Analysis of Smoothed Cepstral Peak Prominence in Tracheoesophageal Voices
Alejandro Klein-Rodriguez1, Irma Cabo-Varela1, Miguel Mayo-Yanez2
1Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario, Universitario (A Coruña (CHUAC), 15006 A Coruña, Spain; Otorhinolaryngology-Head and Neck Surgery Research Group, Institute of Biomedical Research of A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Universidade da Coruña (UDC), 15006 A Coruña, Spain; Health Sciences Programme, International Center for Doctorate (EIDUDC), Universidade da Coruña (UDC), 15001 A Coruña, Spain.
Abstract:
Total laryngectomy (TL) results in loss of laryngeal voice, with tracheoesophageal (TE) speech representing the preferred method of voice rehabilitation after TL. Given the intrinsic irregularity of TE phonation, conventional perturbation measures dependent on fundamental frequency tracking may be unreliable. This study aimed to perform a comprehensive perceptual and objective acoustic evaluation of TE voice in TL patients and to determine the clinical usefulness of smoothed cepstral peak prominence (CPPS) as a robust indicator of vocal quality.
Methods:
An observational analytical cohort study was conducted in 69 TL patients rehabilitated with a Provox® voice prosthesis. Perceptual assessment included the Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale and the Spanish version of the 10-item Voice Handicap Index (VHI-10). Objective acoustic analysis of sustained vowels /a/ and /i/ was performed using PRAAT software. Measured variables included CPPS, sound pressure level (SPL), fundamental frequency, jitter, shimmer, harmonic-to-noise ratio (HNR), and maximum phonation time. Correlation analyses explored associations between CPPS and clinical, perceptual, and acoustic variables.
Results:
Mean CPPS values were 8.44 ± 3.41 dB for /a/ and 7.63 ± 3.08 dB for /i/. No significant correlations were observed between CPPS and GRBAS or VHI-10 scores. CPPS demonstrated significant positive correlations with mean and maximum SPL and with HNR, and significant negative correlations with jitter, shimmer, and frequency-related measures. No significant associations were found with age, type of TE puncture, adjuvant radiotherapy, pulmonary comorbidity, pharyngeal closure technique, or phonation time. A weak trend toward improved CPPS over time since surgery was observed for /i/.
Conclusions:
CPPS is a feasible, objective, and clinically meaningful parameter for assessing TE voice quality in TL patients. Its strong association with acoustic stability and harmonic organization supports its use for longitudinal monitoring of voice quality throughout rehabilitation and follow-up.
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