cancer patients during speech. J Oral Rehabil 30:522–525

    Article  PubMed  CAS  Google Scholar 

  33. Engel H, Huang JJ, Lin CY, Lam W, Kao HK, Gazyakan E, Cheng MH (2010) A strategic approach for tongue reconstruction to achieve predictable and improved functional and aesthetic outcomes. Plast Reconstr Surg 126:1967–1977

    Article  PubMed  CAS  Google Scholar 

  34. Su W-F, Hsia Y-J, Chang Y-C, Chen S-G, Sheng H (2003) Functional comparison after reconstruction with a radial forearm flap or a pectoralis major flap for cancer of the tongue. Otolaryngol Head Neck Surg 128:412–418

    Article  PubMed  Google Scholar 

  35. Terai H, Shimahara M (2004) Evaluation of speech intelligibility after a secondary dehiscence operation using an artificial graft in patients with speech disorders after partial glossectomy. Br J Oral Maxillofac Surg 42:190–194

    Article  PubMed  Google Scholar 

  36. Furia CLB, Kowalski LP, Latorre MRDO, Angelis EC, Martins NMS, Barros APB, Ribeiro CB (2001) Speech intelligibility after glossectomy and speech rehabilitation. Arch Otolaryngol Head Neck Surg 127:877–883

    PubMed  CAS  Google Scholar 

  37. Bressmann T, Sader R, Whitehill TL, Samman N (2004) Consonant intelligibility and tongue motility in patients with partial glossectomy. J Oral Maxillofac Surg 62(3):298–303

    Article  PubMed  Google Scholar 

  38. Pauloski BR, Logemann JA, Rademaker AW, McConnel FM, Stein D, Beery Q, Johnson J, Heiser MA, Cardinale S, Shedd D et al (1994) Speech and swallowing function after oral and oropharyngeal resections: one-year follow-up. Head Neck 16(4):313–322

    Article  PubMed  CAS  Google Scholar 

  39. Pauloski BR, Rademaker AW, Logemann JA, Colangelo LA (1998) Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients. Otolaryngol Head Neck Surg 118(5):616–624

    PubMed  CAS  Google Scholar 

  40. Pauloski BR, Logemann JA, Colangelo LA, Rademaker AW, McConnel FM, Heiser MA, Cardinale S, Shedd D, Stein D, Beery Q, Myers E, Lewin J, Haxer M, Esclamado R (1998) Surgical variables affecting speech in treated patients with oral and oropharyngeal cancer. Laryngoscope 108(6):908–916

    Article  PubMed  CAS  Google Scholar 

  41. Su WF, Chen SG, Sheng W (2002) Speech and swallowing function after reconstruction with a radial forearm free flap or a pectoralis major flap for tongue cancer. J Formos Med Assoc 101:472–477

    PubMed  Google Scholar 

  42. Borggreven PA, Verdonck-de Leeuw I, Langendijk JA et al (2005) Speech outcome after surgical treatment for oral and oropharyngeal cancer: a longitudinal assessment of patients reconstructed by a microvascular flap. Head Neck 27:785–793

    Article  PubMed  Google Scholar 

  43. Heller KS, Levy J, Sciubba JJ (1991) Speech patterns following partial glossectomy for small tumors of the tongue. Head Neck 13:340–343

    Article  PubMed  CAS  Google Scholar 

  44. Mahanna GK, Beukelman DR, Marshall JA, Gaebler CA, Sullivan M (1998) Obturator prosthesis after cancer surgery: an approach to speech outcome assessment. J Prosthet Dent 79:310–316

    Article  PubMed  CAS  Google Scholar 

  45. Eckardt A, Teltzrow T, Schulze A, Hoppe M, Kuettner C (2007) Nasalance in patients with maxillary defects—reconstruction versus obturation. J Cranio Maxillofac Surg 35:241–245

    Article  Google Scholar 

  46. Seikaly H, Rieger J, Wolfaardt J, Moysa G, Harris J, Jha N (2003) Functional outcomes after primary oropharyngeal cancer resection and reconstruction with the radial forearm free flap. Laryngoscope 113:897–904

    Article  PubMed  Google Scholar 

  47. Zecevíc A (2002) Ein sprachgestütztes Trainingssystem zur Evaluierung der Nasalität. University of Mannheim, Germany

    Google Scholar 

  48. Hosemann W, Göde U, Dunker JE, Eysholdt U (1998) Influence of endoscopic sinus surgery on voice quality. Eur Arch Otorhinolaryngol 255(10):499–503

    Article  PubMed  CAS  Google Scholar 

  49. Murillo Rendón S, Orozco Arroyave JR, Vargas Bonillo JF, Arias Londono JD, Castellanos Dominguez CG (2011) Automatic detection of hypernasality in children. In JM Ferrandez et al.: IWINAC part II, LNCS 6687, pp. 167–174

  50. Kazi R, Prasad VM, Kanagalingam J, Georgalas C, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ (2007) Analysis of formant frequencies in patients with oral or oropharyngeal cancers treated by glossectomy. Int J Lang Commun Disord 42(5):521–532

    Article  PubMed  Google Scholar 

  51. Morrish L (1984) Compensatory vowel articulation of the glossectomee: acoustic and videofluorscopic evidence. Br J Disord Commun 19:123–134

    Article  Google Scholar 

  52. Whitehill T, Chiocca V, Chan JC, Samman N (2006) Acoustic analysis of vowels following glossectomy. Clin Linguist Phon 20(2–3):136–140

    Google Scholar 

  53. Cavalho-Teles C, Ubirajara Sennes L, Gielow I (2008) Speech evaluation after palatal augmentation in patients undergoing glossectomy. Arch Otolaryngol Head Neck Surg 134(10):1066–1070

    Article  Google Scholar 

  54. Zimmermann A, Sader R, Hoole P, Bressmann P, Mady K, Horch HH (2003) The influence of oral cavitiy tumour treatment on voice quality and on fundamental frequency. Clin Linguist Phon 17(4–5):273–281

    Article  PubMed  Google Scholar 

  55. Sharp P, Kelly S, Main A, Manley G (1999) An instrument for the multiparameter assessment of speech. Med Eng Phys 21:661–671

    Article  PubMed  CAS  Google Scholar 

  56. Wuyts FL, De Bodt MS, Molenberghs G, Remacle M, Heylen L, Millet B, Van Lierde K, Raes J, Van de Heyning PH (2000) The dysphonia severity index: an objective measure of vocal quality based on a multiparameter approach. J Speech Lang Hear Res 43(3):796–809

    PubMed  CAS  Google Scholar 

  57. Schliephake H, Schmelzeisen R, Schonweiler R et al (1998) Speech, deglutition and life quality after intraoral tumour resection. A prospective study. Int J Oral Maxillofac Surg 27:99–105

    Article  PubMed  CAS  Google Scholar 

  58. Borggreven PA, Verdonck-de Leeuw IM, Muller MJ et al (2007) Quality of life and functional status in patients with cancer of the oral cavity and oropharynx: pretreatment values of a prospective study. Eur Arch Otorhinolaryngol 264:651–657

    Article  PubMed  Google Scholar 

  59. Kamstra JI, Jager-Wittenaar H, Dijkstra PU, Huisman PM, van Oort RP, van der Laan BF et al (2011) Oral symptoms and functional outcome related to oral and oropharyngeal cancer. Support Care Cancer 19:1327–1333

    Article  PubMed  Google Scholar 

  60. ogers SN, Lowe D, Patel M, Brown JS, Vaughan ED (2002) Clinical function after primary surgery for oral and oropharyngeal cancer: an 11-item examination. Br J Oral Maxillofac Surg 40:1–10

    Article  PubMed  CAS  Google Scholar 

  61. Chuang HC, Su CY, Jeng SF, Chien CY (2007) Anterior lateral thigh flap for buccal mucosal defect after resection of buccal cancer. Otolaryngol Head Neck Surg 137:632–635

    Article  PubMed  Google Scholar 

  62. Landes CA, Kovacs AF (2003) Nine-year experience with extended use of the commissure-based buccal musculomucosal flap. Plast Reconstr Surg 111:1029–1039

    Article  PubMed  Google Scholar 

  63. Imai T, Michi K (1992) Articulatory function after resection of the tongue and floor of the mouth: palatometric and perceptual evaluation. J Speech Hear Res 35:68–78

    PubMed  CAS  Google Scholar 

  64. Yoshioka F, Ozawa S, Sumita YI, Mukohyama H, Taniguchi H (2004) The pattern of tongue pressure against the palate during articulating glossal sounds in normal subjects and glossectomy patients. J Med Dent Sci 51(1):19–25

    PubMed  Google Scholar 

  65. Fletcher SG (1988) Speech production following partial glossectomy. J Speech Hear Disord 53:232–238

    PubMed  CAS  Google Scholar 

  66. Wakumoto M, Ohno K, Imai S, Yamashita Y, Akizuki H, Michi KI (1996) Analysis of the articulation after glossectomy. J Oral Rehabil 23(11):764–770

    Article  PubMed  CAS  Google Scholar 

  67. Lewandowski L (2006) Palatograms and linguograms for studying misarticulation following surgery for tumors of the tongue and oral cavity floor. Ann Acad Med Stetin 52(Suppl 3):13–16

    PubMed  Google Scholar 

  68. Hamlet SL, Mathog RH, Patterson RL, Fleming SM (1990) Tongue mobility in speech after partial glossectomy. Head Neck 12:210–217

    Article  PubMed  CAS  Google Scholar 

  69. Georgian DA, Logemann JA, Fisher HB (1982) Compensatory articulation patterns of a surgically treated oral cancer patient. J Speech Hear Disord 47:154–159

    PubMed  CAS  Google Scholar 

  70. Bressmann T, Flowers H, Wong W, Irish JC (2010) Coronal view ultrasound imaging of movement in different segments of the tongue during paced recital: findings from four normal speakers and a speaker with partial glossectomy. Clin Linguist Phon 24:589–601

    Article  PubMed  Google Scholar 

  71. Bressmann T, Ackloo E, Heng CL, Irish JC (2007) Quantitative three-dimensional ultrasound imaging of partially resected tongues. Otolaryngol Head Neck Surg 136:799–805

    Article  PubMed  Google Scholar 

  72. Rastadmehr O, Bressmann T, Smyth R, Irish JC (2008) Increased midsagittal tongue velocity as indication of articulatory compensation in patients with lateral partial glossectomies. Head Neck 30:718–726

    Article  PubMed  Google Scholar 

  73. Buchaillard S, Brix M, Perrier P, Payan Y (2007) Simulations of the consequences of tongue surgery on tongue mobility: implications for speech production in post-surgery conditions. Int J Med Robot 3:252–261

    Article  PubMed  Google Scholar 

  74. Nicoletti G, Soutar DS, Jackson MS et al (2004) Objective assessment of speech after surgical treatment for oral cancer: experience from 196 selected cases. Plast Reconstr Surg 113:114–125

    Article  PubMed  Google Scholar 

  75. Haderlein T, Nöth E, Toy H, Batliner A, Schuster M, Eysholdt U, Hornegger J, Rosanowski F (2007) Automatic evaluation of prosodic features of tracheoesophageal substitute voice. Eur Arch Otorhinolaryngol 264(11):1315–1321

    Article  PubMed  Google Scholar 

  76. Maier A, Hönig F, Bocklet T, Nöth E, Stelzle F, Nkenke E, Schuster M (2009) Automatic detection of articulation disorders in children with cleft lip and palate. J Acoust Soc Am 126(5):2589–2602

    Article  PubMed  Google Scholar 

  77. Botinhao CV (2009) Speech classification for sigmatism in children. Friedrich-Alexander-University Erlangen-Nürnberg

  78. Wilpon JG, Jacobsen CN (1996) A study of speech recognition for children and the elderly. Proc. of ICASSP, pp 349–352

  79. Bocklet T, Riedhammer K, Nöth E, Eysholdt U, Haderlein T (2012) Automatic intelligibility assessment of speakers after laryngeal cancer by means of acoustic modeling. J Voice 26(3):390–397

    Article  PubMed  Google Scholar 

  80. Bocklet T, Haderlein T, Hönig F, Rosanowski F, Nöth E (2009) Evaluation and assessment of speech intelligibility on pathologic voices based upon acoustic speaker models. Proceedings of the 3rd advanced voice function assessment international workshop (3rd advanced voice function assessment international workshop), pp. 89–92, ISBN 978-84-95227-65-2

  81. Peppé SJE (2009) Why is prosody in speech-language pathology so difficult? Int J Speech Lang Pathol 11(4):258–271

    Article  Google Scholar 

  82. Kitzing P, Maier A, Ahlander VL (2009) Automatic speech recognition (ASR) and its use as a tool for assessment or therapy of voice, speech, and language disorders. Logop Phoniatr Vocol 34(2):91–96

    Article  Google Scholar 

  83. Van Nuffelen G, Middag C, De Bodt M, Martens JP (2009) Speech technology-based assessment of phoneme intelligibility in dysarthria. Int J Lang Commun Disord 44(5):716–730

    Article  PubMed  Google Scholar 

  84. Maier A, Haderlein T, Nöth E, Rosanowski F, Eysholdt U, Schuster M (2008) Visualisierung der Differenzierung von Stimm- und Sprechbefunden In: Gross, M.; am Zehnhoff-Dinnesen, A. (Eds.) Aktuelle phoniatrische Aspekte 2008 Vol. 16 Mönchengladbach : rheinware Verlag, pp. 191–192 - ISBN 978-3-938975-31-2

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Schuster, M., Stelzle, F. Outcome measurements after oral cancer treatment: speech and speech-related aspects—an overview. Oral Maxillofac Surg 16, 291–298 (2012). https://doi.org/10.1007/s10006-012-0340-y

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