Klaske van Sluis

General introduction 11 Figure 1.4: Schematic drawing of electrolarynx speech. The electrolarynx is placed against the neck, the generated sound transmitted through the tissue into the mouth and articulated into speech. in voice and speech, the total laryngectomy procedure leads to lifelong changes in physical, psychological and social functioning. The surgical procedure leads to changes in respiration, swallowing, olfaction, and general health. This can severely impact the patients’ normal daily functioning and their general well- being. 1.6 Multidimensional analysis of voice and speech To evaluate voice and speech it is recommended to perform a multidimensional analysis, which evaluates both objective and subjective aspects. Multidimen- sional analysis of voice and speech includes analysis of perceptual, acoustic, and patient-reported outcome measures (PROM) [22]. Substitute voices are generally characterized by strong irregular voice quality compared to healthy speakers; therefore, a well-thought-out approach is required to evaluate substi- tute speech [23]. 1.6.1 Perceptual analysis Perceptual evaluation includes standardized listening experiments. As commu- nication is mostly a perceptual matter, auditory-perceptual evaluations are considered as the “gold standard”. For laryngeal voices perceptual evaluation