###### Abstract  
Introduction: This study pursued two objectives: (1) to determine the potential association between listener (\(n=51\)) judgments of 20 male tracheoesophageal speaker samples for two auditory-perceptual dimensions of voice, overall severity (OS) and listener comfort (LC); and (2) to assess the temporal and spectral acoustic correlates for these auditory-perceptual dimensions. Methodology: Three separate correlation analyses were performed to evaluate the association between OS and LC. First, scores of OS and LC from all listeners were pooled together, and then the correlation between OS and LC was computed. Second, scores of OS and LC were averaged over all listeners to derive a single estimate of OS and LC for each TE speaker sample; the correlation between the average OS and LC was then computed. Third, listener-to-listener variability in the association between OS and LC was evaluated by computing the correlation between OS and LC scores from each listener across all TE samples. Finally, two stepwise multiple regression models were created to relate the average LC score to spectral and temporal variation in the acoustic signal. Results: While the pooled OS and LC scores had a moderate positive correlation (r = 0.66, \(p<0.00001\)), the averaged OS and LC exhibited a near perfect positive correlation (r = 0.99, \(p<0.00001\)). The significant differences between the pooled and averaged scores were explained by significant listener-to-listener variability in the association between OS and LC. OS and LC scores from 5 listeners had non-significant correlations, 10 had moderate correlations (r < 0.7), 35 listeners had high correlations (0.7 < r < 0.9), and 1 listener had a very high correlation (r < 0.9 < 1). Finally, the acoustic models created based on the spectral and temporal variations in the signal were able to account for 87.7% and 61.8% of variation in the average LC score. Conclusions: The strong correlations between OS and LC suggest that LC may, in fact, provide a more comprehensive auditory-perceptual surrogate for the voice quality of TE speakers. Although OS and LC are distinct conceptual dimensions, LC appears to have the advantage of assessing the social impact and potential communication disability that may exist in interactions between TE speakers and listeners. tracheoesophageal speech; auditory-perceptual evaluation; voice disorders; perceptual psychophysics +
Footnote †: journal: Medical  
replete with reports on its widespread use and success as an alaryngeal voice rehabilitation ([2; 3; 4; 5] and others). Overall, this postlarynectomy, alaryngeal method of voice and speech has gained wide acceptance as a rehabilitation option. Both empirical information on TE speech as well as clinical reports suggest a range of acoustic advantages that cross the frequency, intensity, and temporal domains associated with voice and speech production [6; 7]. Further, TE voice restoration has been shown to exhibit relatively good levels of speech intelligibility compared with other alaryngeal methods such as esophageal speech and the use of the electrolarynx [7]. However, despite the apparent success of TE puncture voice restoration as an alaryngeal method, TE speech remains perceptually \"abnormal\" in comparison to normal laryngeal speakers; additionally, intrinsic variability between speakers clearly exists, and this type of variability directly influences auditory-perceptual judgments by listeners [8; 9; 10; 11; 12]. Current data indicate that factors inherent to the TE voice signal may affect listener judgments and that these factors are multidimensional in nature [13]. This is primarily accounted for by the nature of the postlarynectomy voicing source and its interaction with the aerodynamic driving source (i.e., the lungs) during TE voice production. Thus, TE speech is typically characterized by reduced and variable pitch, inconsistent vocal intensity, and variable degrees of aperiodic vocal noise (i.e., \"roughness\") that is easily identified by listeners.