title: Voice outcomes after transoral laser microsurgery for early glottic cancer-considering signal type and smoothed cepstral peak prominence.
abstract: OBJECTIVE
  This study proposed the use of signal typing and acoustic measures experimentally validated for aperiodic voices to investigate voice outcomes after transoral laser microsurgery (TLM) for early glottic carcinoma. It was of interest whether signal type and pitch-tracking indicators would reveal unreliable perturbation and noise measures. As an alternative, smoothed cepstral peak prominence (CPPS) was used for the first time in this population.
  
  
  METHODS
  A descriptive study of patients treated with TLM for early glottic carcinoma.
  
  
  METHODS
  All participants (n=14) performed a series of vocal tasks. Narrowband spectrograms were generated from voice recordings and classified into one of four signal types. The perturbation and noise measures of periodic or near-periodic signals only were reported. The CPPS for sustained vowel (CPPS-/a/) and connected speech (CPPS-s) were calculated for all participants. The relationship between voice outcomes and tumor and TLM factors was investigated.
  
  
  RESULTS
  Nine of 14 participants had an aperiodic type 3 signal. Three of 14 participants had voices considered reliable for perturbation analysis. Absolute jitter, %jitter, %shimmer, and signal-to-noise ratio were all low; however, CPPS-/a/ and CPPS-s amplitudes were below the normal range for most participants. Involvement of the anterior commissure, number of TLM episodes, and time post-surgery were associated with worse voice outcomes. There were strong correlations between signal type, CPPS-/a/, and pitch-tracking indicators.
  
  
  CONCLUSIONS
  The limitations of perturbation analysis should be considered when analyzing the voice after TLM. Signal type should be considered before conducting perturbation analysis. The CPPS-/a/ and CPPS-s may be more reliable acoustic outcome measures for this population.
authors.affiliation: Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia; Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia; Department of Speech Pathology, Westmead Hospital, Sydney, New South Wales, Australia. Electronic address: dsto8240@uni.sydney.edu.au.
authors.forename: Danielle
authors.initials: D
authors.lastname: Stone
authors.affiliation: Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia.
authors.forename: Patricia
authors.initials: P
authors.lastname: McCabe
authors.affiliation: Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia; Department of Otolaryngology Head Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Carsten E
authors.initials: CE
authors.lastname: Palme
authors.affiliation: Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Heard
authors.affiliation: Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia.
authors.forename: Clare
authors.initials: C
authors.lastname: Eastwood
authors.affiliation: Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, New South Wales, Australia; Department of Otolaryngology Head Neck Surgery, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Faruque
authors.initials: F
authors.lastname: Riffat
authors.affiliation: Voice Research Laboratory, Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Madill
mesh_terms: D000162:Acoustics; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005931:Glottis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D009367:Neoplasm Staging; D012815:Signal Processing, Computer-Assisted; D013018:Sound Spectrography; D013061:Speech Acoustics; D013068:Speech Production Measurement; D016896:Treatment Outcome; D014832:Voice Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014833:Voice Quality
keywords: Acoustic analysis; Early glottic cancer; Laryngeal cancer; Transoral laser microsurgery; Voice assessment