## 1 Introduction  
Surgical removal of the larynx due to cancer will impact multiple physiologic functions, including swallowing, respiration, voice, and speech. Due to the loss of the larynx, verbal communication will be permanently altered. The loss of normal speech also has been shown to have far-reaching post-treatment impacts that may lead to significant social, psychosocial, and financial disadvantages [1; 2; 3]. While several postsurgical, alaryngeal verbal communication options exist, tracheoesophageal (TE) puncture voice restoration [4] remains a valuable and widely used postlaryngectomy rehabilitation option more than 40 years after its introduction. Further, TE puncture voice restoration does appear to have advantages relative to broader communication functioning and quality of life (QoL) in this population [5; 6]. One of the most significant advantages of TE voice and speech evolves from its use of a pulmonary air source. Experimental data reveal that this advantage involves changesthat directly influence the frequency, intensity, and temporal characteristics of the TE voice signal [7; 8; 9]. Further, the ability to utilize the air volume provided by the lungs results in a range of aerodynamic advantages inherent to the acoustic properties of the voice/speech signal as compared to other alaryngeal speech methods [9; 10; 11; 12]. Research has revealed that the specific aerodynamic changes which exist with TE voice production may also account for increases in speech accuracy. This finding is based on comparisons made between traditional esophageal speech and of TE speech, as both methods use the same biological voicing source, the pharyngoesophageal segment [12; 13; 14]. In fact, research findings suggest that when compared to traditional esophageal speakers, those who use TE speech are favored by listeners for both judgments of speech intelligibility and acceptability [7; 12; 13; 14; 15; 16; 17; 18; 19]. That is, TE speakers' access to pulmonary air may help them generate increased airflows and associated air pressures within the vocal tract during TE speech production. However, an additional concern in this context rests with the fact that TE speakers do not have an adductor-abductor voicing mechanism; rather, the response of the postlamyngectomy vibratory source may in many respects be somewhat passive despite increased driving pressures secondary to the access to lung air by these speakers [20; 21; 22]. Data reported in the literature support this assumption [9]. More specifically, although traditional esophageal speakers use the same voicing mechanism as TE speakers (the pharyngoesophageal segment), they exhibit a substantially reduced driving pressure due to limitations in the volume of the esophageal reservoir [22; 23; 24; 25; 26; 27]. Thus, the aerodynamic advantages associated with TE speech production and the inherent capacity to maintain air volumes within the esophageal reservoir have been suggested to result in concurrent advantages in speech production and its perceived listener accuracy [7]. Although esophageal and TE speech differ from each other and clearly differ from that of normal speech production, the aerodynamic capacity and trans-pseudoglottal flows and pressure are greater during TE speech [8; 9; 10; 20; 21; 22; 28; 29]. In comparing TE, esophageal, and normal speakers on acoustical characteristics of fundamental frequency, intensity, and duration, [PERSON] et al. [9] found that TE speech was characterized as having the greatest intensity, a higher frequency than esophageal speakers, and finally, temporal features that approximated normal speakers. Data from that study [9] further suggest that TE speech more closely approximates normal speech based solely on acoustic measures; however, TE speech remains identifiable by listeners as abnormal in its perceptual quality with associated reductions and variability in intelligibility [8].