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Eadie Et Al. 2021 AJSLP Research Article Effect of Noise on Speech Intelligibility and Perceived Listening Effort in Head and Neck Cancer Tanya L. Eadie,a Holly Durr,a Cara Sauder,a Kathleen Nagle,b Mara Kapsner-Smith,a and Kristie A. Spencera Purpose: This study (a) examined the effect of different levels Results: Significant Group × Noise interactions were found of background noise on speech intelligibility and perceived for speech intelligibility and perceived listening effort. While listening effort in speakers with impaired and intact speech no differences in speech intelligibility were found between following treatment for head and neck cancer (HNC) and the speaker groups in quiet, the results showed that, as (b) determined the relative contribution of speech intelligibility, the signal-to-noise ratio decreased, speakers with intact speaker group, and background noise to a measure of speech (HNC control) performed significantly better (greater perceived listening effort. intelligibility, less perceived listening effort) than those with Method: Ten speakers diagnosed with nasal, oral, or speech imprecisions in the two noise conditions. Perceived oropharyngeal HNC provided audio recordings of six sentences listening effort was also shown to be associated with from the Sentence Intelligibility Test. All speakers were 100% decreased speech intelligibility, imprecise speech, and intelligible in quiet: Five speakers with HNC exhibited mild increased background noise. speech imprecisions (speech impairment group), and five Conclusions: Speakers with HNC who are 100% intelligible speakers with HNC demonstrated intact speech (HNC control in quiet but who exhibit some degree of imprecise speech group). Speech recordings were presented to 30 inexperienced are particularly vulnerable to the effects of increased listeners, who transcribed the sentences and rated perceived background noise in comparison to those with intact speech. listening effort in quiet and two levels (+7 and +5 dB SNR) of Results have implications for speech evaluations, counseling, background noise. and rehabilitation. ne of the most significant difficulties experienced speech may lead to social isolation and may affect relation- by individuals diagnosed and treated for head ships, the ability to return to work, and quality of life O and neck cancer (HNC) relates to deficits in ver- (Dwivedi et al., 2009). As a result, speech outcomes are im- bal communication. When cancer involves the oral cavity, portant for measuring the impact and success of HNC treat- nasal cavity, and/or the pharynx, the tumor and/or the ment and for providing directions for follow-up care. treatment may alter the structure, strength, range of mo- Traditional methods of assessing speech after HNC tion, and/or precision of the articulators. Difficulties with include both objective and subjective methods. Objective speech measures often include acoustic and physiological measures, whereas subjective measures may include percep- aDepartment of Speech and Hearing Sciences, University of tual judgments made by clinicians, as well as patient-reported Washington, Seattle outcomes. One additional method for assessing the impact bDepartment of Speech-Language Pathology, Seton Hall University, of a speech disorder includes judgments made by unfamiliar South Orange, NJ communication partners. These measures typically include Correspondence to Tanya L. Eadie: [email protected] auditory–perceptual ratings of speech intelligibility or accept- Portions of this paper were presented at the Conference on Motor ability (Doyle & Eadie, 2005). Speech, February 20–23, 2020, Santa Barbara, CA. While measures of speech intelligibility may provide Editor-in-Chief: Deanna Britton important information about the severity of a speech defi- Editor: Jessica E. Huber cit secondary to HNC, the degree of speech signal disruption Received May 26, 2020 perceived by the listener may differ from the cognitive effort Revision received August 13, 2020 needed to complete this processing. In addition, real-life Accepted September 22, 2020 https://doi.org/10.1044/2020_AJSLP-20-00149 Publisher Note: This article is part of the Special Issue: Select Papers Disclosure: The authors have declared that no competing interests existed at the time From the 2020 Conference on Motor Speech. of publication. American Journal of Speech-Language Pathology • 1–14 • Copyright © 2021 American Speech-Language-Hearing Association 1 Downloaded from: https://pubs.asha.org Kathleen Nagle on 02/25/2021, Terms of Use: https://pubs.asha.org/pubs/rights_and_permissions communication exchanges are often not performed in quiet for voice and speech were not reached for individuals who environments. The effect of background noise is particularly had undergone chemoradiation protocols, even in the long important to understand because it not only impacts com- term. All of these types of treatments must be considered municative exchanges in typical speakers, but there is prelimi- when developing assessment protocols and identifying indi- nary evidence to show that it might differentially penalize viduals who could benefit from rehabilitation. those with other types of speech disorders (Chiu & Neel, It is clear that speech intelligibility may be affected 2020; Ishikawa et al., 2017; McAuliffe et al., 2009). This in many patients with HNC beyond laryngeal cancer and factor must be considered when interpreting the meaning- total laryngectomy and that long-term performance may fulness of any outcome measure in individuals with speech be widely variable. While measures of speech intelligibility disorders. are important for capturing the severity of a speech disor- der, they may be limited. For example, consider a speaker who has undergone HNC treatment who is 100% intelligi- Speech Intelligibility in HNC ble but who may have some residual speech imprecisions The most common measure of speech performance (e.g., distortions of phonemes). While a communication in individuals treated for HNC includes ratings of speech partner may be able to understand all of the words in a con- intelligibility performed by listeners, such as unfamiliar com- versation with this individual, the intelligibility score may munication partners (Dwivedi et al., 2009). Speech intelligi- not reflect the amount of work the listener expends (or bility has been defined as “thedegreetowhichthespeaker’s perceives to expend) when deciphering the message. That intended message is recovered by the listener” (Kent et al., burden is better captured by another measure: perceived 1989, p. 484). Similar to approaches used in dysarthria, speech listening effort. intelligibility after HNC is typically measured using tran- scription to determine a percentage of recognizable words within a speech sample (Constantinescu et al., 2017), per- Perceived Listening Effort in HNC ceived severity using rating scales (Borggreven et al., 2005), Listening effort is considered an umbrella term for or speech recognition software (Windrich et al., 2008). two types of effort. Processing effort corresponds with the Studies examining the speech intelligibility of patients objective extent to which processing resources are con- with HNC often include participants with specific tumor sumedtoaccomplishataskand is measured instrumen- sites or they focus on outcomes related to specific treat- tally (Pichora-Fuller et al., 2016). On the other hand, ments, such as surgical approaches or chemoradiation proto- perceived listening effort is the term used for “subjective esti- cols (Dwivedi et al., 2009; Jacobi et al., 2010). While many mates of how taxing a listening task is or was” (Lemke & studies have documented the effect of total laryngectomy Besser, 2016, p. 77S) and is fundamentally measured through (secondary to laryngeal cancer) on speech intelligibility and questionnaires or perceptual rating scales. Perceived listening other related outcomes (e.g., Eadie et al., 2016; Holley et al., effort may be a stronger indicator of communicative success 1983), fewer studies have investigated the effects in other than speech intelligibility, in that it may involve consideration types of HNC or other treatments for HNC beyond total of the speech signal, the listener, and even interactions be- laryngectomy (Dwivedi et al., 2009). Across these studies, tween them (Olmstead et al., 2020; Pichora-Fuller et al., results indicate that there is wide variability in speech 2016). Examining relationships between intelligibility and performance. perceived listening effort and other factors that contribute General trends indicate that intelligibility is typically to perceived listening effort is therefore important for under- higher preceding treatment of HNC, followed by a decline standing communicative success in individuals with speech after treatment, which is then usually followed by long-term disorders. improvement after approximately 1 year (Jacobi et al., 2010). The majority of research on perceived listening effort For example, patients with oral cancer treated using surgical has focused on how hearing loss affects communication resection of the tongue with or without a free flap inevitably (McGarrigle et al., 2014; Pichora-Fuller et al., 2016). How- show a reduction in speech intelligibility because of the ever, the usefulness of perceived listening effort as an important role the anterior portion of the tongue plays in outcome measure has also been highlighted in studies inves- articulatory precision (Hutcheson & Lewin, 2013). Single- tigating outcomes
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