Klaske van Sluis

Summary 163 tracheoesophageal speakers using speech samples that were recorded with at least seven years in between. Intelligibility and voice quality are perceptually evaluated by ten experienced speech and language pathologists. In addition, automatic speech evaluations are performed with tools from Ghent University as well as AVQI. No statistical significant group effect was found for changes in voice quality and intelligibility. The results show a wide inter-speaker variabil- ity. Perceptual ratings show a high variation for the perceptual ratings by the speech language pathologists. Tools for automatic evaluation of voice quality and intelligibility correlated strongly, these tools are promising for analyzing trends within individual speakers over time. We can conclude that intelligibility and voice quality of tracheoesophageal speech is mostly stable over a period of seven to 18 years. In Chapter 6 we present the results of a worldwide survey assessing func- tional and participation issues after total laryngectomy. A questionnaire was sent out to 8119 recipients of whom 1705 (21%) responded. The question- naire included 26 questions, including demographic information and regarding medical product use of the respondents, their experienced overall health and independence, and functional and participation issues. For the analysis, respon- dents are grouped based on sex, age, time since total laryngectomy, educational level, and country of residence. Questions are grouped in a measure of reported- Quality of Life (r-QoL) and seven issue themes (esthetic issues, experienced limitations in daily activities, avoiding social activities, communication issues, experienced vulnerability due to environmental factors, pulmonary issues and sleep issues) which allowed us to assess the underlying relations. The outcomes of the study show that a higher amount of functional and participation issues and a lower r-QoL was reported in the group of younger respondents (<60yrs), women, and respondents who have had the total laryngectomy procedure less than two years ago. The ability to participate in meaningful and social activ- ities was a major factor determining r-QoL. A strong correlation was found between pulmonary issues and most other themes. Pulmonary issues might be an underlying cause of many other issues and therefore negatively influence r-QoL. We have investigated the effect of an Expiratory Muscle Strength Train- ing (EMST) program in Chapter 7 . EMST is a threshold based device-driven treatment for improving expiratory pressure and cough function in order to diminish pulmonary complaints. Ten male participants who had undergone total laryngectomy were included. For this pilot study we aimed to examine feasibility, safety, and compliance of the EMST training program. Objective and subjective outcome measures included manometry, spirometry, cardio pul- monary exercise testing, voice recordings, and patient reported outcome mea- sures. Nine participants completed the full study protocol. Compliance to the training program was high. All were able to perform the training, although it requires adjustments of the device and skills of the participants. The results show that maximum expiratory pressure (MEP) and vocal functioning in loud- ness improve over time. After EMST, no changes were seen in other objective