Impact of perceptual-learning strategies and background noise on disordered speech intelligibility

Objective: There is a plethora of research showing reduced speech intelligibility for a variety of voice disorders (i.e., dysphonia, alaryngeal). Therapeutic approaches to improve intelligibility typically involve targeting the speaker (e.g., clear speech, reduced rate) with minimal attention to the listener. Therefore, there were three purposes of this study: 1) to determine the impact of background noise on the speech intelligibility of disordered speakers; 2) to determine the impact of providing listeners with perceptual-learning strategies on the speech intelligibility of speakers with a voice disorder; and 3) to determine if subjective ratings of voice quality can predict speech intelligibility. Methods: Sentences were recorded from 12 speakers (2 typical, 3 alaryngeal, 7 dysphonic). Sentences were divided into one of three groups of signal-to-noise ratios (SNR: quiet, +5 dB SNR, and 0 dB SNR) and individually presented to 129 healthy listeners divided into one of three groups (i.e., control, acknowledgment of disorder, cognitive-perceptual strategies). Orthographic transcription was used to assess speech intelligibility. In addition, three expert listeners provided subjective voice quality ratings of all speakers. Results: Listeners had significantly more intelligibility errors with increased background noise (p <.001) and providing strategies to listeners did not result in a statistical improvement level F(6, 486) = 1.53, p = .17, η2p = 0.02. Regression analysis showed that the subjective voice quality overall severity was able to predict speech intelligibility in the noisy condition (0 dB SNR), accounting for 37% of the variance, R2 = .365, F(1,10) = 5.759, p = .037. Conclusion: Results suggest that increased background noise has a deleterious effect on the speech intelligibility of those with a voice disorder but that providing listeners with strategies in hopes of improving speaker intelligibility was not successful. Results did provide support, however, for the use of subjective voice quality ratings as a potential index of speech intelligibility.