Advertisement

Effect of Dysphonia and Cognitive-Perceptual Listener Strategies on Speech Intelligibility

      ABSTRACT

      There is a high prevalence of dysphonia among professional voice users and the impact of the disordered voice on the speaker is well documented. However, there is minimal research on the impact of the disordered voice on the listener. Considering that professional voice users include teachers and air-traffic controllers, among others, it is imperative to determine the impact of a disordered voice on the listener. To address this, the objectives of the current study included: (1) determine whether there are differences in speech intelligibility between individuals with healthy voices and those with dysphonia; (2) understand whether cognitive-perceptual strategies increase speech intelligibility for dysphonic speakers; and (3) determine the relationship between subjective voice quality ratings and speech intelligibility. Sentence stimuli were recorded from 12 speakers with dysphonia and four age- and gender-matched typical, healthy speakers and presented to 129 healthy listeners divided into one of three strategy groups (ie, control, acknowledgement, and listener strategies). Four expert raters also completed a perceptual voice assessment using the Consensus Assessment Perceptual Evaluation of Voice for each speaker. Results indicated that dysphonic voices were significantly less intelligible than healthy voices (P0.001) and the use of cognitive-perceptual strategies provided to the listener did not significantly improve speech intelligibility scores (P = 0.602). Using the subjective voice quality ratings, regression analysis found that breathiness was able to predict 41% of the variance associated with number of errors (P = 0.008). Overall results of the study suggest that speakers with dysphonia demonstrate reduced speech intelligibility and that providing the listener with specific strategies may not result in improved intelligibility.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Benninger M.S.
        • Holy C.E.
        • Bryston P.C.
        • et al.
        Prevalence and occupation of patients presenting with dysphonia in the United States.
        J Voice. 2017; 31: 594-600
        • Bhattacharyya N.
        The prevalence of voice problems among adults in the U.S.
        Laryngoscope. 2014; 124: 2359-2362
        • Cohen S.M.
        Self-reported impact of dysphonia in a primary care population: an epidemiological study.
        Laryngoscope. 2010; 120: 2022-2032
        • Roy N.
        • Merrill R.M.
        • Thibeault S.
        • et al.
        Voice disorders in teachers and the general population: effects on work performance, attendance, and future career choices.
        J Speech Lang Hear Res. 2004; 47: 542-551
        • Roy N.
        • Merrill R.M.
        • Gray S.D.
        • et al.
        Voice disorders in the general population: prevalence, risk factors, and occupational impact.
        Laryngoscope. 2005; 115: 1988-1995
        • Verdolini K.
        • Ramig L.O.
        Review: occupational risks for voice problems.
        Logop Phoniatr Vocol. 2001; 26: 37-46
        • Titze I.R.
        • Lemke J.
        • Montequin D.
        Populations in the U.S. primary tool of workforce who rely on voice trade: a preliminary report.
        J Voice. 1997; 1: 254-259
        • Williams N.R.
        Occupational groups at risk of voice disorders: a review of the literature.
        Occup Med. 2003; 53: 458-460
        • Korn G.P.
        • Augusto de Lima Pontes A.
        • Abranches D.
        • et al.
        Hoarseness and risk factors in university teachers.
        J Voice. 2015; 29: 518
        • Kyriakou K.
        • Petinou K.
        • Phinikettos I.
        Risk factors for voice disorders in university professors in cyprus.
        J Voice. 2018; 32: 643.e1-643.e9
        • Higgins K.P.
        The Prevalence of Voice Disorders in University Teaching Faculty.
        ([Master's Thesis]) University of Maine, Orono, ME2006
        • Newman C.
        • Kersner M.
        Voice problems of aerobics instructors: implications for preventative training.
        Logoped Phoniatr Vocol. 1998; 23: 177-180
        • Rumbach A.
        • Khan A.
        • Brown M.
        Voice problems in the fitness industry: Factors associated with chronic hoarseness.
        Int J Speech Lang Pathol. 2015; 17 (Epub 2014 Dec 18): 441-450https://doi.org/10.3109/17549507.2014.987820
        • Villar A.C.
        • Korn G.P.
        • Azevedo R.R.
        Perceptual-auditory and acoustic analysis of air traffic controllers' voices pre- and postshift.
        J Voice. 2016; (768.e11–768.e15)
        • Korn G.P.
        • Villar A.C.
        • Azevedo R.R.
        Hoarseness and vocal tract discomfort and associated risk factors in air traffic controllers.
        Braz J Otorinolaryngol. 2018;
        • Roy N.
        • Merrill R.M.
        • Thibeault S.
        • et al.
        Prevalence of voice disorders in teachers and the general population.
        J Speech Lang Hear Res. 2004; 47: 281-293
        • Sliwinska-Kowalska M.
        • Niebudek-Bogusz E.
        • Fiszer M.
        • et al.
        The prevalence and risk factors for occupational voice disorders in teachers.
        Folia Phoniatr Logop. 2006; 58: 85-101
        • Angelillo M.
        • Di Maio G.
        • Costa G.
        • et al.
        Prevalence of occupational voice disorders in teachers.
        J Prev Med Hyg. 2009; 50: 26-32
        • Van Houtte E.
        • Claeys S.
        • Wuyts F.
        • et al.
        The impact of voice disorders among teachers: vocal complaints, treatment-seeking behavior, knowledge of vocal care, and voice-related absenteeism.
        J Voice. 2011; 25 (Epub 2010 Jul 15): 570-575https://doi.org/10.1016/j.jvoice.2010.04.008
        • Lira Luce F.
        • Teggi R.
        • Ramella B.
        • et al.
        Voice disorders in primary school teachers.
        Acta Otorhinolaryngol Ital. 2014; 34: 412-418
        • Rogerson J.
        • Dodd B.
        Is there an effect on dysphonic teachers voices on children's processing of spoken language.
        J Voice. 2004; 19: 47-60
        • Morsomme D.
        • Minell L.
        • Verduyuckt I.
        Impact of teachers’ voice quality on children's language processing skills.
        Vocologie: stem en stemstoornissen. 2011; : 9-15
        • Imhof M
        • Välikoski T-R
        • Laukkanen A-M
        • Orlob K
        Cognition andinterpersonal communication: the effect of voice quality on information processing and person perception.
        Stud Commun Sci. 2014; 14: 37-44
        • Kent R.D.
        • Weismer G.
        • Kent J.F.
        • et al.
        Toward phonetic intelligibility testing in dysarthria.
        J Speech Hear Disord. 1989; 54: 482-499
        • Colton R.
        • Casper J.
        • Leonard R.
        Understanding Voice Problems: A Physiological Perspective for Diagnosis and Treatment.
        3rd ed. Lippincott Williams & Wilkins, Philadelphia2006
        • Hillenbrand J.
        • Cleveland R.A.
        • Erickson R.L.
        Acoustic correlates of breathy vocal quality.
        J Speech Hear Res. 1994; 37: 769-778
        • Keintz C.K.
        • Bunton K.
        • Hoit J.D.
        Influence of visual information on the intelligibility of dysarthric speech.
        Am J Speech Lang Pathol. 2007; 16: 222-234
        • Hustad K.C.
        • Cahill M.A.
        Effects of presentation mode and repeated familiarization on intelligibility of dysarthric speech.
        Am J Speech Lang Pathol. 2003; 12: 198-208
        • Garcia J.
        • Cannito M.
        Influence of verbal and nonverbal contexts on the sentence intelligibility of a speaker with dysarthria.
        J Speech Hearing Res. 1996; 39: 750-760
        • Searl J.P.
        • Carpenter M.A.
        • Banta C.L.
        Intelligibility of stops and fricatives in tracheoesophageal speech.
        J Commun Disord. 2001; 34: 305-321
        • Sitler R.W.
        • Schiavetti N.
        • Metz D.E.
        Contextual effects in the measurement of hearing-impaired speakers' intelligibility.
        J Speech Lang Hear Res. 1983; 26: 30-35https://doi.org/10.1044/jshr.2601.30
        • Metz D.E.
        • Samar V.J.
        • Schiavetti N.
        • et al.
        Whitehead acoustic dimensions of hearing-impaired speakers' intelligibility.
        J Speech Lang Hear Res. 1985; 28: 345-355https://doi.org/10.1044/jshr.2803.345
        • Bender B.
        • Cannito M.P.
        • Murry T.
        • et al.
        Speech intelligibility in severe adductor spasmodic dysphonia.
        J Speech Lang Hear Res. 2004; 47: 21-33
        • Evitts P.M.
        • Starmer H.
        • Teets K.
        • et al.
        The Impact of dysphonic voices on healthy listeners: listener reaction times, speech intelligibility, and listener comprehension.
        Am J Speech Lang Pathol. 2016; 25: 561-575
        • Ishikawa K.
        • Boyce S.
        • Kelchner L.
        • et al.
        The effect of background noise on intelligibility of dysphonic speech.
        J Speech Lang Hear Res. 2017; 60: 1919-1929
        • Jaywant A.
        • Pell M.D.
        Listener impressions of speakers with Parkinson's disease.
        J Int Neuropsychol Soc. 2010; 16: 49-57https://doi.org/10.1017/S1355617709990919
        • Lallh A.K.
        • Rochet A.P.
        The effect of information on listeners’ attitudes toward speakers with voice or resonance disorders.
        J Speech Lang Hear Res. 2000; 43: 782-795
        • Evitts P.M.
        • Gabel R.
        • Searl J.
        Listeners’ perceptions of the personality of male laryngeal speakers.
        Logoped Phoniatr Vocol. 2007; 32: 53-59https://doi.org/10.1080/14015430601105979
        • Blood G.W.
        • Mahan B.W.
        • Hyman M.
        Judging personality and appearance from voice disorders.
        J Commun Disord. 1979; 12: 63-68
        • Blood G.W.
        • Blood I.M.
        A tactic for facilitating social interaction with laryngectomees.
        J Speech Hear Dis. 1982; 47: 416-419
        • Lindblom B.
        On the communication process: speaker-listener interaction and the development of speech.
        Augment Altern Commun. 1990; 6: 220-230
        • Hustad K.C.
        • Beukelman D.R.
        Effects of linguistic cues and stimulus cohesion on intelligibility of severely dysarthric speech.
        J Speech Lang Hear Res. 2001; 44: 497-519
        • Hustad K.C.
        • Beukelman D.R.
        Listener comprehension of severely dysarthric speech: effects of linguistic cues and stimulus cohesion.
        J Speech Lang Hear Res. 2002; 45: 545-558
        • Liss J.M.
        • Spitzer S.
        • Caviness J.M.
        • Adler C.
        • Edwards B.
        Syllabic strength and lexical boundary decisions in the perception of hypokinetic dysarthric speech.
        J Acoust Soc Am. 1998; 104: 2457-2466
        • Liss J.M.
        • Spitzer S.
        • Caviness J.M.
        • Adler C.
        • Edwards B.W.
        Lexical boundary error analysis in hypokinetic and ataxic dysarthria.
        J Acoust Soc Am. 2000; 107: 3415-3424
        • Liss J.M.
        • Spitzer S.
        • Caviness J.M.
        • Adler C.
        The effects of familiarization on intelligibility and lexical segmentation in hypokinetic and ataxic dysarthria.
        J Acoust Soc Am. 2002; 112: 3022-3030
        • Klasner E.R.
        • Yorkston K.M.
        Speech intelligibility in ALS and HD Dysarthria: the everyday listener's perspective.
        J Med Speech Lang Pathol. 2005; 13: 127-139
        • Hustad K.
        • Dardis C.
        • Kramper A.
        Use of listening strategies for the speech of individuals with dysarthria and cerebral palsy.
        Augment Altern Commun. 2011; 27: 5
        • Ramig L.O.
        The role of phonation in speech intelligibility: a review and preliminary data from patients with Parkinson's disease.
        (editor)in: Kent R.D. Intelligibility in Speech Disorders. John Benjamins, Philadelphia, PA1992
        • Linville S.E.
        • Fisher H.B.
        Acoustic characteristics of women's voices with advancing age.
        J Gerontol. 1985; 40: 324-330
        • Kent R.D.
        Reference Manual for Communicative Sciences and Disorders: Speech and Language.
        Pro-Ed, Austin, TX1994
      1. U.S. Bureau of Labor Statistics. https://www.bls.gov/emp/tables/emp-by-detailed-occupation.htm (accessed December 12, 2018).

        • Feistritzer C.E.
        Profiles of teachers in the U.S. 2011.
        National Center for Education Information. 2014 (Retrieved from) (October 8, 2014 (Accessed December 12, 2018))
        • American Speech-Language-Hearing Association
        Guidelines for Audiologic Screening.
        ASHA, Rockville, MD1997
        • Nilsson M.
        • Soli S.D.
        • Sullivan J.A.
        Development of the hearing in noise test for the measurement of speech reception thresholds in quiet and in noise.
        J Acoust Soc Am. 1994; 95: 1085-1099
        • Hustad K.C.
        The relationship between listener comprehension and intelligibility scores for speakers with dysarthria.
        J Speech Lang Hear Res. 2008; 51: 562-573
        • Tjaden K.K.
        • Liss J.M.
        The role of listener familiarity in the perception of dysarthric speech.
        Clin Linguist Phonetics. 1995; 16: 139-154
        • Evitts P.M.
        • Portugal L.
        • Van Dine A.
        • et al.
        Effects of audiovisual information on alaryngeal speech intelligibility.
        J Comm Dis. 2010; 43: 92-104
        • Kempster G.B.
        • Gerratt B.R.
        • Verdolini A.K.
        • et al.
        Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol.
        Am J Speech Lang Pathol. 2009; 18: 124-132
        • Hustad K.C.
        A closer look at transcription intelligibility for speakers with dysarthria: evaluation of scoring paradigms and linguistic errors made by listeners.
        Am J Speech Lang Pathol. 2006; 15: 268-277
        • Mertler C.A.
        • Vannatta R.A.
        Advanced and Multivariate StatisticalMethods: Practical Application and Interpretation.
        2nd ed. Pyrczak, Los Angeles2002
        • Tavakol M.
        • Dennick R.
        Making sense of Cronbach's alpha.
        Int J Med Educ. 2011; : 53-55https://doi.org/10.5116/ijme.4dfb.8dfd
        • Ishikawa K.
        • de Alarcon A.
        • Khosla S.
        • et al.
        Predicting intelligibility deficit in dysphonic speech with cepstral peak prominence.
        Ann Otol Rhinol Laryngol. 2018; 127: 69-78
        • Bless D.M.
        • Hirano M.
        • Feder R.J.
        Videostroboscopic evaluation of the larynx.
        Ear Nose Throat J. 1987; 66: 289-296
        • Kluender K.R.
        • Coady J.A.
        • Kiefte M.
        Sensitivity to change in perception of speech.
        Speech Commun. 2003; 41: 59-69
        • Yanagihara N.
        Significance of harmonic changes and noise components in hoarseness.
        J Speech Lang Hear Res. 1967; 10: 531-541
        • McHenry M.
        An exploration of listener variability in intelligibility judgments.
        Am J Speech Lang Pathol. 2011; 20: 119-123
        • Choe Y.
        • Liss J.
        • Azuma T.
        • et al.
        Evidence of cue use and performance differences in deciphering dysarthric speech.
        J Acoust Soc Am. 2012; 131: EL112-EL118https://doi.org/10.1121/1.3674990
        • Hustad K.C.
        A closer look at transcription intelligibility for speakers with dysarthria: evaluation of scoring paradigms and linguistic errors made by listeners.
        Am J Speech Lang Pathol. 2006; 15: 268-277
        • Turner G.S.
        • Tjaden K.
        Acoustic differences between content and function words in amyotrophic lateral sclerosis.
        J Speech Lang Hear Res. 2000; 43: 769-781
        • Grosjean F.
        • Gee J.P
        Prosodic structure and spoken word recognition.
        Cognition. 1987; 25: 135-155