Invitational Round Table
“Evidence-based Voice and Speech Rehabilitation in Head and Neck Cancer”

Amsterdam, The Netherlands
May 15-16, 2008

Oral and Oropharyngeal Cancer: Speech Outcomes and the Need to Monitor Change Over Time

Philip C. Doyle

Voice Production and Perception Laboratory, Department of Otolaryngology and Reconstructive Surgery, Schulich School of Medicine and Dentistry, Doctoral Program in Rehabilitation Sciences, and Communication Sciences and Disorders, University of Western Ontario, London, ON, Canada

Objectives: Despite the long history of surgery as the primary treatment for cancer of the oropharyngeal structures, a relative paucity of information on speech outcomes currently exists. While the importance of this voice and speech performance is clearly identified as an essential outcome along with chewing and swallowing, there remains inconsistency in how outcomes for speech are obtained and interpreted. It is clear that surgical treatment for oral and oropharyngeal tumors and subsequent reconstruction has a direct influence on the integrity of the human vocal tract. As a result, surgery and reconstruction holds the significant potential for alteration of signal transmission characteristics of the vocal tract. This presentation provides a brief summary of existing data on outcomes and serves to raise several questions related to a need for research. Further, preliminary data obtained in our laboratory using established methodology to assess the acoustic structure of English vowels in individuals who have undergone surgery for oral cancer is presented for consideration.

Patients/Materials and Methods: Following a cursory review of the literature, results from a preliminary study of 11 participants (3 women, 8 men) who had received surgery for treatment of oral cancer are presented. All participants had undergone surgery for oral tumors and received subsequent reconstruction using a radial free forearm flap. A group of age- and gender-matched control participants were also studied. All participants produced multiple productions of 10 English vowels consistent with methods outlined by Peterson and Barney (1952); formant frequencies were then determined via spectrographic analysis.

Results: Data obtained revealed remarkable similarity across the speaker groups for values obtained for formants 1, 2, and 3 (F1, F2, and F3). When proportional relationships between F1 and F2 were compared, no differences between surgical and control participants were identified. Overall, and in the presence of substantial surgical reconstruction, these 11 surgical participants appear capable of modifying their vocal tracts so as to adequately code the basic and essential acoustic requirements for the 10 vowels studied.

Conclusions: These preliminary findings demonstrate that traditional and fundamental methods of vocal tract assessment, namely determination of formant frequencies through acoustic analysis, can serve as a valuable index of postsurgical vocal tract function and signal transmission. These acoustic data represent one specific measure of vocal tract transmission characteristics that could be exploited in additional analyses of the postsurgical system. The lack of significant differences between these groups does not, however, suggest that the speaker groups are equivalent with respect to overall speech production capabilities. The current data provide an initial step toward establishing standardized methods of post-treatment speech evaluation.

Key words: oral cancer, oropharyngeal cancer, vocal tract, speech acoustics, speech rehabilitation

Full Paper

Bibliographic reference.  Doyle, Philip C. (2008): "Oral and oropharyngeal cancer: speech outcomes and the need to monitor change over time", In EVSR-2008, 90-114.