Speech restoration following total laryngo-pharyngectomy with free jejunal repair

Nine patients who have undergone total laryngo-pharyngectomy with free jejunal reconstruction between 1984 and 1993, have had Blom-Singer valves inserted. All patients had little or no voice prior to valve insertion, compared with a good but gravelly voice after valve insertion. Tracheo-oesophageal puncture and valve insertion provides a safe and reliable means of restoring voice after laryngo-pharyngectomy with free jejunal repair.

[Speech rehabilitation after laryngectomy, primary insertion of a speech ventilator]

During a period of three years, 30 patients were submitted to laryngectomy in our department. In 23 of these, primary tracho-oesophageal puncture had been performed and secondary puncture was performed in one patient. Fifteen of the prostheses were of the Blom Singer type and nine were Provox prostheses. Twenty-one patients learned to use the voice prosthesis and obtained fluent or understandable speech while three patients never used the prosthesis. Three patients subsequently abandoned the speech prosthesis and preferred to continue using oesophageal speech. Side effects were restricted to leakage around the prosthesis and slight stenosis in the pharyngo-oesophageal segment.

Tracheoesophageal speech: with and without tracheostoma valve

The tracheostoma valve, developed by Blom and Singer combines the advantages of pulmonary air for phonation with hands-free speech. Patients have anecdotally reported "more normal speech" with the use of the valve. This study was designed to objectively determine if speech acoustic and temporal measures existed between tracheoesophageal puncture using the valve, and those without the valve prosthesis, during speech production among the same subjects. The speech samples of nine male laryngectomees were recorded with and without the valve. Six speech acoustic and temporal measures were calculated and compared under both speaking conditions. No statistically significant differences were found between the two speaking conditions for the six tasks measured. However, other advantages and disadvantages were observed and reported under the valve condition.

Fabrication of a custom recessed tracheostoma valve retainer for the total laryngectomy patient

Total laryngectomy patients who depend on a prosthesis for the production of alaryngeal speech often have irregular peristomal anatomy. The standard tracheostoma (speech) valve retainer cannot be intimately adapted to uneven and highly mobile tissue. Fabrication of a custom speech valve retainer is indicated under such circumstances but may be complicated by restricted access to the surgically created stoma. This article describes the clinical and laboratory techniques for the fabrication of a custom tracheostoma valve retainer that displaces the peristomal soft tissues and musculature. This technique permits access for placement of the speech valve and valve retainer in close proximity to the speech button prosthesis. Enclosure of the custom retainer in the recess underlying the peristomal musculature also provides a plug that enhances retention and increases patient confidence during alaryngeal speech. The coordinated efforts of the speech specialist and the prosthodontist in the fabrication of this prosthesis enhances the quality of life for the total laryngectomy patient.

[Voice quality in laryngectomees with phonatory prosthesis]

The Work is a study of quality voice in laryngectomy patients with speech prosthetic supports. We have studied the quality voice objective and subjective. We explain the results.

Squamous cell papilloma at the tracheoesophageal puncture stoma

Over 140 tracheoesophageal punctures were performed at the Cleveland Clinic Foundation, Department of Otolaryngology and Communicative Disorders over the last seven years. In all cases the Blom-Singer duckbill prosthesis was utilized for alaryngeal voice restoration. Of these patients, two examples were noted where squamous cell papilloma was found at the tracheoesophageal stoma site. The preoperative evaluation and surgical laser technique for surgical excision of the papilloma with postoperative care are described. The case reports of each of the patients that have been diagnosed as having squamous cell papilloma of the tracheoesophageal puncture site are reviewed.

[Long-term experiences with the Asai and Staffieri methods of voice rehabilitation after laryngectomy: a comparative study]

Follow up of 45 patients who had undergone a surgical voice rehabilitation by Asai's or Staffieri's method showed clearly that the main problem of such operations is not the restoration of a good voice but the guarantee of a normal swallow. The low position of the tracheo-pharyngeal fistula in Staffieri's operation is particularly disadvantageous and often requires surgical closure of the neoglottis. A strict pre-operative assessment is indicated before all operative methods for voice rehabilitation. Oesophageal speech remains the best voice after laryngectomy and operative reconstruction is relegated to second place.

Tracheostoma valve for speech rehabilitation in laryngectomees

In the newer surgical procedures for fistula speech, finger occlusion of the tracheostoma is mandatory for speech production. This can be embarrassing as it draws attention to the patient's stoma. Finger occlusion is unhygienic and at times inconvenient. A new tracheostoma valve has been designed to eliminate the need for finger occlusion for speech. It has been evaluated clinically in nine laryngectomees, all of whom retained a good objective quality of speech similar to that obtained by finger occlusion. Vocal efficiency measurements with the valve are very encouraging. The valve is simple to use, of universal size, self-retaining, does not need any skin cleansing and obviates the need for skin adhesives to hold the valve in place.

Evaluation of the electrolarynx in the short-term hospital setting

We evaluated the effectiveness of the electrolarynx as a communication tool in the short-term hospital setting with 22 tracheostomized patients. Following an initial training period, we found that 14 of 22 patients achieved good results in communicating with the electrolarynx, three patients had fair results, and five patients had poor results. There were no differences in success rates for older or younger patients or for men or women; we could not correlate specific disease diagnosis with success or failure. The instrument could be effectively cleaned at the bedside. With the exception of patients who are severely confused or who have undergone extensive head and neck surgery, all tracheostomized patients can be considered candidates for this method of communication.

Effect of amplification on the intelligibility of speech produced with an electrolarynx

The purpose of this study was to look at the effect of orolabial amplification on the intelligibility of speech spoken with a neck model electrolarynx for two distance conditions, three noise conditions, and in relative quiet. A speaker using a neck model electrolarynx read single-answer questions to six listeners. The questions were read with and without amplification at 1.5 and 2.5 m distance, in relative quiet as well as in 66 dB, 72 dB, and 76 dBSPL (A-weighted) prerecorded cafeteria noise. The results of the study showed that speech-to-noise ratios were improved for amplified speech, with improvement in intelligibility for speech spoken in moderate background noise (66 and 72 dBSPL). The effect of the "buzz" of the artificial larynx is reduced, and speakers are better understood in moderate background noise with this amplification system.

[Voice rehabilitation following laryngectomy by the Gronigen prosthesis]

The Groningen voice prosthesis is a self-retaining silicone device, placed in the tracheooesophageal wall as a primary procedure during laryngectomy or some time after surgery. Prosthetic vocal rehabilitation was successful in 80% of the patients. Indications, contra-indications, advantages, disadvantages and complications are discussed.

Acceptability and intelligibility of tracheoesophageal speech

The original Blom-Singer voice prosthesis, introduced in 1979, has been recently modified to provide lower airway resistance. A tracheostoma breathing valve, introduced in 1982, permits unrestricted two-way breathing, yet eliminates the need for manual occlusion of the stoma. To date, the acceptability and intelligibility of tracheoesophageal (TE) speakers, using these prostheses, has not been extensively studied. Forty-six naive listeners rated the acceptability and intelligibility of 15 TE speakers, all of whom were wearing the tracheostoma breathing valve and a prototype low-pressure prosthesis. Acceptability was judged on an equal-appearing interval scale. Intelligibility judgments were based on randomized word lists of 50 items. Results suggest a high level of acceptability and intelligibility among both male and female TE speakers.

Selected acoustic features of tracheoesophageal, esophageal, and laryngeal speech

Voice samples of 15 laryngeal, esophageal, and tracheoesophageal speakers using the Blom-Singer voice prosthesis were analyzed for intensity, frequency, and rate. Results indicate that characteristic values for tracheoesophageal speech are more similar to laryngeal speech than esophageal speech, demonstrating the powerful advantage of this pulmonary-supported method of alaryngeal voice.

[Glottoplasty--a new method of surgical voice rehabilitation]

A simple operative technique is presented which restores speech without any later risk of aspiration in a one-stage operation performed together with the laryngectomy. 4 types can be distinguished depending on the extent of the resection and the amount of reconstruction necessary. The surgical technique is described. Resection of the tumour is not restricted. Our results on 85 patients are presented. Attention is drawn to mistakes and dangers.