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Searl J, Genoa K, Fritz A, Kearney A, Pandian V, Brenner MJ, Doyle P. Perceptions and practices of people with a total laryngectomy during COVID-19 pandemic: A mixed methods analysis. Am J Otolaryngol 2024; 45:104126. [PMID: 38039911 PMCID: PMC10939873 DOI: 10.1016/j.amjoto.2023.104126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE People with a total laryngectomy (PTL) confront safety threats related to altered airway anatomy and risk of adverse events is amplified during healthcare crises, as exemplified by COVID-19 pandemic. Understanding these challenges, how they are navigated by PTL, and what resources can be deployed to alleviate risk can improve interprofessional care by speech-language pathologists (SLPs), otolaryngologists, and other professionals. MATERIALS AND METHODS An online survey was disseminated to PTL in the United States during the COVID-19 pandemic, querying participants about safety concerns and sources of information accessed to address care. Descriptive statistics and Chi-square were used to analyze information sources consumed by tracheoesophageal, esophageal, and electrolaryngeal speakers. Content analysis was completed to identify themes and quantify responses by subtheme. RESULTS Among 173 respondent PTL, tracheoesophageal speakers preferentially sought otolaryngologist input, whereas esophageal and electrolaryngeal speakers more often chose SLPs (p < .01). Overall, tracheoesophageal speakers had more SLP or otolaryngologist contact. Many PTL reported stringent handwashing, neck cleaning, and hygienic risk mitigation strategies. Six themes emerged in content analysis involving risk of infection/transmission, heightened vigilance, changes to alaryngeal communication, modified tracheostoma coverage, diagnostic testing, and risk from comorbid conditions. Limited provider contact suggested pandemic barriers to healthcare access. CONCLUSIONS PTL have a range of laryngectomy-specific needs and concerns, and type of alaryngeal communication was associated with source of information sought. Collaborations among healthcare professionals need to be optimized to improve patient navigation and overall access to specialized care.
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Affiliation(s)
- Jeff Searl
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA.
| | - Kathryn Genoa
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA.
| | - Alyssa Fritz
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA.
| | - Ann Kearney
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - Vinciya Pandian
- Center for Immersive Learning and Digital Innovation, Johns Hopkins School of Nursing, Baltimore, MD, USA.; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA; Global Tracheostomy Collaborative, Raleigh, NC, USA.
| | - Michael J Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA; Global Tracheostomy Collaborative, Raleigh, NC, USA.
| | - Philip Doyle
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Ng ML, Tsang GCK. The Lombard effect associated with Chinese male alaryngeal speech. Int J Speech Lang Pathol 2019; 21:584-592. [PMID: 30732483 DOI: 10.1080/17549507.2018.1551932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
Objective: Alaryngeal speech shows marked reduction in vocal intensity, resulting in reduced intelligibility. Lombard effect, speaking with background noise has been found to boost speakers' intensity. The study investigated oesophageal (ES), tracheoesophageal (TE) and electrolaryngeal (EL) speech production under quiet and noisy background conditions to determine if the Lombard effect is still present after laryngectomy.Method: Fifteen laryngeal and thirty-seven alaryngeal speakers who were native speakers of Cantonese were recruited and instructed to read aloud a Cantonese passage under two background conditions: quiet and 100 dB background noise conditions.Result: Significant increase in vocal intensity was found in all speaker types under the noise condition. In addition, perceived intelligibility ratings provided by naïve Cantonese listeners revealed that the overall intelligibility under noise was improved for TE and laryngeal speakers, but not for ES and EL speakers, when compared with quiet condition.Discussion and conclusion: Results confirmed that the Lombard effect is still present after total laryngectomy. However, intelligibility may not always be improved with increased vocal loudness. Improved intelligibility was only observed for TE and laryngeal speakers, but not ES and EL speakers. Clinical implications for the use of the Lombard effect in post-laryngectomy speech rehabilitation are discussed.
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Affiliation(s)
- Manwa L Ng
- Speech Science Laboratory, Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, China
| | - Gloria C K Tsang
- Speech Science Laboratory, Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, China
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Gitomer SA, Hutcheson KA, Christianson BL, Samuelson MB, Barringer DA, Roberts DB, Hessel AC, Weber RS, Lewin JS, Zafereo ME. Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture. Head Neck 2016; 38:1765-1771. [PMID: 27394060 PMCID: PMC5118069 DOI: 10.1002/hed.24529] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/04/2016] [Accepted: 05/06/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We evaluated the impact of radiation, reconstruction, and timing of tracheoesophageal puncture (TEP) on complications and speech outcomes. METHODS Retrospective review identified 145 patients who underwent TEP between 2003 and 2007. RESULTS Ninety-nine patients (68%) had primary and 46 (32%) had secondary TEP, with complications occurring in 65% and 61%, respectively (p = .96). Twenty-nine patients (20%) had major complications (18 primary and 11 secondary; p = .42). Ninety-four patients (65%) had pre-TEP radiation, 39 (27%) post-TEP radiation, and 12 (8%) no radiation. With patients grouped by TEP timing and radiation history, there was no difference in complications, fluency, or TEP use. With mean 4.7-year follow-up, 82% primary and 85% secondary used TEP for primary communication (p = .66). Free-flap patients used TEP more commonly for primary communication after secondary versus primary TEP (90% vs 50%; p = .02). CONCLUSION Primary and secondary tracheoesophageal speakers experience similar high rates of complications. Extent of pharyngeal reconstruction, rather than radiation, may be more important in selection of TEP timing. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1765-1771, 2016.
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Affiliation(s)
- Sarah A. Gitomer
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Kate A. Hutcheson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Brandon L. Christianson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Madeleine B. Samuelson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Denise A. Barringer
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Dianna B. Roberts
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Amy C. Hessel
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Randal S. Weber
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Jan S. Lewin
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Mark E. Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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Lansaat L, de Kleijn BJ, Hilgers FJM, van der Laan BFAM, van den Brekel MWM. A prospective multicenter clinical feasibility study of a new automatic speaking valve for postlaryngectomy voice rehabilitation. Eur Arch Otorhinolaryngol 2016; 274:1005-1013. [PMID: 27637753 PMCID: PMC5281650 DOI: 10.1007/s00405-016-4304-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 09/08/2016] [Indexed: 11/26/2022]
Abstract
Evaluation of short- and long-term clinical feasibility and exploration of limitations and advantages of a new automatic speaking valve (ASV) for laryngectomized patients with integrated HME, the Provox FreeHands FlexiVoice (FlexiVoice). This ASV not only enables automatic, but also manual closure of the valve. A multicenter, prospective clinical study in 40 laryngectomized patients was conducted. Participants were asked to use the FlexiVoice for 26 weeks. The primary outcome measure was long-term compliance. Secondary outcome measures were: patient preference, hours of FlexiVoice use, device life of adhesive, voice and speech quality, and quality of life. After 26 weeks, 15 patients (37.5 %) were using the FlexiVoice on a daily basis, for a mean of 12.64 h/day (SD ± 5.03). Ten patients (25 %) were using the device on a non-daily basis, for a mean of 3.76 h/day (SD ± 2.07). The remaining 15 patients (37.5 %) discontinued using the FlexiVoice. Sixty percent of the 25 long-term users applied both automatic and manual closure of the valve. Unpredictable fixation of the adhesive was the main reason for discontinuing or not using the FlexiVoice on a daily basis. Overall, 18 patients (45 %) preferred the FlexiVoice, 16 patients (40 %) their usual HME, 3 patients (7.5 %) their usual ASV, 1 patient (2.5 %) preferred no device at all, and in 2 patients preference was not recorded. The minor technical issues identified could be corrected. The Provox FreeHands FlexiVoice appears to be a useful ASV, which allows for hands-free speech in a larger proportion of laryngectomized patients in the present cohort. The additional manual closure option of the device is beneficial for maintaining the adhesive seal longer.
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Affiliation(s)
- L Lansaat
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - B J de Kleijn
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F J M Hilgers
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Department of Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - B F A M van der Laan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Institute of Phonetic Sciences (ACLC), University of Amsterdam, Amsterdam, The Netherlands
- Department of Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Heaton JT, Goldstein EA, Kobler JB, Zeitels SM, Randolph GW, Walsh MJ, Gooey JE, Hillman RE. Surface Electromyographic Activity in Total Laryngectomy Patients following Laryngeal Nerve Transfer to Neck Strap Muscles. Ann Otol Rhinol Laryngol 2016; 113:754-64. [PMID: 15453536 DOI: 10.1177/000348940411300915] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hands-free triggering and pitch control would improve electrolarynx devices, which are inconvenient to use and sound unnatural. The present study tested the strategy of salvaging voice-related neural signals for hands-free electrolarynx control either by transferring cut recurrent laryngeal nerves (RLNs) to denervated neck strap muscles or by preserving strap muscles with their normal innervation. An RLN nerve transfer was performed at the time of total laryngectomy in 8 individuals, and in 5 of these subjects, strap muscles with intact ansa cervicalis innervation were also preserved for comparison. Neck surface electromyography performed over the strap muscles was used periodically for more than 1 year on phonatory and nonphonatory tasks. Signals were eventually obtained in all subjects from both RLN-innervated and ansa-innervated strap muscles that correlated with speech production. After 1 year, RLN-driven signals were larger than ansa-driven signals in magnitude, and their timing appeared better correlated with intended phonation. The results show that neck surface electromyography is an effective control source for hands-free electrolarynx activation, and that RLN transfer may provide the best approach for obtaining phonation-related activity.
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Affiliation(s)
- James T Heaton
- W. M. Keck Foundation Neural Prosthesis Research Center, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Adam SI, Srinet P, Aronberg RM, Rosenberg G, Leder SB. Verbal communication with the Blom low profile and Passy-Muir one-way tracheotomy tube speaking valves. J Commun Disord 2015; 56:40-46. [PMID: 26176711 DOI: 10.1016/j.jcomdis.2015.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 06/08/2015] [Accepted: 06/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate physiologic parameters, voice production abilities, and functional verbal communication ratings of the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves. STUDY DESIGN Case series with planned data collection. SETTING Large, urban, tertiary care teaching hospital. SUBJECTS AND METHODS Referred sample of 30 consecutively enrolled adults requiring a tracheotomy tube and tested with Blom and Passy-Muir valves. Physiologic parameters recorded were oxygen saturation, respiration rate, and heart rate. Voice production abilities included maximum voice intensity in relation to ambient room noise and maximum phonation duration of the vowel/a/. Functional verbal communication was determined from randomized and blinded listener ratings of counting 1-10, saying the days of the week, and reading aloud the sentence, "There is according to legend a boiling pot of gold at one end." RESULTS There were no significant differences (p>0.05) between the Blom and Passy-Muir valves for the physiologic parameters of oxygen saturation, respiration rate, and heart rate; voice production abilities of both maximum intensity and duration of/a/; and functional verbal communication ratings. Both valves allowed for significantly greater maximum voice intensity over ambient room noise (p<0.001). CONCLUSIONS The Blom low profile voice inner cannula and Passy-Muir one-way speaking valves exhibited equipoise regarding patient physiologic parameters, voice production abilities, and functional verbal communication ratings. LEARNING OUTCOMES Readers will understand the importance of verbal communication for patients who require a tracheotomy tube; will be able to determine the differences between the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves; and will be confident in knowing that both the Blom and Passy-Muir one-way tracheotomy tube speaking valves are equivalent regarding physiological functioning and speech production abilities.
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Affiliation(s)
- Stewart I Adam
- Department of Surgery, Section of Otolaryngology, Yale School of Medicine, New Haven, CT, USA
| | - Prateek Srinet
- Department of Surgery, Section of Otolaryngology, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Steven B Leder
- Department of Surgery, Section of Otolaryngology, Yale School of Medicine, New Haven, CT, USA.
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Benyamini L, Gil Z, Cohen JT. Management of aphonic patients following total laryngectomy and trachea esophageal puncture. Isr Med Assoc J 2014; 16:768-770. [PMID: 25630206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Trachea esophageal puncture (TEP) is performed following total laryngectomy to allow speech and communication. The most common reason for long-term speech failure in this population is hypertonicity of the constrictor muscle. OBJECTIVES To present our experience with the treatment of aphonic patients after total laryngectomy and TEP and suggest a protocol for treatment. METHODS Of 50 patients who underwent total laryngectomy and TEP, 6 suffered from aphonia after surgery. All patients underwent radiotherapy with or without chemotherapy. Delay in speech continued for more than 6 months after surgery. The patients received percutaneous lidocaine injection to the neopharynx in different locations around the stoma in order to map the hypertonic segments in the neopharynx. RESULTS Lidocaine injection immediately enabled free speech in five patients. One patient (patient 6) suffered from aphonia and from severe dysphagia and required a feeding tube. This patient succeeded to pronounce abbreviations after lidocaine injection. Another (patient 4) gained permanent ability to speak following a single lidocaine injection; this patient was not injected with botolinium toxin (BTX). For the other five, lidocaine had a transient effect on speech. These patients received BTX percutaneous injections. After BTX injections four regained free speech within 14 days. The fifth patient (patient 6) gained a conversational voice and his swallowing improved only after additional intensive speech therapy. CONCLUSIONS Percutaneous lidocaine and BTX injections represent first-line treatment in this population, with good success and minimal complications.
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8
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Bornbaum CC, Day AMB, Doyle PC. Examining the construct validity of the V-RQOL in speakers who use alaryngeal voice. Am J Speech Lang Pathol 2014; 23:196-202. [PMID: 24686439 DOI: 10.1044/2013_ajslp-13-0024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The construct validity of the Voice-Related Quality of Life (V-RQOL; Hogikyan & Sethuraman, 1999) measure was evaluated in a sample of 109 individuals who have undergone total laryngectomy. METHOD A principal components factor analysis was performed on participant responses to the 10-question V-RQOL measure. RESULTS Factor analysis of the V-RQOL in our alaryngeal sample confirmed the presence of two factors (physical and social-emotional), which is consistent with the identified domains in the current V-RQOL. However, the current data indicate that some of the questions proposed by the original authors of the V-RQOL (Questions 7 and 9) do not align with their proposed domains in this postlaryngectomy sample. CONCLUSION The results indicate that some V-RQOL questions do not align with their proposed domains. Consequently, an alternative scoring algorithm may be warranted for alaryngeal populations, and the authors make suggestions for this change that are simple and efficient. Based on the findings of the present factor analysis, use of this modified scoring procedure may serve to increase the sensitivity of the V-RQOL for those who are laryngectomized and use alaryngeal methods of voice and speech. Consequently, the value and application of the V-RQOL may be expanded in the clinical setting.
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Hutcheson KA, Lewin JS, Sturgis EM, Risser J. Multivariable analysis of risk factors for enlargement of the tracheoesophageal puncture after total laryngectomy. Head Neck 2012; 34:557-67. [PMID: 21692129 PMCID: PMC4012756 DOI: 10.1002/hed.21777] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Enlarged tracheoesophageal puncture (TEP) is a challenging complication of surgical prosthetic voice restoration. Prevention of this complication requires identification of high-risk individuals, and surgical and prosthetic correlates of TEP enlargement. METHODS Multivariable logistic regression methods were used to analyze preoperative, perioperative, and postoperative risk factors for enlarged TEP in a 5-year retrospective cohort. RESULTS Enlarged TEP only occurred in irradiated patients. Adjusting for length of follow-up and timing of TEP, advanced (N2 or N3) nodal disease (odds ratio [OR](adjusted) , 4.3; 95% confidence interval [CI], 1.0-19.1), postoperative stricture (OR(adjusted) , 3.2; 95% CI, 1.2-8.6), and diagnosis of locoregional recurrence or distant metastasis after laryngectomy (OR(adjusted) , 6.2; 95% CI, 2.3-16.4) increased risk of enlarged TEP. Extended resection and preoperative nutritional status were also significantly associated with enlarged TEP. Prosthetic parameters did not significantly correlate with enlargement. CONCLUSION Development of enlarged TEP is a multifactorial process related to both baseline and postoperative factors.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Sayed SI, Datta S, Deore N, Kazi RA, Jagade MV. Prevention of voice prosthesis biofilms: current scenario and future trends in prolonging prosthesis lifetime. J Indian Med Assoc 2012; 110:175-180. [PMID: 23029949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Voice rehabilitation after a total laryngectomy is an important requisite for patients' rehabilitation. Oesophageal speech using tracheo-oesophageal-valved prostheses is now considered the state-of-art in postlaryngectomy voice rehabilitation. One of the major drawbacks of voice prostheses is their limited device lifetime. This is due to the deterioration of the silicone rubber material by different bacterial and yeast species, which are organised in the form of a biofilm resulting in internal leakage, increased airflow resistance, impeding speech, respiration and swallowing. The use of antimicrobials though easily applicable is associated with development of resistance if used on long-term basis. Other techniques in the form of modification of physicochemical properties of the silicon surface or covalent binding of antimicrobial agents to the silicon surface have been employed. This article reviews the different strategies investigated until now and the future trends in preventing biofilm formation for prolonging the lifetime of the silicon voice prostheses. Data was collected by conducting a computer aided search of the MED-LINE and PUBMED databases, supplemented by hand searches of key journals. Over 35 articles in the last two decades on the topic have been reviewed out of which 27 were found to be of relevant value for this article.
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Affiliation(s)
- Sushail I Sayed
- Department of ENT and Head & Neck Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai 400008
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11
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Kawahara H, Nakamura T. [Voice restoration after laryngectomy]. Nihon Rinsho 2011; 69 Suppl 6:444-448. [PMID: 22471058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Wei X, Jin G, Jun W, Zhang J, Gao X. Aerodynamic characteristics of the slit-like trachea-esophagus puncture for voice rehabilitation following total laryngectomy. Acta Otolaryngol 2011; 131:539-45. [PMID: 21171832 DOI: 10.3109/00016489.2010.535849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS The slit-like trachea-esophagus puncture is a reliable procedure to restore the voice in the patient who has undergone a total laryngectomy. The new voice quality could be similar to normal and could meet the patient's daily needs. OBJECTIVES We report a new method of tracheoneoesophageal (TE) voice rehabilitation. A slit-like trachea-esophagus puncture was made in the tracheoesophageal wall after the total laryngectomy. No voice prosthesis was used. The purpose of this study was to observe its aerodynamic characteristics. METHODS All 60 patients received voice rehabilitation with the slit-like fistula after total laryngectomy. All patients' voices were evaluated as excellent. The aerodynamic characteristics of trachea-esophagus voices were observed. RESULTS When a patient attempted to phonate, the upper esophagus was closed. Then, the hypopharyngeal cavity expanded. Just before phonating, the upper esophagus was full of air as a ball. The air flow escaped through the segment of the trachea-esophagus slit and entered the pharyngoesophageal segment (PES). The esophageal meatus opened. It was vibrated together with nearby mucus and mucosa to form the voice. The maximum phonation time of the slit-like fistula voice was not significantly different from the Blom-Singer prosthesis voice. Its sound intensity was similar to the normal voice.
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Affiliation(s)
- Xudong Wei
- Department of Otolaryngology-Head and Neck Surgery, People's Hospital of GanSu Province, 160 DongGangXiLu Road, lanzhou, China.
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14
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Abstract
Prosodic information aids segmentation of the continuous speech signal and thereby facilitates auditory speech processing. Durational and pitch variations are prosodic cues especially necessary to convey prosodic boundaries, but alaryngeal speakers have inconsistent control over acoustic parameters such as F0 and duration, being as a result noisy and less intelligible than normal speech. This case study has investigated whether one Spanish alaryngeal speaker proficient in both oesophageal and tracheoesophageal speech modes used the same acoustic cues for prosodic boundaries in both types of voicing. Pre-boundary lengthening, F0-excursions and pausing (number of pauses and position) were measured in spontaneous speech samples, using Praat. The acoustic analysis has revealed that the subject has relied on a different combination of cues in each type of voicing to convey the presence of prosodic boundaries.
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Affiliation(s)
- M H Cuenca
- Phonetics Laboratory, University of Seville, Spain.
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Bohnenkamp TA, Stowell T, Hesse J, Wright S. Speech breathing in speakers who use an electrolarynx. J Commun Disord 2010; 43:199-211. [PMID: 20193954 DOI: 10.1016/j.jcomdis.2010.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 01/26/2010] [Accepted: 01/28/2010] [Indexed: 05/28/2023]
Abstract
UNLABELLED Speakers who use an electrolarynx following a total laryngectomy no longer require pulmonary support for speech. Subsequently, chest wall movements may be affected; however, chest wall movements in these speakers are not well defined. The purpose of this investigation was to evaluate speech breathing in speakers who use an electrolarynx during speech and reading tasks. Six speakers who use an electrolarynx underwent an evaluation of chest wall kinematics (e.g., chest wall movements, temporal characteristics of chest wall movement), lung volumes, temporal measures of speech, and the interaction of linguistic influences on ventilation. Results of the present study were compared to previous reports in speakers who use an electrolarynx, as well as to previous reports in typical speakers. There were no significant differences in lung volumes used and the general movement of the chest wall by task; however, there were differences of note in the temporal aspects of chest wall configuration when compared to previous reports in both typical speakers and speakers who use an electrolarynx. These differences were related to timing and posturing of the chest wall. The lack of differences in lung volumes and chest wall movements by task indicates that neither reading nor spontaneous speech exerts a greater influence on speech breathing; however, the temporal and posturing results suggest the possibility of a decoupling of the respiratory system from speech following a total laryngectomy and subsequent alaryngeal speech rehabilitation. LEARNING OUTCOMES The reader will be able to understand and describe: (1) The primary differences in speech breathing across alaryngeal speech options; (2) how speech breathing specifically differs (i.e., lung volumes and chest wall movements) in speakers who use an electrolarynx; (3) How the coupling of speech and respiration is altered when pulmonary air is no longer used for speech.
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Affiliation(s)
- Todd A Bohnenkamp
- University of Northern Iowa, Department of Communication Sciences and Disorders, 1555 West 27th Street, 231 Communication Arts Center, Cedar Falls, IA 50614-0356, USA.
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Kosztyła-Hojna B, Rogowski M, Kasperuk J, Moskal D, Rutkowski R, Falkowski D. [Analysis of comparison between different kinds of alaryngeal speech in laryngectomized patients with euphonic speech]. Pol Merkur Lekarski 2010; 28:277-283. [PMID: 20491337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED The aim of the rehabilitation in laryngectomized patients is to produce phonatory communication. It is important to choose the optimal method of rehabilitation. Most of the patients use the oesophageal or pharyngeal speech as an effect of natural rehabilitation with vocalistic method. Another group of larygectomized patients is rehabilitated with surgical method which leads to shunt speech. THE AIM OF STUDY was to compare the quality of oesophageal and shunt speech with euphonic voice to choose the optimal method of rehabilitation in laryngectomized patients. MATERIAL AND METHODS The quality of vicarious phonation was examined in 30 patients with shunt speech and in 20 patients with oesophageal speech. Examination results of the subjective, objective and acoustic assessment were compared with values registered in physiological (euphonic) speech. The results of objective assessment were statistically analysed. RESULTS The shunt and oesophageal speech enabled effective verbal communication of laryngectomized patients. The parameters of clinical subjective and objective assessment of shunt speech pointed to its high quality which is similar to physiological phonation. CONCLUSIONS The acoustic analysis of voice confirmed the results of subjective and objective assessment of quality of shunt voice and speech in laryngectomized patients. In conclusion, the surgical rehabilitation of voice after total laryngectomy gave patients the great opportunity for a remarkable improvement in vicarious phonation.
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Abstract
Total laryngectomy is often the treatment of choice for many individuals diagnosed with advanced laryngeal cancer. This procedure alters the normal voice production mechanism, and tracheoesophageal (TE) speech is one alternative method of voicing postlaryngectomy. TE speech is created when pulmonary air is passed through the upper esophagus to create a vibratory source that is then articulated into speech. TE speech is often characterized by abnormal voice quality. Acoustic analysis of TE speech has the potential of quantifying the voice quality and assisting the speech language pathologist in facilitating rehabilitation. Motivated in part by the recent advances in telecommunication industry for speech quality estimation, this paper investigated the application of an auditory model in predicting the ratings of TE speech by normal hearing listeners. The Moore-Glasberg auditory model was employed to extract perceptually relevant features from the acoustic waveform, and these features were later combined to estimate the subjective ratings of TE speech. This approach was validated with a database of subjective ratings of speech samples recorded from 35 TE speakers. Results showed moderate correlations between the objective metrics and the subjective ratings, and these correlations were significantly better than those obtained with traditional methods used in the telecommunication applications.
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Affiliation(s)
- Robert McDonald
- Department of Electrical and Computer Engineering, and National Centre for Audiology, University of Western Ontario, London, N6A 4B8 Ontario, Canada
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18
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Abstract
PURPOSE Current electrolarynx (EL) devices produce a mechanical speech quality that has been largely attributed to the lack of natural fundamental frequency (F0) variation. In order to improve the quality of EL speech, in the present study the authors aimed to develop and evaluate an automatic F0 control scheme, in which F0 was modulated based on variations in the root-mean-square (RMS) amplitude of the EL speech signal. METHOD Recordings of declarative sentences produced by 2 male participants before and after total laryngectomy were used to develop procedures for calculating F0 contours for EL speech. Specifically, the positive linear relationship between F0 and RMS amplitude observed in pre-laryngectomy speech was used as the basis for generating an F0 contour based on the amplitude variation of EL speech. An analysis-by-synthesis approach was used to modify the F0 contour, and a perceptual experiment was conducted to examine its impact on the quality of the EL speech. RESULTS The results of perceptual experiments showed that modulating the F0 of EL speech using a linear relationship between amplitude and frequency made it significantly more natural sounding than EL speech with constant F0. CONCLUSIONS The current study provides preliminary support for amplitude-based control of F0 in EL speech.
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Affiliation(s)
- Yoko Saikachi
- Massachusetts General Hospital Voice Center, Boston, MA, USA
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19
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Abstract
The aim of the research was to compare voice and speech in three groups of alaryngeal speakers: 1) patients using esophageal speech, 2) patients with electro-acoustical speech aids and 3) patients with voice prostheses. Acoustic analysis and pronunciation tests were used for the analysis. Acoustic analysis included fundamental frequency, maximum phonation time, jitter, shimmer and intensity. Pronunciation parameters were: phonetic block duration, number of syllables in a phonetic block, rate of speech, maximum number of syllables in a phonetic block and rate of articulation in a maximal phonetic block. Our results demonstrated the advantages of tracheoesophageal puncture with implantation of a voice prosthesis over the other two techniques of alaryngeal speech. Voice and pronunciation with voice prostheses were closer to normal in many parameters: fundamental frequency, maximum phonation time, jitter, shimmer, duration of a phonetic block, number of syllables in a phonetic block, rate of speech and rate of articulation in maximal phonetic block.
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Affiliation(s)
- D Globlek
- Sestre Milosrdnice University Hospital, ENT Department, Zagreb, Croatia.
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20
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Qin JW, Wei L, Liu ST, Zheng ZY. [Rehabilitation evaluation of Amatsu's tracheoesophageal shunt operation after total laryngectomy with sphincter mechanism]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2009; 44:400-403. [PMID: 19567050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate rehabilitation effect of Amatsu's tracheoesophageal shunt operation after total laryngectomy with sphincter mechanism. METHODS Voice rehabilitation were performed for 60 cases with Amatsu's tracheoesophageal shunt operation after total laryngectomy with sphincter mechanism, in which 20 cases were involved in post-operation radiation therapy. RESULTS Fifty two (86.7%)cases developed speech with voice and swallow rehabilitation, but 1 case of them suffered water drip from his tracheoesophageal shunt when drinking. The other 8 (11.3%) cases developed swallow rehabilitation but failed in speech rehabilitation for pharyngeal fistula (4 cases, in which 1 had pre-operative radiation therapy), tracheoesophageal shunt obstruction (2 cases), dyspnea with unknown reason (1 cases), no desire to speech (1 cases). Furthermore, all the 20 cases who were involved in post-operative radiative therapy restore their speech and swallow capability finally. CONCLUSIONS Amatsu's tracheoesophageal shunt operation with sphincter mechanism brought effective speech rehabilitation results for total laryngectomy even with post-operation radiation therapy.
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Affiliation(s)
- Jian-wu Qin
- Department of Head and Neck Surgery, Henan Tumor Hospital, Zhengzhou 450008, China.
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21
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Kubert HL, Stepp CE, Zeitels SM, Gooey JE, Walsh MJ, Prakash SR, Hillman RE, Heaton JT. Electromyographic control of a hands-free electrolarynx using neck strap muscles. J Commun Disord 2009; 42:211-225. [PMID: 19233382 PMCID: PMC3748802 DOI: 10.1016/j.jcomdis.2008.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 10/14/2008] [Accepted: 12/27/2008] [Indexed: 05/26/2023]
Abstract
UNLABELLED Three individuals with total laryngectomy were studied for their ability to control a hands-free electrolarynx (EL) using neck surface electromyography (EMG) for on/off and pitch modulation. The laryngectomy surgery of participants was modified to preserve neck strap musculature for EMG-based EL control (EMG-EL), with muscles on one side maintaining natural innervation and those on the other side receiving a transferred recurrent laryngeal nerve (RLN). EMG from each side of the neck controlled the EMG-EL across a day of unstructured practice followed by a day of formal training, including EMG biofeedback. Using either control source, participants spoke intelligibly and fluently with the EMG-EL before formal training. This good initial performance did not consistently improve across testing for either control source in terms of voice timing, speech intelligibility, fluency, and intonation of interrogative versus declarative sentences. Neck strap muscles have activation patterns capable of simple alaryngeal voice control without requiring RLN transfer. LEARNING OUTCOMES The reader will better understand (1) functionality of the hands-free electrolarynx (2) modification of laryngectomy surgery to preserve neck strap musculature and (3) performance of hands-free electrolarynx with different control sources.
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Affiliation(s)
- Heather L. Kubert
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston, MA
- Massachusetts General Hospital Institute for Health Professions, Boston, MA
| | - Cara E. Stepp
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston, MA
- Harvard-MIT Division of Health Science & Technology, Cambridge, MA
| | - Steven M. Zeitels
- Harvard-MIT Division of Health Science & Technology, Cambridge, MA
- Department of Surgery, Harvard Medical School, Boston, MA
| | - John E. Gooey
- VA Health Center Boston, Boston, MA
- Department of Otolaryngology/Head and Neck Surgery, Boston University Medical Center Hospital, Boston, MA
| | - Michael J. Walsh
- Department of Otolaryngology/Head and Neck Surgery, Boston University Medical Center Hospital, Boston, MA
| | - S. R. Prakash
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston, MA
- Harvard-MIT Division of Health Science & Technology, Cambridge, MA
| | - Robert E. Hillman
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston, MA
- Massachusetts General Hospital Institute for Health Professions, Boston, MA
- Harvard-MIT Division of Health Science & Technology, Cambridge, MA
- Department of Surgery, Harvard Medical School, Boston, MA
| | - James T. Heaton
- Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston, MA
- Massachusetts General Hospital Institute for Health Professions, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
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23
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Kobayashi M, Meguro E, Hayakawa Y, Irinoda T, Noda Y. A new technique using free ileocaecal patch transplantation for secondary voice restoration after total laryngectomy. J Plast Reconstr Aesthet Surg 2008; 61:e5-9. [PMID: 17664086 DOI: 10.1016/j.bjps.2007.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 12/12/2006] [Accepted: 06/11/2007] [Indexed: 10/23/2022]
Abstract
SUMMARY We introduce our newly designed voice restoration technique, which uses free ileocaecal patch transplantation for patients who have undergone prior total laryngectomy. Two women received ileocaecal patch transplantation for secondary voice restoration after total laryngectomy. In order to make the tracheoesophageal shunt for speech, a new orifice on the anterior wall of the hypopharynx had to be opened, which was closed at the time of laryngectomy. The hypopharyngeal orifice was covered by a free caecal patch harvested from an ileocaecal segment. Then, a tracheoesophageal shunt was created by anastomosing the terminal ileum of the patch and the remnant of the cervical trachea. Expiratory air was diverted into the pharynx through the ileum of the transplanted graft when the tracheostoma was closed by digital occlusion. Aspiration through an oesophagotracheal shunt in swallowing was prevented by the ileocaecal valve on the patch. Both patients began to speak up to 4 weeks after surgery without requiring training or difficult practice to achieve initial phonation and to be able to swallow without aspiration. The advantages of our procedure are (1) it can be carried out at the time of laryngectomy and also at secondary voice restoration after earlier laryngectomy; (2) the graft contains an ileocaecal valve that prevents aspiration through the shunt and also functions as a vibrating device to produce voice; (3) our procedure can be adapted to individuals whose tracheostoma is detached from the oesophagus and becomes contraindicated for a voice prosthesis. We believe that our newly designed procedure is a unique and useful alternative, especially for secondary voice restoration after prior total laryngectomy.
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Affiliation(s)
- M Kobayashi
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate City, Hokkaido, Japan.
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Thomson SL, Tack JW, Verkerke GJ. A numerical study of the flow-induced vibration characteristics of a voice-producing element for laryngectomized patients. J Biomech 2007; 40:3598-606. [PMID: 17662296 PMCID: PMC4010319 DOI: 10.1016/j.jbiomech.2007.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Revised: 05/04/2007] [Accepted: 06/06/2007] [Indexed: 11/22/2022]
Abstract
A computational model for exploring the design of a voice-producing voice prosthesis, or voice-producing element (VPE), is presented. The VPE is intended for use by laryngectomized patients who cannot benefit from current speech rehabilitation techniques. Previous experiments have focused on the design of a double-membrane voice generator as a VPE. For optimization studies, a numerical model has been developed. The numerical model introduced incorporates the finite element (FE) method to solve for the flow-induced vibrations of the VPE system, including airflow coupled with a mass-loaded membrane. The FE model includes distinct but coupled fluid and solid domains. The flow solver is governed by the incompressible, laminar, unsteady Navier-Stokes equations. The solid solver allows for large deformation, large strain, and collision. It is first shown that the model satisfactorily represents previously published experimental results in terms of frequency and flow rate, enabling the model for use as a design tool. The model is then used to study the influence of geometric scaling, membrane thickness, membrane stiffness, and slightly convergent or divergent channel geometry on the model response. It is shown that physiological allowable changes in the latter three device parameters alone will not be sufficient to generate the desired reduction in fundamental frequency. However, their effects are quantified and it is shown that membrane stiffness and included angle should be considered in future designs.
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Affiliation(s)
- S L Thomson
- Department of Mechanical Engineering, Brigham Young University, 435 CTB, Provo, UT, USA.
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25
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Kazi R, Singh A, Mullan GPJ, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Can objective parameters derived from videofluoroscopic assessment of post-laryngectomy valved speech replace current subjective measures? An e-tool-based analysis. Clin Otolaryngol 2006; 31:518-24. [PMID: 17184458 DOI: 10.1111/j.1365-2273.2006.01320.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The primary purpose of this study was to assess the pharyngoesophageal segment in total laryngectomy patients using a videofluoroscopy e-tool. STUDY DESIGN Cross-sectional study. SETTING Head and Neck Oncology Unit, Tertiary Referral Centre. PATIENTS Forty-two patients following total laryngectomy. INTERVENTION Videofluoroscopy using an e-tool (JRuler). MAIN OUTCOME MEASURES Subjective and objective videofluoroscopy parameters correlated with the GRBAS scale and treatment variables. RESULTS Of 32 men and 10 women, mean age 63.5 years (10.8) the majority (64.3%) had a reasonable voice (good = 11 and poor = 4 patients). Comparing subjective and objective parameters, significant correlations were only seen with a smaller minimal neoglottic distance at phonation with no regurgitation of barium at phonation (P = 0.05) and a type 1 shape of neoglottis at phonation (P = 0.02). There were also significant correlations between smaller maximum sub-neoglottic distance at phonation and type 1 shape of neoglottis (P = 0.02), smaller maximum sub-neoglottic distance at rest and absence of stasis of barium at phonation (P = 0.05) and the length of neoglottis at phonation and type 1 shape of neoglottis (P = 0.01). For perceptual evaluation, significant correlation was seen only between G1 voice and a smaller minimal neoglottic distance at phonation (P = 0.03) amongst the subjective and objective parameters. There were no correlations between visual parameters and the clinical parameters. CONCLUSIONS Our observations suggest that this interesting concept has limitations. While objective and quantifiable data can be obtained using videofluoroscopy in laryngectomees, only a few correlate with each other and with voice quality.
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Affiliation(s)
- R Kazi
- Head and Neck Unit, Royal Marsden Hospital, The Institute of Cancer Research, London, UK.
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Kazi R, Kiverniti E, Prasad V, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Multidimensional assessment of female tracheoesophageal prosthetic speech. Clin Otolaryngol 2006; 31:511-7. [PMID: 17184457 DOI: 10.1111/j.1365-2273.2006.01290.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to undertake a multidimensional assessment of female tracheoesophageal prosthetic speech. STUDY DESIGN A cross-sectional cohort study. SETTING Head and Neck Unit in a tertiary oncology referral centre. PATIENTS Ten female and 10 male total laryngectomy patients with no signs of recurrence and using voice prosthesis were compared to 10 normal female speakers. INTERVENTION(S) Electroglottographic and acoustic analysis of voice parameters for both sustained vowel /i/ and connected speech, perceptual evaluation using GRBAS (with 2 experienced raters) and questionnaire assessment using the University of Washington Quality of Life and the Voice Handicap Index. Statistical analysis was done using the Statistical Package for Social Sciences, (v. 14, SPSS Inc., Chicago III). RESULTS Median age of the female larygectomy patients was 65 years (range: 41-81), that of male laryngectomees was 66.5 years (range: 40-79) and that of the normal female subjects was 47.5 years (range: 35-72). All electroglottographic, acoustic parameters and GRBAS ratings of the female laryngectomy patients were significantly worse as compared with the normal female subjects. The median fundamental frequency (111.8 Hz) was comparable to male tracheoesophageal speakers (115.8 Hz). Mean composite University of Washington Quality of Life score and overall Voice Handicap Index score was 79.3(12.5) and 47.5(27.6) for the female laryngectomy patients and for the males was 81.2 (9.6) and 39.4(18.7). CONCLUSIONS Gender frequency differences as seen in normal subjects are lost following a laryngectomy operation as evidenced by electroglottographic and perceptual data. Although the quality of life scores are comparable to the male tracheoesophageal speakers, they exhibit a greater voice handicap as compared to their male counterparts.
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Affiliation(s)
- R Kazi
- Head and Neck Unit, Royal Marsden Hospital, The Institute of Cancer Research, London, UK.
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27
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Chen HC, Mardini S, Yang CW. Voice reconstruction using the free ileocolon flap versus the pneumatic artificial larynx: a comparison of patients' preference and experience following laryngectomy. J Plast Reconstr Aesthet Surg 2006; 59:1269-75. [PMID: 17113502 DOI: 10.1016/j.bjps.2006.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2006] [Revised: 06/14/2006] [Accepted: 06/16/2006] [Indexed: 10/24/2022]
Abstract
This study compares the psychological adjustment and voice function of patients undergoing voice rehabilitation using the free ileocolon flap for creation of a voice tube shunt and patients undergoing voice rehabilitation using the pneumatic artificial larynx. Twelve laryngectomy patients were included; six underwent free ileocolon transfer following a period of pneumatic artificial larynx use. Mean duration after laryngectomy was 5.2 years. Mean follow-up was 210 days. A chart review, questionnaires and a prospective evaluation were performed. Voice tube shunt patients had better speech function and higher self-esteem. People's discrimination and appearance when speaking were important in the patients' choice of method for rehabilitation. There was a high preference for choosing the voice tube shunt and a higher motivation and willingness to use that voice mechanism in the voice tube shunt group. Patients who undergo free flap reconstruction of voice have better speech function and self-esteem than patients who continue to use the external pneumatic device. Psychological assessments are important for surgical patients in order to evaluate a critical aspect of our perceived success - the patients' perception.
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Affiliation(s)
- Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, E-DA Hospital, I-Shou University, No. 1 Yi-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung, Taiwan
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Tack JW, Verkerke GJ, van der Houwen EB, Mahieu HF, Schutte HK. Development of a Double-Membrane Sound Generator for Application in a Voice-Producing Element for Laryngectomized Patients. Ann Biomed Eng 2006; 34:1896-907. [PMID: 17066324 DOI: 10.1007/s10439-006-9196-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
For voice rehabilitation after total laryngectomy a shunt valve is usually placed in the tracheo-esophageal (TE) wall, thereby enabling the production of a TE voice. Some patients, however, are unable to produce a voice of sufficient quality. Furthermore, the TE voice is low pitched, which presents a problem especially for female laryngectomized patients. The voice quality after laryngectomy might be improved by introducing a voice-producing element (VPE) into the TE shunt valve. In this study a sound generator was developed that is suitable for application in such a VPE. This sound generator consists of two elastic membranes placed parallel inside a circular housing. A substitute voice source is created when the membranes start to vibrate via a constant flow of air passing between them. To determine the optimal membrane configuration for proper functioning under physiological conditions, up-scaled physical VPE models with different membrane geometries were evaluated using in vitro experimental tests. For certain membrane geometries the tests showed that a basic sound, containing multiple harmonics, could be successfully produced under physiological air pressure and airflow conditions. The fundamental frequency (60-95 Hz) and sound pressure level (57-78 dB, at 15 cm microphone distance) were regulated via changes in the driving pressure, thereby enabling the possibility of intonation in laryngectomized patients' speech. The obtained frequency range is considered appropriate for producing a substitute voice source for female patients. The geometry considerations in this study can be used for the development of a true scale VPE that can be evaluated clinically, to eventually replace the voice after laryngectomy.
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Affiliation(s)
- J W Tack
- Department of BioMedical Engineering, University Medical Center Groningen, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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Abstract
Electrolarynx (EL) speech provides a valuable means of verbal communication for the laryngectomees. Yet EL speech tends to be less intelligible speech due to the presence of background noise. This paper addresses the issue of EL speech enhancement. The proposed approach takes into account the frequency-domain masking properties of the human auditory system for a subtractive-type enhancement process. Subtractive-type algorithms can efficiently reduce the radiated noise of EL speech but not to reduce the additive noise from the environment due to the use of fixed subtraction parameters. Considering the particular characteristics of EL speech, a new computationally efficient algorithm based on the perceptual weighting technique is developed to adapt the subtraction parameters. This leads to a significant reduction of the unnatural structure of the residual noise. Acoustic and perceptual experiments confirm that the enhanced EL speech is more pleasant to human listeners and the proposed algorithm results in improved performance over classical subtractive-type algorithms.
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Affiliation(s)
- Hanjun Liu
- Key Laboratory of Biomedical Information Engineering of Ministry of Education Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
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30
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Op de Coul BMR, Ackerstaff AH, van As-Brooks CJ, van den Hoogen FJA, Meeuwis CA, Manni JJ, Hilgers FJM. Compliance, quality of life and quantitative voice quality aspects of hands-free speech. Acta Otolaryngol 2005; 125:629-37. [PMID: 16076712 DOI: 10.1080/00016480510031515] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSIONS With the use of a new automatic stoma valve (ASV) it appears possible to rehabilitate patients who have previously been unsuccessful in acquiring hands-free speech. As well as making daily ASV use possible for an additional group of patients, this new device was also appreciated by many patients as an additional rehabilitation tool for specific occasions. Despite statistically significant improvements in aspects of voice and breathing using this novel ASV, improvement of peristomal adhesion is probably the main factor needed to further increase success rates. Nevertheless, our results show that it makes sense to keep trying to achieve hands-free speech, even if previous attempts have failed. OBJECTIVE To make a long-term (6 months) assessment of compliance and aspects of voice, breathing and quality of life using a new ASV: the Provox FreeHands heat and moisture exchanger (HME). MATERIAL AND METHODS This was a prospective clinical multicentre trial in 79 laryngectomized patients (8 regular ASV users, 58 previously unsuccessful users and 13 new users). Data were collected at baseline and after 1 and 6 months by means of European Organization for Research and Treatment of Cancer Quality of Life questionnaires and specific structured questionnaires concerning compliance, skin adhesion, voicing and pulmonary aspects. An objective assessment of voice parameters (maximum phonation time, maximum phonation time while counting, dynamic loudness range and number of pauses in a standard read-aloud text) was made for comparison of different stoma occlusion methods (digital occlusion via an HME and two different ASVs). A subjective assessment of overall voice quality was made. RESULTS After 6 months, 19% of patients used the new ASV on a daily basis (mean 5 h/day), while 57% used it on an irregular basis as an additional rehabilitation tool for special occasions. Two-thirds of the study group indicated that they would continue to use the new ASV after the study period. With respect to the objective parameters, statistically significantly better maximum phonation times and dynamic loudness ranges were observed with the new ASV compared to the Blom-Singer ASV. However, the best results for all the objective parameters were obtained with digital occlusion via the Provox HME.
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Affiliation(s)
- B M R Op de Coul
- Department of Otolaryngology, Head and Neck Surgery, University Medical Centre St Radboud, Nijmegen, The Netherlands
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Abstract
In spite of the progress made in organ-preserving therapy modalities, including endoscopic or external partial laryngectomies, radiotherapy or chemoradiation in many patients with advanced laryngeal and hypopharyngeal carcinomas, total laryngectomy remains the only safe possibility for long lasting local tumour control. The existing strategies for a sufficient restoration of voice following total laryngectomy are still controversial. Besides the strictly conservative methods of esophageal voice and electronic devices, different surgical procedures are carried out worldwide. At present, the exclusively surgical voice shunt techniques are only offered in a few very specialized centres. In Germany, three surgical methods are in use: (1) microvascular laryngoplasty according to Hagen (> 300 cases), (2) the "jejunal speaking siphon" according to Ehrenberger modified by Remmert (> 60 cases), and (3) the modified Asai-technique according to Maier and Weidauer (> 80 cases).
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Affiliation(s)
- R Hagen
- Klinik für Hals-Nasen-Ohrenkrankheiten, Plastische Operationen, Katharinenhospital, Klinikum Stuttgart, 70174 Stuttgart.
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Suda Y, Haruta A, Komatsubara S, Nakazima T, Shimizu J, Naono H, Toyama K. [Tracheoesophageal puncture with tracheal tube and flexible endoscope]. Nihon Jibiinkoka Gakkai Kaiho 2005; 107:1033-7. [PMID: 15678899 DOI: 10.3950/jibiinkoka.107.1033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Tracheoesophageal shunt phonation is one method of voice restoration after total laryngectomy. Singer and Blom reported an endoscopic technique for voice restoration after laryngectomy, but this is not easy for all cases, because introducing nonflexible endoscope is difficult due to of scarring in the neck and reconstruction with free jejunum. We conducted tracheoesophageal puncture with a tracheal tube and flexible endoscope, finding this useful for all cases of secondary shunt procedures.
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Affiliation(s)
- Yoshihito Suda
- Department of Otolaryngology, Miyazaki University, Miyazaki
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Abstract
The effect of age and gender of listeners on the perceptions of Mandarin electrolaryngeal speech was investigated. Sixty males and 40 females were categorized into five age groups (20-29, 30-39, 40-49, 50-59, and 60-70 years), who were regarded as naive listeners for having no experience with electrolaryngeal speech. They were instructed to score acceptability of a passage and intelligibility of isolated words and embedded words. The results revealed no gender effects but significant age effects on the perceptual evaluation. It was more difficult for the 50-59 and 60-70 groups to understand electrolaryngeal speech. The results were also analyzed for tonal and segmental errors, and errors of tone alone were found to occur more often than segmental errors. In addition, a preliminary study was presented for the perceptions of the four Mandarin tones. Higher percent correct identification was found for the high-level tone compared to the other three tones.
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Affiliation(s)
- Hanjun Liu
- Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, PR China
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34
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Abstract
A look at the many disciplines working with voice over the past 50 years is provided from the perspective of a speech-language pathologist (SLP). Some of the earliest collaborations between medicine and speech-language pathology were seen in the management of cleft palate and velopharyngeal inadequacy problems and observed, also, in laryngectomee rehabilitation. The earlier concern of the SLP for the emotional and psychological aspects of patients with voice disorders appeared replaced with the rise of symptomatic therapy. Dramatic improvement in instrumentation assisted by computer analyses increased our awareness and understanding of both normal and disordered phonation. Although instrumentation today allows for many forms of visual feedback in voice training and therapy, this may be often at the expense of providing needed kinesthetic-proprioceptive and auditory feedback. Particular voice therapy approaches (cognitive, gestalt-holistic, imagery, resonant therapy, muscle training, and symptomatic therapy) used today are described. Suggestions are given for improving educational requirements and clinical experience in voice for SLPs.
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Affiliation(s)
- Daniel R Boone
- Department of Speech & Hearing Sciences, University of Arizona, Tucson, USA.
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Bancel C. [During vocal rehabilitation of the laryngectomy patient]. Soins 2004:44-5. [PMID: 15042772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Catherine Bancel
- Service ORL, pathologie et chirurgie de la tête et du cou, chirurgie cervico-faciale, Hôpital Saint-Louis, Paris
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36
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Niu HJ, Wan MX, Wang SP, Liu HJ. Enhancement of electrolarynx speech using adaptive noise cancelling based on independent component analysis. Med Biol Eng Comput 2004; 41:670-8. [PMID: 14686593 DOI: 10.1007/bf02349975] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The electrolarynx provides a valuable means of verbal communication for people who cannot use their natural voice-production mechanism, but technology has changed very little since it was introduced in the 1950s. The presence of background noise degrades the resulting speech. In this study background noise was reduced by a new method, independent component analysis-based adaptive noise cancelling, which can remove noise components of the primary input signal based on statistical independence, by incorporating both second-order and higher-order statistics. The method shows better performance than the conventional least mean square algorithm. Acoustic analysis of the denoised electrolarynx speech revealed a significant reduction in the amount of background noise. Results from the perceptual evaluations indicated that the new filtering technique produced a noticeable improvement in the acceptability of the electrolarynx speech in a quiet environment (from 1.75 to 2.49, arbitrary units) or a noisy environment (from 0.59 to 1.82). In general, there was no significant improvement or degradation in intelligibility in the quiet environment (from 52.7 to 53.3). However, the processing did improve the intelligibility in a babble-noise environment (from 24.9 to 40.6). The improvement in acceptability and intelligibility may increase the communication ability of the user in daily situations.
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Affiliation(s)
- H J Niu
- Department of Biomedical Engineering, School of Life Science & Technology, Xi'an Jiaotong University, Xi'an, China
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37
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Abstract
The enteric flaps commonly used in free tissue head and neck reconstruction include the gastro-omental flap, the omental flap, and the free jejunal flap. These flaps have demonstrated excellent reconstructive results for defects of the oral cavity, oropharynx, hypopharynx, cervical esophagus, and contouring defects of the head and neck. Their main advantages include tissue pliability, tubed shape, ease of contouring, and the ability to secrete mucus. Recent studies report outcome measurements for flap loss, fistula rates, postoperative swallowing, speech, and cosmesis. Now that experience has been gained to the point of routine use of these flaps, randomized trials are needed to determine the functional advantages of the enteric flaps compared with other reconstructive options.
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Affiliation(s)
- Robert R Lorenz
- Department of Otolaryngology and Communicative Disorders, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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38
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Ramachandran K, Arunachalam PS, Hurren A, Marsh RL, Samuel PR. Botulinum toxin injection for failed tracheo-oesophageal voice in laryngectomees: the Sunderland experience. J Laryngol Otol 2003; 117:544-8. [PMID: 12901809 DOI: 10.1258/002221503322112978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Spasm of the pharyngo-oesophageal segment is one of the important causes of tracheo-oesophageal voice failure. Traditionally it has been managed by either prolonged speech therapy, surgical pharyngeal myotomy or pharyngeal plexus neurectomy with varying degrees of success. Botulinum neurotoxin has been found to be effective in relieving pharyngo-oesophageal segment spasm. Since 1995, we have used botulinum toxin injection on 10 laryngectomees with either aphonia or hypertonicity due to pharyngo-oesophageal segment spasm. Early results were analysed by the Sunderland Surgical Voice Restoration Rating scale. Seven of the 10 patients, who were previously completely aphonic, developed voice following this therapy and are using their valve choice as their only method of communication. Out of the three patients who were treated for hypertonic voice, two did derive some benefit from the procedure. One patient developed a hypotonic voice, which lasted for a few months.
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Affiliation(s)
- K Ramachandran
- Department of Otolaryngology and Head and Neck Surgery, Sunderland Royal Hospital, Sunderland
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Tsai TL, Chang SY, Guo YC, Chu PY. Voice rehabilitation in laryngectomees: comparison of daily-life performance of 4 types of alaryngeal speech. J Chin Med Assoc 2003; 66:360-3. [PMID: 12889505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND We compared 4 kinds of alaryngeal speech available in Taiwan in the performance of daily-life tasks. The speech methods included pneumatic device (Taiwan tube), electrolaryngeal speech, esophageal speech, and tracheoesophageal prosthesis. METHODS Questionnaires covering various communication situations in daily-life tasks as well as subjective feelings about using alaryngeal speech were distributed to members of The Taiwan Laryngectomees' Association and were collected mostly in April 2000 in their annual meeting. RESULTS A total of 108 members responded to the questionnaire (totally 160 were questionnaires distributed). The mean age of respondents was 68.6 years, and the average time after surgery was 14.5 years. A pneumatic device was used by 58.8% of the responders, esophageal speech was used by 24.7%, an electrolarynx by 10.3%, and a tracheoesophageal prosthesis by 6.2%. No statistical difference was noted among patients using any of the 4 devices in terms of 13 communication tasks in daily life, except 4 questions such as the convenience of alaryngeal speech, embarrassment in face of strangers, the effort required to speak, and the discomfort in throat/neck/mouth when speaking. No statistical differences were noted among the 4 devices in terms of intelligibility. CONCLUSIONS All 4 alaryngeal speech methods can serve most of the communication functions in daily life tasks with no differences in intelligibility. Limitations in loudness and tone were common problems. It is crucial for surgeons to understand the performance of various alaryngeal speeches in daily life during rehabilitation consultations with patients.
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Affiliation(s)
- Tung-Lung Tsai
- Department of Otolaryngology, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
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40
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Abstract
Several problems have been observed when performing the classic endoscopic technique for voice restoration following laryngectomy. An easy and safe method is described for the insertion of a Provox voice prosthesis using a Yankauer tonsil suction tube and an antrum trocar with an irrigation cannula.
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Affiliation(s)
- Kemal Görür
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey.
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41
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Perry AR, Shaw MA, Cotton S. An evaluation of functional outcomes (speech, swallowing) in patients attending speech pathology after head and neck cancer treatment(s): results and analysis at 12 months post-intervention. J Laryngol Otol 2003; 117:368-81. [PMID: 12803787 DOI: 10.1258/002221503321626410] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We have earlier reported establishing a computerized database to audit functional outcomes in patients who underwent head and neck cancer treatment in Victoria, Australia and attended speech pathology services from April 1997-April 1999. This paper presents the statistical analyses and results from this study. Speech pathologists collected, prospectively, functional outcome data on 293 patients who underwent head and neck cancer treatment, and sent these for analysis to La Trobe University. Clinician and patient assessments of outcomes: speech, swallowing, activity, pain, employment, health, QOL status were made. Initial data on 293 patients were collected and data on mortality and morbidity were compiled at three, six and 12 months post-treatment. Within twelve months, 74 patients had died. Three, six and/or 12-month follow-up data was available on 219 patients, with both clinician and patient assessments of status completed. The status forms are presented as appendices to this paper. Complete status forms on 179 patients at 12 months were obtained. This clinical audit of functional outcomes represents the first study of this kind, collecting data from speech pathologists and patients in a multi-centre study of patients with head and neck cancer. We present data to demonstrate optimal recovery of function at six months, such that this may represent a good reference point for reporting and comparison of functional outcomes.
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Affiliation(s)
- Alison R Perry
- School of Human Communication Sciences, Faculty of Health Sciences, La Trobe University and Department of Biostatistics, La Trobe University, Victoria, Australia.
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Saito H, Fujieda S, Ohtsubo T, Tsuda G, Saito T, Shibamori Y, Sunaga H. Tracheoesophageal shunt method with omohyoid muscle loop for voice restoration. Arch Otolaryngol Head Neck Surg 2003; 129:321-3. [PMID: 12622541 DOI: 10.1001/archotol.129.3.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To decrease the aspiration rate of the previously reported simple mucodermal tracheoesophageal (TE) shunt method for voice restoration after total laryngectomy with the use of omohyoid muscle loop. DESIGN Retrospective clinical analysis. SETTING Department of Otorhinolaryngology, Fukui Medical University, Fukui, Japan. PATIENTS Ten male patients underwent total laryngectomy and received TE shunt by the omohyoid muscle loop method for voice restoration. There were 5 patients with glottic laryngeal cancer, 2 with supraglottic laryngeal cancer, and 3 with hypopharyngeal cancer. Patients' age ranged from 46 to 66 years. INTERVENTION The dermal incision on the neck was U-shaped with a superiorly pedicled, small U-shaped dermal flap. This small flap was used to form the anterior wall of the shunt. Bilateral omohyoid muscles were preserved at the total laryngectomy site with or without neck dissection. After creating a TE shunt directly on the posterior wall of the tracheal stump, the bilateral omohyoid muscles were looped through each other beneath the TE shunt. MAIN OUTCOME MEASUREMENTS Maximum phonation time, maximum phonation intensity, and rating scales of shunt voice, aspiration rate, and survival time. RESULTS Mean maximum phonation time was 20 seconds, while mean maximum phonation intensity was 83 dB. The first voice was obtained on postoperative day 29 on average. Of the 10 patients, 9 could phonate, with 1 case (10%) of slight aspiration 3 months after the surgery. CONCLUSIONS Although this omohyoid muscle loop method needs to preserve the hyoid bone with those muscles, aspiration was prevented more effectively compared with the former, direct mucodermal TE shunt method. The indication for this method is preferably glottic laryngeal cancer.
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Affiliation(s)
- Hitoshi Saito
- Department of Otorhinolaryngology, Fukui Medical University, Japan
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43
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Eksteen EC, Rieger J, Nesbitt M, Seikaly H. Comparison of Voice Characteristics Following Three Different Methods of Treatment for Laryngeal Cancer. ACTA ACUST UNITED AC 2003; 32:250-3. [PMID: 14587566 DOI: 10.2310/7070.2003.41731] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Laryngeal cancer treatment has become more complex and diversified in past decades. Many different methods of treatment have evolved, and most have been able to restore the patient's function and maintain some form of functional speech. This study was designed to evaluate the voice and speech characteristics of patients who have undergone different treatments for laryngeal cancer and to compare those characteristics with those of age- and sex-matched normal laryngeal speakers. METHODS Twenty-two male subjects participated in the study. Five men were treated with radiation therapy, 6 men had supracricoid partial laryngectomy, 6 men had undergone total laryngectomy with tracheoesophageal puncture, and 5 men were normal laryngeal speakers. Acoustic, aeromechanical, and perceptual assessments of speech were collected. RESULTS Significant age effects were found for maximum phonation times. As age increased, maximum phonation time decreased (p < .005). Significant differences were found between groups for the following dependent variables: percentage of voiceless phonation, maximum phonation time, laryngeal airway resistance, subglottal pressure, oral flow, and word intelligibility. Trends in the data for differences between groups were noted for the following acoustic variables: noise-to-harmonics ratio, jitter, and shimmer. CONCLUSIONS All patients developed or maintained a source of voicing after treatment and could use speech functionally, as demonstrated by normal sentence intelligibility. The radiation treatment group had voices that differed the least from the control group, whereas the opposite was true for the surgical groups, especially for those with total laryngectomy.
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Affiliation(s)
- Eddie C Eksteen
- Division of Otolaryngology--Head and Neck Surgery, University of Alberta, Edmonton
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44
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Abstract
Tracheoesophageal puncture has made high-quality voice restoration readily available to most individuals who must undergo TL. Although none of these patients would voluntarily choose to undergo TL if not faced with a life-threatening condition, at least some achieve a better quality of life, including better vocal function, after treatment and rehabilitation. The methods involved in placement and maintenance of a tracheoesophageal prosthesis are straightforward and permit successful, long-term voice restoration for most patients. Although far from perfect, TL with TEP affords both quality and quantity of life to a group of individuals who currently have no alternative but to undergo debilitating surgery in an effort to extend their lives.
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Affiliation(s)
- Wayne M Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA.
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45
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Wu Y, Shang Y, Zhou Y, Tao ZF, Li Q, Di B, Xiao SF, Song Q, Zhao G. [Long-term results of one stage tracheoesophageal end-side anastomosis voice restoration after total laryngectomy]. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2002; 16:462-4. [PMID: 15515531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE The purpose of this study is to discuss long-term results of one different kind of voice restoration after total laryngectomy with 10 years experience. METHOD One stage tracheoesophageal end-side anastomosis after total laryngectomy was performed in 36 patients from 1991-1996. The key technique of this operation is to make a tongue-ship flap(1.5 cm x 1.5 cm-1.8 cm x 1.5 cm) with tracheal membranous part and dissect it from the esophagus to 1 cm below the upper incisal margin of trachea. Then a 0.8 cm middle vertical incision was made on the lowest anterior wall of the separated esophagus. Folding the tongue-ship flap posteriorly to approximate the esophagus incision and make an end-side anastomosis. Close the upper incisal margin of trachea with left to right direction suture. The follow up time is 5 - 10 year. One lost follow 2.5 years later and was judged as dead. RESULT The short-term and long-term success rate were 69% (25/36) and 83% (30/36) respectively. The 3-, 5- and 10 year survival rate are 72%, 69%, 69%, respectively. CONCLUSION This technique does not change the pattern of total laryngectomy and various neck dissections do not affect voice rehabilitation. Advantages of the operation: easy to operate and learn; the special form of tracheoesophageal shunt (high in the tracheal side and low in esophageal side) prevents the aspiration; high successful rate, excellent speech, fluent language, good acceptability and lower aspiration.
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Affiliation(s)
- Yanqiao Wu
- Department of Otolaryngology, Bethune International Peace Hospital, Shijiazhuang 050082
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46
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Abstract
OBJECTIVES To determine the success rate and relating clinical factors of voice prosthesis rehabilitation and to analyze the discrimination ability of the multidimensional Harrison-Robillard-Shultz Tracheoesophageal Puncture Rating Scale (HRS Rating Scale). DESIGN Prospective clinical study. SETTING University Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Inselspital, Bern, Switzerland. SUBJECTS AND METHODS From 1992 through 1998, 87 patients with advanced squamous cell carcinoma of the larynx and/or hypopharynx underwent primary tracheoesophageal puncture after total laryngectomy. Clinician otolaryngologists and speech/language pathologists independently used the HRS Rating Scale for success assessment of voice prosthesis rehabilitation. RESULTS Age, sex, tumor localization, tumor stage, and radiation therapy had no influence on the success of voice prosthesis rehabilitation. Overall, voice rehabilitation success rates between 40% and 62% were achieved. Speech/language pathologists and clinician otolaryngologists evaluated the same patient group without significant statistical differences. The HRS Rating Scale analysis showed an equal distribution of the subscale parameter care in functional and nonfunctional speakers and a strong correlation between the subscale parameters quality and use. CONCLUSIONS Because of its safety and simplicity, tracheoesophageal puncture has become a state of the art method for voice rehabilitation after total laryngectomy. The short-term superiority of voice prosthesis in voice rehabilitation over esophageal speech rehabilitation must be seen in light of comparable long-term success rates of the 2 methods.
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Affiliation(s)
- Michel A Hotz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Inselspital, 3010 Bern, Switzerland.
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47
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Ahern R, Lippincott LH, Wisdom G. Voice rehabilitation after laryngectomy: an overview. J La State Med Soc 2002; 154:118-20. [PMID: 12139355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Kawahara H, Tatematsu H, Yamataka K, Sakurai T, Yamamoto T. [Surgical voice restoration after pharyngolaryngoesophagectomy]. Nihon Geka Gakkai Zasshi 2001; 102:659-62. [PMID: 11579478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Although pharyngolaryngoesophagectomy (PLE) offers the only reliable possibility for cure in patients with advanced carcinomas of the cervical esophagus, the majority must reconcile themselves to subsequent voicelessness. Various surgical methods for voice restoration have been devised to solve this problem. Among these methods, the most common following PLE are the tracheogastric shunt, double tracheo-esophagogastric shunt, elephant trunk-shaped tracheo-esophageal shunt, tracheo-jejunal shunt, and tracheo-ileocecal shunt. The basic premise of these procedures is to introduce expiratory air from the trachea into the reconstructed esophagus to produce voice without aspiration of liquid or food during deglutition. The resultant speech is acceptable in most patients.
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Affiliation(s)
- H Kawahara
- Surgical Division, Kawasaki Ida Municipal Hospital, Kawasaki, Japan
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49
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Abstract
BACKGROUND Some patients fail to acquire tracheoesophageal (TE) speech after laryngectomy because of pharyngeal constrictor hypertonicity. Botox injection relieves hypertonicity, but there are little objective data regarding outcomes, duration of effect, and reinjection rates. METHODS Hypertonicity was identified by means of insufflation testing and confirmed videofluoroscopically in 23 unsuccessful TE speakers. Each patient received an EMG-guided Botox injection. Additional injections were offered if the first injection failed to produce fluent speech. RESULTS Overall, 20 of 23 patients (87%) achieved fluent TE speech production after Botox injections; 5 after additional injections. Two patients declined further intervention, and 1 failed to achieve fluent TE speech production even after 3 Botox injections. The longest sustained effect was 37 months, the shortest was 5 months for 1 patient who required reinjection of Botox to maintain her TE speech production. CONCLUSIONS Botox injection relieves constrictor hypertonicity in selected cases of TE speech failure with little need for reinjection to maintain long-term speech success.
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Affiliation(s)
- J S Lewin
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 441, Houston, Texas 77030-4009, USA.
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50
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Abstract
Over the past 20 years, use of tracheo-oesophageal puncture (TEP) speech after total laryngectomy has resulted in reported success rates of 90-93 per cent worldwide. Despite this, data collected from major acute hospitals in Victoria, Australia indicated that, of 38 patients who underwent total laryngectomy in 1997, only 10 (26 per cent) were using TEP speech as their primary mode of communication at 12 months post-operatively. This paper describes how a quantitative research methodology was used to investigate why so few patients in Victoria were successfully using TEP speech as their chosen mode of rehabilitation after total laryngectomy. Patients, speech pathologists and ENT surgeons were interviewed. Their thoughts and beliefs regarding speech rehabilitation were mapped, and themes were identified, coded and analysed. This paper describes and discusses the results of this research and its possible implications for future patient management, through establishing a model for 'ideal' speech rehabilitation.
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Affiliation(s)
- J Frowen
- Speech Pathology Department, The Alfred Hospital, Commercial Road, Prahran, Melbourne, Australia
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