# Assessing Gender Bias in Auditory-Perceptual Ratings of Tracheoesophageal Speakers
### Gender Considerations  
Historically, studies of TE speakers have focused on men due to the relative predominance of males in those diagnosed with laryngeal cancer. However, it is increasingly important to consider the female perspective, given the increasing proportional number of women who today are diagnosed with laryngeal cancer and may subsequently require total laryngectomy. In fact, recent data suggest that the ratio of men to women who are diagnosed with laryngeal cancer has now fallen to less than 4:1 [9; 10]. Additionally, because TE speech is widely employed as a primary method of speech rehabilitation in North America, the increase in female TE speakers will also increase [10; 11; 12].  
Considering the dramatic change in voice quality following laryngectomy and TE puncture (i.e., lowered pitch, increased aperiodicity in voice signal, etc.), speaker gender becomes of considerable importance. In fact, published data indicate that women who use TE speech experience a considerable deviation from their prelaryngectomy voice [13]. Specifically, female TE speakers experience a significantly lower vocal pitch that that of their prelaryngectomy voice, a variably rough voice quality and, consequently, the loss of a feminine-sounding voice [3]. Further, female TE speakers commonly report being misidentified as male when speaking on the telephone [13] or where other visual information is unavailable to a communication partner. Therefore, it is possible that, when compared to men, women may experience more negative judgments of their TE speech because of its more significant deviation from the expected qualities of a normal female voice [14; 15; 16; 17; 18]. Reductions in voice quality for women who have undergone laryngectomy have been shown to be socially penalizing and stigmatizing [19].  
Although the relative impact of changes specific to females who undergo laryngectomy and use TE speech have been documented in part, at present, little is known about how a listener's awareness of a TE speaker's gender potentially affects their judgments of a TE speaker's voice [4; 13]. Previous studies have confirmed that auditory-perceptual data serve as a valuable complement to patient-reported outcomes (PROs) following laryngectomy [19]. However, at present, there have been no explorations of potential gender bias in any group of postlaryngectomy speakers. Given the popularity of TE puncture voice restoration today, such questions have clear merit relative to understanding rehabilitation outcomes. Therefore, auditory-perceptual evaluation can be valuable in helping to understand the potentially different communication experiences of both male and female TE speakers in terms of their desire to share, interact socially, and participate in life activities [20; 21; 22; 23; 24; 25]. When such considerations are coupled with the potential for social penalty, issues specific to voice quality become of even greater importance [26; 27; 25]. Clinically, information of this type would also appear important as it may serve to shape the counseling that is provided during both pre- and postlaryngectomy speech/voice rehabilitation efforts. Consequently, it was hoped that information presented in the present study could empirically identify the presence or absence of a gender bias in perceptions of TE speakers. Ultimately, the goal was to determine how perceptions of TE speech may be influenced by the listener's knowledge of a speaker's gender.