The Effects of Contextual Priming and Alaryngeal Speech Mode on Auditory-Perceptual Ratings of Listener Comfort * ,† Sebastiano Failla, *,‡ Noor Al-Zanoon, * ,§ Natalie Smith, and * ,║ Philip C. Doyle, *London, yFort Lauderdale, and xPeterborough, Canada, and ║Stanford, California Summary: Background. The effectiveness of postlaryngectomy communication methods (esophageal, tra- cheoesophageal, and electrolaryngeal speech) has been primarily evaluated using functional outcomes. This evaluation neglects the importance of listeners and their influence on communicative effectiveness. Listener comfort (LC), or the ease with which a listener interacts with alaryngeal speakers, may provide an important index of communicative effectiveness. The present study investigated the use of LC in the auditory-percep- tual evaluation of alaryngeal speech modes, as well as evaluating the influence of contextual cues used to elicit ratings on listener judgments of all three alaryngeal modes. Methods. Thirty-three naïve listeners provided independent ratings of LC for 39 alaryngeal speech samples using a visual analogue scaling procedure. Each group of listeners rated alaryngeal speech in three imagined lis- tening conditions (Telephone Conversation, Social Situation, and a non-specified Control Condition). To analyze LC ratings obtained, a 3 £ 3 mixed factor analysis of variance was conducted. Results. A significant interaction effect between alaryngeal speech mode and listening condition (P = 0.04) was identified. Overall, pairwise comparisons of alaryngeal speech mode indicated that listeners were more comfortable when presented with tracheoesophageal speech samples compared to those of esophageal and electrolaryn geal speakers. Conclusions. Our data suggest that LC ratings are influenced by alaryngeal speech mode. Tracheoesophagea speech was perceived to have the most favorable LC ratings compared to the other alaryngeal speech modes in all listening conditions. Contextual cues (i.e., social condition and telephone condition) did not have an effect on LC ratings. Key Words: Alaryngeal speech-Semantic priming-Word priming-Listener comfort-Total laryngectomy. INTRODUCTION Total laryngectomy is a highly invasive surgical procedure reserved for the treatment of advanced laryngeal cancer. The resultant loss of normal voice following the removal of the larynx has prompted the need for the acquisition of alternative postoperative “alaryngeal” methods of verbal communication; these methods include tracheoesophageal (TE), esophageal (ES), and electrolaryngeal (EL) speech. Regardless of the chosen method of postlaryngectomy communication, alaryngeal speakers report a negative impact on their overall level of communication and voice- related quality of life, including deficits in specific areas such as daily activities and social participation. 1-6 These communication deficits extend to a variety of common activities including challenges when speaking over the tele- phone and/or in social situations (SS) during both individ- ual and group interactions. The observed negative consequences of an aberrant voice quality associated with all alaryngeal speakers highlight the importance and influ- ence of listener perceptions on one’s overall communicative effectiveness. Additionally, a recognition of the level of ease or comfort that listeners directly experience when interacting with alaryngeal speakers who exhibit a range of abnormal voice quality is equally important. It is well documented in the literature that regardless of postlaryngectomy speech mode (i.e., EL, ES, or TE), alaryngeal speakers generate a voice signal that is both unusual and unnatural 2 ; because of this change in alaryngeal voice and speech quality, the abnor- mality of the new signal holds the potential to negatively influence the interpersonal communication process. Accord- ingly, this impact must be considered at the level of both the speaker and their listener. Although postlaryngectomy verbal communication methods often result in functional levels of communication, previous research has consistently demonstrated that listeners may still penalize alaryngeal speakers for their aberrant voice quality. 1-6 This finding has led researchers to further investigate sub- jective measures of communicative effectiveness, in addi- tion to objective measures (acoustics) of the alaryngeal voice signal. 7,8 The literature in postlaryngectomy voice rehabilitation has provided a considerable body of work that addresses these changes at an auditory-perceptual level. Because the vocal changes resulting from any Accepted for publication March 2, 2020. The first two authors have contributed equally to the manuscript and share first authorship. Funding: This work was not funded. From the *Voice Production and Perception Laboratory, School of Communication Sciences and Disorders, University of Western Ontario, London, Ontario, Canada; yDr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida; zDepartment of Communication Sciences and Disorders, University of Alberta, Edmonton, Alberta, Canada; xSpeech and Language Services, Kawartha Pine Ridge District School Board, Peterborough, Ontario, Canada; and the ║Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, California. Address correspondence and reprint requests to Noor Al-Zanoon, Faculty of Reha- bilitation Medicine, Department of Communication Sciences and Disorders, Clinical Sciences Building, Room 6-126E, University of Alberta, Edmonton, Alberta T6G 2R3, Canada. E-mail: alzanoon@ualberta.ca Journal of Voice, Vol. &&, No. &&, pp. &&-&& 0892-1997 © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jvoice.2020.03.001 ARTICLE IN PRESS