71-7386 ALEO, Edward Louis, 1944- ASAI SPEECH AS COMPARED TO ESOPHAGEAL SPEECH AND THE SPEECH PRODUCED BY FIVE ARTIFICIAL LARYNGES. The Ohio State University, Ph.D. , 1970 Speech Pathology University Microfilms, Inc., Ann Arbor, Michigan Copyright by Edward Louis Aleo 1971 ASAI SPEECH AS COMPARED TO ESOPHAGEAL SPEECH AND THE SPEECH PRODUCED BY FIVE ARTIFICIAL LARYNGES A DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Edward Louis Aleo, B.S., M.A. The Ohio State University 1970 Approved by Advi sar Department pr Speech ACKNOWLEDGMENTS To cite each and every person who has contributed and helped make this study possible would take pages equal in number to this dissertation. The author expresses his most sincere thanks and gratitude to the laryngectomized patients who provided the recordings and to ray fellow students and friends who so graciously donated their time as listeners and judges. Acknowledgment is given to Dr. Gordon Monteith and his assistants, of the College of Dentistry, for their craftsman­ ship and help in designing and perfecting the prosthesis for the Tait Oral Vibrator. Also, acknowledgment is given to Mr. Marshall Duguay of The Department of Speech and Hearing at the State University College in Buffalo, New York, for his encouragement and loan of the various artificial devices employed in this study. Appreciation for the reproduction of various drawings used to illustrate significant aspects of this study is ex­ tended to Mrs. Sheila Greenawald. Indebtedness to Dr. Buth Beckey Irwin for her close and most constructive supervision of this study is hereby acknowledged.. A very special thanks is directed to my parents Mr. and ii Mrs. Joseph P. Aleo and my brothers Tom and Joe for their consistent encouragement and backing throughout my endeavors to obtain and complete my formal education. There isn’t a word that encompasses or can describe my appreciation for the patience, help, guidance, companionship, and love of the one person, my wife Sue, who has been my motivation and most important single factor in the completion of my graduate program. Acknowledgment, love and welcome are extended to our son, Edward Louis, for his arrival (six days late) on August 11, 1970. iii VITA Personal Born in Rochester, New York, March 8, 19^4. Married to Sue Ann (Peeler) Aleo, June 10, 196?• Children: Edward Louis Aleo, Jr., born August 11, 1970* Academic Degrees B.S. Idaho State University 1966 Speech Pathology and Audiology M.A. The Ohio State University 1968 Speech and Hearing Science Training and Professional Experience The Ohio State University 1966 V.R.A. Traineeship; Diagnosis and treat­ ment of speech and hearing disorders The Ohio State University 1967 Research Associate, Project LIFE; con­ struct program material to be used in teaching the deaf The Ohio State University 1968 American Cancer to Society Fellow; present Supervisor, The Laryngectomy Clinic Elmira College June, Director of Speech 1970 and Hearing Clinic, Elmira College, Elmira, New York iv VITA - Continued• Research - Unpublished An Exploratory Study Investigating Three Modalities of Constructed Response of Programmed Language Material for the Hearing Impaired Child The Effects of Delayed Side tone on the Duration of the Speech of the Cerebral Palsy and Non-Cerebral Palsy Speakers. M.A. Thesis, 19o8. v TABLE OF CONTENTS Page ACKNOWLEDGMENTS ................................... ii VITA . ......................................... iii CHAPTER I. INTRODUCTION ............................. 1 Statement of The Problem ................ 3 Definition of Terras .................... 4 Organization of S t u d y .................. 5 II. REVIEW OF LITERATURE ..................... 6 Incidence ..... .................... 6 Diagnoses and Classifications ...... 10 T r e a t m e n t .............................. 11 Physiology of Esophageal Speech ..... 11 Types of Speech .................. 12 Methods of Air I n t a k e .................. 12 Esophageal Speech Production ............ 14 Factors Influencing Intelligibility of Speech .......................... 15 Alaryngeal Speech . ................ 17 S u m m a r y ................................ 22 III. METHODS AND PROCEDURES................... 23 Experimental Speakers..... ........... 23 Selection of Listeners ..... 24 Recording Procedures .................... 25 Recording of The D a t a .................. 26 Summary ...... 27 IV. RESULTS AND DISCUSSION................... 2b The Mull Hypotheses . ................. 2b Statistical Treatment..... ........... 29 Analyses of D a t a ........................ 30 S u m m a r y .................. 41 vi Page CHAPTER V. SUMMARY AND CONCLUSIONS............ 42 The Null Hypotheses ....... ...... 42 Results ......... .................... 43 Conclusions........................ 46 Implications for Further Investigation. 47 BIBLIOGRAPHY ................................... 4S APPENDICES .................................... 54 Appendix A ............................ 55 Appendix B ............................ ...... 5y vii LIST OP TABLES Table Page I. Smoking Habits of Sixty-four Patients Diagnosed as Having Laryngeal Carcinoma 8 II. Age and Incidence of Sixty-four Patients Diagnosed as Having Laryngeal Carcinoma 9 III. The Type I Analysis of Variance for Seven Treatments and Three Groups of Judges . 33 IV. The Type I Analysis of Variance for Seven Treatments and Three Groups of Judges . 3^ V. Newman-Keuls Critical Difference Test for the Multiple-Choice Intelligibility Tests . ............ 37 V I . Newman-Keuls Critical Difference Test for the Seven-Point Hating Scale . 38 viii LIST OF FIGURES Figure Page I. Occurrence of Carcinoma of the Larynx in Various Decades of L i f e .......... 9 II. Mucosal Tunnel in the Conley Operation . 21a III. Asai, Three Stage O p e r a t i o n ........... 21b ix CHAPTER I INTRODUCTION The voice is one of the essential assets to the communi­ cative and social processes. Due to a sharp increase in the incidence of cancer of the larynx, a keener understanding of methods of speech rehabilitation for the laryngectomized patient is needed. The method chosen should allow immediate attention to restoring the patient to pre-operative economic, social, and psychological status as quickly as possible. It has been stated by Creech (1966), Levin (1952, 1967), and Lauder (1969) that of the methods available to the laryn­ gectomee, esophageal speech is the most desirable method of communication. Hyman (1955) found that there was no signif­ icant difference in the scores obtained on Blackfs (1957) Multiple-Choice Intelligibility Tests between esophageal speech and speech when an artificial larynx was used. In another study, McCroskey and Mulligan (1963) found that naive listeners obtained higher intelligibility scores for users of the artificial larynx than for esophageal speakers. These results were in opposition to the experiences of the speech therapists, who found esophageal speech to be significantly more intelligible than when an artificial larynx was used. The authors noted that the speech pathologists may have been influenced by professional training or bias. Lauder (1968, 1969) emphasized that esophageal speech was the best method of communication available to the laryn­ gectomee. In 1970, Lauder published an article in which he was less emphatic about teaching esophageal speech. The immediate need for vocal rehabilitation for the speechless laryngectomee was stressed as being of the utmost importance. In addition to the economic and social demands to speak, in time of emergency the speech produced with the aid of an artificial larynx is immediate and adequate. In reviewing the literature, there was no statistical data available indicating that the use of the artificial larynx interferes with learning esophageal speech. The early employment of the artificial larynx may lessen the anxiety and frustration of not being able to communicate readily; moreover, the artificial larynx may even aid the laryn­ gectomee in the learning of esophageal speech by producing a more relaxed and less demanding learning atmosphere. Duguay (1968) studied the intelligibility of seven different artificial larynxes and esophageal speech. He con­ cluded that esophageal speech was significantly more intelli­ gible than the artificial devices used. It was noted that the Super Aurex Electrolarynx and Cooper-Hand Artificial Speech Aid were considered adequate equipment in introducing a laryngectomee to artificial speech aids. Since many authors (Duguay, 1968; Lauder, 1968, 1969; and Levin, 1952, 1967) have found esophageal speech to be superior, it may be reasonable to suspect that intelligi­ bility of various artificial aids, esophageal speech, and Asai speech (Miller, 1967, 1968) may warrant further investi­ gation. If Asai speech is judged to be more intelligible than other methods of alaryngeal speech, or one artificial device is judged to be more intelligible than others, then it may be important information in deciding the course of speech rehabilitation for the laryngectomized patient. Statement of the Problem The purpose of this study was to investigate the intelligibility of seven different methods of producing alaryngeal speech as evaluated by various listeners on cer­ tain listening tasks. The specific questions proposed for study were as follows: 1. Do intelligibility scores of various types of alaryngeal speech differ when measured by Black's Multiple- Choice Intelligibility