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Longobardi Y, D'Alatri L, Brandi VF, Mari G, Marenda ME, Marchese MR, Galli J, Parrilla C. Automatic speaking valve in tracheo-esophageal speech: treatment proposal for a widespread usage. Eur Arch Otorhinolaryngol 2024; 281:3197-3205. [PMID: 38568297 DOI: 10.1007/s00405-024-08605-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/05/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Aim of this study was to calculate the percentage of the Automatic Speaking Valve (ASV) use in a large cohort of laryngectomized patients with voice prosthesis (VP) and to analyze the main reasons for non-use. Subsequently, a specific rehabilitation training was proposed. METHODS One hundred-ten laryngectomized patients with VP were enrolled in the first phase of the study (census). Among them, 57 patients were included in the second phase (intervention), in which a training based on moving phonatory exercises was proposed. Structured questionnaires were used before and after training in order to investigate ASV use rate (days/week and hours/day; reasons for impeding the ASV use), average adhesive life-time during ASV use; hands-free speech duration; skin irritation. Patients also expressed their degree of on a VAS scale from 0 to 100. RESULTS In the census phase the percentage of use of ASV (everyday, without problems) was equal to 17.27% (19/110 patients). The main causes of disuse concerned excessive fatigue and poor durability of the adhesives. The analysis of the results pre vs. post-training showed a statistically significant increase (p < 0.05) in all the investigated parameters. Patients reported a good level of treatment compliance (average frequency of performing exercises equal to 4.2 ± 2.5 days/week for 1.4 ± 1.01 h/day) and high degrees of satisfaction. After treatment, the percentage of use of AVS increased by 43% reaching a rate of 60% (66/110 patients). CONCLUSION A specific and targeted approach that simulate the phonatory and breathing difficulties of everyday life can increase the ASV usage rate.
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Affiliation(s)
- Ylenia Longobardi
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia
| | - Lucia D'Alatri
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia.
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-collo e organi di senso, Università Cattolica del Sacro Cuore, Roma, Italia.
| | | | - Giorgia Mari
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia
| | - Maria Elisabetta Marenda
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia
| | - Maria Raffaella Marchese
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia
| | - Jacopo Galli
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-collo e organi di senso, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Claudio Parrilla
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento Scienze dell'InvecchiamentoNeurologicheOrtopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli, IRCCS, L.go Agostino Gemelli 8, Roma, Italia
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Maniaci A, Lavalle S, Mayo-Yanez M, Parisi FM, Cocuzza S. Videofluoroscopy-guided botulinum toxin for pharyngoesophageal spasm: a promising advance in laryngectomy rehabilitation. Eur Arch Otorhinolaryngol 2024; 281:3305-3306. [PMID: 38456929 DOI: 10.1007/s00405-024-08554-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Antonino Maniaci
- Faculty of Medicine and Surgery, University of Enna Kore, 94100, Enna, Italy
| | - Salvatore Lavalle
- Faculty of Medicine and Surgery, University of Enna Kore, 94100, Enna, Italy
| | - Miguel Mayo-Yanez
- Department of Otorhinolaryngology-Head and Neck Surgery, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006, A Coruña, Spain
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital San Rafael (HSR), 15006, A Coruña, Spain
| | - Federica Maria Parisi
- Deparment of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, 95123, Catania, Italy
| | - Salvatore Cocuzza
- Deparment of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, 95123, Catania, Italy.
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do Monte LEF, Simão IC, dos Reis JR, Leal PDC, Dibai AV, Oliveira CMB, Moura ECR. Evolution of the quality of life of total laryngectomy patients using electrolarynx. Rev Assoc Med Bras (1992) 2024; 70:e20231146. [PMID: 38716939 PMCID: PMC11068385 DOI: 10.1590/1806-9282.20231146] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/30/2023] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Therapy and vocal rehabilitation in laryngeal cancer impact patients' quality of life. The objective of this study was to evaluate the evolution of the quality of life of patients with laryngeal cancer submitted to total laryngectomy and using electrolarynx. METHODS This is an observational study with a cross-sectional design and a quantitative approach. It was conducted between April 2022 and January 2023 in a Brazilian cancer hospital. For data collection, a quality of life questionnaire, validated for patients with head and neck cancer at the University of Washington, was applied in two phases: from 7 days after total laryngectomy and, subsequently, from 70 days after surgery using electronic larynx for at least 60 days. The inclusion criteria were patients undergoing total laryngectomy included on the Aldenora Bello Cancer Hospital's election list to receive the electronic larynx. Patients who did not sign the informed consent form were not included. RESULTS The sample consisted of 31 patients, of which approximately 84% were men and approximately 93% at the age of 50 years or older. When comparing the phases, it is possible to observe that the item speech had the greatest progress, while chewing had the least. Only the item recreation, swallowing, taste, and saliva did not show any statistical significance. The score for the general quality of life questions increased. CONCLUSION Electronic larynx is a viable and useful method of voice rehabilitation. Our data suggest that the use of the electrolarynx as a postlaryngectomy method of verbal communication is responsible for positive effects on patients' quality of life.
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Peres Borges Dos Santos N, Costa Santos I, Alves E Silva AC, Esteves PH, Dias FL, Silva de Freitas A. Associated Factors With the Prosthetic Vocal Rehabilitation Outcome in Older Patients (Over 70 Years). J Voice 2024; 38:539.e21-539.e27. [PMID: 34782223 DOI: 10.1016/j.jvoice.2021.09.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Tracheoesophageal puncture (TEP) with voice prosthesis (VP) is considered the gold standard in vocal rehabilitation of total laryngectomized patients, for generating better speech intelligibility and good vocal result. The aspects of aging that may be related to the success of this method of rehabilitation are rarely discussed in the literature. OBJECTIVE To describe the factors that influence the rehabilitation outcome of the total laryngectomized older patients with voice prosthesis. METHODS A retrospective cohort study enrolled in the Head and Neck Cancer Surgery Section of the Brazilian National Cancer Institute. Secondary data were collected through physical and electronic medical records of patients undergoing vocal rehabilitation using tracheoesophageal prosthesis, from 2006 to 2019. Descriptive analysis presented the distribution of the demographic and clinical characteristics of this population. RESULTS Thirty patients rehabilitated with VP over 70 years old (mean age: 73.7 years), of which 93.3% were male. Married (73.3%), with low education (70%) and had a tumor of size T4a (60%). Adjuvant radiotherapy was performed in 66.7% of patients, 16.7% to previous radical radiotherapy, Complication rate was 53.3%, (68.7% granuloma and 18.7% shunt enlargement). All patients with shunt enlargement removed the prosthesis, whereas the prevalence of removal among those patients without complications was 14.3%. Logistic regression indicated that secondary TEP had 96% less chance of failure for phonation than primary TEP. CONCLUSIONS Patients with more complications are more likely to have phonation issues and to remove the prosthesis. Older patients with larger tumors and who underwent salvage laryngectomy or were submitted to a primary puncture seem to be more likely to have complications and/or aphonia.
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Affiliation(s)
| | - Izabella Costa Santos
- Instituto Nacional do Câncer - INCA - Ministério da Saúde, Rio de Janeiro (RJ), Brasil
| | | | | | - Fernando Luiz Dias
- Instituto Nacional do Câncer - INCA - Ministério da Saúde, Rio de Janeiro (RJ), Brasil
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Maniaci A, Lechien JR, Caruso S, Nocera F, Ferlito S, Iannella G, Grillo CM, Magliulo G, Pace A, Vicini C, La Mantia I. Voice-Related Quality of Life After Total Laryngectomy: Systematic Review and Meta-Analysis. J Voice 2024; 38:539.e11-539.e19. [PMID: 34763996 DOI: 10.1016/j.jvoice.2021.09.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND To compare voice rehabilitation-related quality of life among patients surgically treated for total laryngectomy and rehabilitated with esophageal (EV) and tracheoesophageal (TEV) voice. METHODS A systematic literature review of articles from the past 20 years was conducted, and only full-text English articles comparing VTE and EV results in laryngectomized patients were included. RESULTS We provided 15 articles for a total of 1085 laryngectomized patients undergoing voice rehabilitation, of which 869 (80.1%) were treated with voice prosthesis while 216 (19.9%) to esophageal speech. Pooled VHI outcomes showed a significantly better score for the TEV group than EV one (31.93±12.11 versus 35.39±20.6; P = 0.003), but no significant difference was recorded at VrQoL (8.27±5.98 versus 9.27±2.02; P = 0.19). CONCLUSION TEV and EV are both effective procedures in voice rehabilitation after laryngectomy. Although TEV allows for significantly better speech performance, it does not necessarily correlate with a high VrQoL.
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Affiliation(s)
- Antonino Maniaci
- Department of Medical, Surgical Sciences and Advanced Technologies G.F.Ingrassia, University of Catania, Catania, 95100 Italy.
| | - Jerome Rene Lechien
- Research Committee of the Young Otolaryngologists, International Federations of ORL Societies, Paris, France; Department of Human Anatomy and Experimental Oncology, School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, (University of Paris-Saclay), Paris, France
| | - Sebastiano Caruso
- Department of Medical, Surgical Sciences and Advanced Technologies G.F.Ingrassia, University of Catania, Catania, 95100 Italy
| | - Francesco Nocera
- Department of Medical, Surgical Sciences and Advanced Technologies G.F.Ingrassia, University of Catania, Catania, 95100 Italy
| | - Salvatore Ferlito
- Department of Medical, Surgical Sciences and Advanced Technologies G.F.Ingrassia, University of Catania, Catania, 95100 Italy
| | - Giannicola Iannella
- Department of 'Organi di Senso', University "Sapienza", Rome, Italy; Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Caterina Maria Grillo
- Department of Medical, Surgical Sciences and Advanced Technologies G.F.Ingrassia, University of Catania, Catania, 95100 Italy
| | | | - Annalisa Pace
- Department of 'Organi di Senso', University "Sapienza", Rome, Italy
| | - Claudio Vicini
- Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Ignazio La Mantia
- Department of Medical, Surgical Sciences and Advanced Technologies G.F.Ingrassia, University of Catania, Catania, 95100 Italy
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Pires RC, Gama RR, da Silveira Júnior PS, Teixeira FM, Santos CR, de Castro Capuzzo R. Analysis of durability and replacement of vocal prostheses in total laryngectomy patients at a head and neck surgery referral center. Eur Arch Otorhinolaryngol 2024; 281:351-357. [PMID: 37776343 DOI: 10.1007/s00405-023-08180-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/07/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE The use of tracheoesophageal prostheses has become the gold standard in vocal rehabilitation of patients undergoing total laryngectomy. However, this method also has limitations, such as the need for frequent replacement of prostheses due to leakage or other complications. We have designed a study to access the clinical profile of patients using tracheoesophageal prostheses as vocal rehabilitation after total laryngectomy and to determine the average rate of changes, as well as the main causes of prostheses replacement. METHODS A retrospective cohort study was performed based on patients who underwent rehabilitation with voice prostheses after total laryngectomy between 2008 and 2017. RESULTS The sample consisted of 93 patients and 432 vocal prostheses replacement events. The median change of prostheses per patient was 210.25 days, (range 57.33 to 651.50). The most frequent cause of prostheses replacement was leakage through the prostheses, 218 (50.46%). Lower level of education was associated to higher prostheses replacement rate. CONCLUSION The results of this study show that the median of prostheses durability is higher than that presented in the literature, the main cause of replacement was protheses leakage and that low educational level is associated to higher replacement rate.
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Affiliation(s)
- Rafael Cardoso Pires
- Head and Neck Surgery Department, Amazonia Cancer Hospital, Rodovia BR 364, Km 15, S/N, Área Rural, Porto Velho, Rondônia, Brazil.
| | - Ricardo Ribeiro Gama
- Head and Neck Surgery Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Paulo Sérgio da Silveira Júnior
- Head and Neck Surgery Department, Amazonia Cancer Hospital, Rodovia BR 364, Km 15, S/N, Área Rural, Porto Velho, Rondônia, Brazil
| | | | - Carlos Roberto Santos
- Head and Neck Surgery Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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7
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Stanisce L, McGlone M, Koshkareva Y, Swendseid B, Lawrence I, Kubicek GJ, Gaughan JP, Solomon DH, Ahmad N. Socioeconomic Influence on Speech Rehabilitation After Total Laryngectomy. Otolaryngol Head Neck Surg 2023; 169:1499-1505. [PMID: 37422889 DOI: 10.1002/ohn.412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Speech rehabilitation following a total laryngectomy significantly impacts the quality of life. Indwelling prosthetic voice restoration provides optimal outcomes; however, the long-term maintenance of these devices carries considerable financial costs, which are not universally covered by insurance. This investigation aimed to analyze associations between socioeconomic factors and outcomes in postlaryngectomy speech rehabilitation. STUDY DESIGN Retrospective cohort analysis. SETTING Academic tertiary-care center from May 2014 to September 2021. METHODS In patients undergoing total laryngectomy, the incidence of tracheoesophageal puncture with indwelling vocal prostheses (TEP-VP) placement within the first postoperative year was compared among household income, demographic factors, and disease characteristics. Functional and maintenance outcomes served as secondary endpoints. RESULTS Seventy-seven patients were included. Forty-five (58%) underwent indwelling TEP-VP (41 primaries). Eighty-nine percent of patients with annual incomes greater than $50k underwent TEP-VP compared to only 35% with incomes less than $50k/year. TEP-VP was performed in 85% of patients with commercial insurance, 70% with Medicare, 42% with Medicaid, and 0% with no insurance. On multivariate analysis, annual household incomes greater than $50k were predicted for TEP-VP placement (odds ratio: 12.7 [2.45-65.8], p = .002). The utilization of postoperative speech therapy and functional communication outcomes were similar among socioeconomic groups. Twelve patients were unable to afford supplies within the first year, with differences noted among insurance (p = .015) and income status (p = .003). CONCLUSION Disparities in vocal and speech rehabilitation following laryngectomy may disproportionally affect underserved patients.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Mick McGlone
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Yekaterina Koshkareva
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
| | - Brian Swendseid
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
| | - Ian Lawrence
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
- Division of Speech and Language Pathology, Cooper University Health Care, Camden, New Jersey, USA
| | - Gregory J Kubicek
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
- Department of Radiation Oncology, Cooper University Health Care, Camden, New Jersey, USA
| | - John P Gaughan
- Cooper Research Institute, Cooper University Health Care, Camden, New Jersey, USA
| | - Donald H Solomon
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Nadir Ahmad
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
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Leemans M, Longobardi Y, Dirven R, Honings J, D'Alatri L, Galli J, van den Brekel M, Parrilla C, van Sluis KE. Improving Hands-Free Speech Rehabilitation in Laryngectomized Patients with a Moldable Adhesive. Laryngoscope 2023; 133:2965-2970. [PMID: 36883657 DOI: 10.1002/lary.30636] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE This study aims to assess the product performance of a new moldable peristomal adhesive with corresponding heating pad designed to facilitate and improve automatic speaking valve (ASV) fixation for hands-free speech in laryngectomized patients. METHODS Twenty laryngectomized patients, all regular adhesive users with prior ASV experience, were included. Study-specific questionnaires were used for data collection at baseline and after two weeks of moldable adhesive use. The primary outcome parameters were adhesive lifetime during hands-free speech, use and duration of hands-free speech, and patient preference. Additional outcome parameters were satisfaction, comfort, fit, and usability. RESULTS The moldable adhesive enabled ASV fixation adequate for hands-free speech in the majority of participants. Overall, the moldable adhesive significantly increased adhesive lifetime and duration of hands-free speech compared to participants' baseline adhesives (p < 0.05), regardless of stoma depth, skin irritation, or regular use of hands-free speech at baseline. The participants who preferred the moldable adhesive (55% of participants) experienced a significant increase in the adhesive lifetime (median of 24 h, range 8-144 h) and improved comfort, fit, and ease of speech. CONCLUSION The moldable adhesive's lifetime and functional aspects, including the ease of use and custom fit, are encouraging outcomes and enable more laryngectomized patients to use hands-free speech more regularly. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2965-2970, 2023.
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Affiliation(s)
- Maartje Leemans
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Ylenia Longobardi
- UOC di Otorinolaringoiatria, Dipartimento di Scienza dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Richard Dirven
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lucia D'Alatri
- UOC di Otorinolaringoiatria, Dipartimento di Scienza dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jacopo Galli
- UOC di Otorinolaringoiatria, Dipartimento di Scienza dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michiel van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (AUMC), Amsterdam, The Netherlands
| | - Claudio Parrilla
- UOC di Otorinolaringoiatria, Dipartimento di Scienza dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Klaske E van Sluis
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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9
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Wang CC, Liao JS, Lai HC, Lo YH. Voice-Related Quality of Life Outcomes from Pneumatic Artificial Laryngeal and Esophageal Speakers. J Voice 2023; 37:970.e19-970.e27. [PMID: 34226090 DOI: 10.1016/j.jvoice.2021.05.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 10/20/2022]
Abstract
The self-reporting voice-related quality of life (V-RQOL) instrument has been viewed as a modular index of quality of life for speakers using tracheoesophageal, esophageal (ES), or electrolaryngeal speech. However, V-RQOL has never been studied with pneumatic artificial laryngeal (PA) individuals. This study attempted to quantify the self-assessed voice-related performance of PA and ES speakers in Taiwan via the V-RQOL questionnaire, and further to compare the results for PA and ES speakers. METHODS V-RQOL was assessed in 79 PA and 25 ES speakers undergoing total laryngectomy without using tracheoesophageal puncture. Data were collected from members of Taiwan's Association of Laryngectomees. RESULTS There was no significant difference between PA and ES participants in social-emotional, physical functioning and total scores, suggesting both may consider their quality of life comparable with each other. In ES participants, there was a significant effect of time after total laryngectomy in physical functioning and total scores. CONCLUSIONS PA speakers did not exhibit more dissatisfaction or disability than ES speakers on 10 statements in the V-RQOL, but after total laryngectomy the ES have been shown to improve over time. Information on the experience of PA and ES speakers could be used by clinicians to inform patients of potential outcomes, and help them select suitable rehabilitation techniques.
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Affiliation(s)
- Chen-Chi Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan; Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Jia-Shiou Liao
- Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan; Speech and Language Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Hsiu-Chin Lai
- Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Hsuan Lo
- Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
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10
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Mouret F, Crevier-Buchman L, Pillot-Loiseau C. Intelligibility of pseudo-whispered speech after total laryngectomy. Clin Linguist Phon 2023; 37:866-882. [PMID: 35818773 DOI: 10.1080/02699206.2022.2092425] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to assess the intelligibility of so-called 'pseudo-whispered speech' (pseudo-WS), as produced without voice nor pulmonic airstream by some alaryngeal patients prior to rehabilitation. Several perception tests were submitted to three experienced clinicians and three naive listeners, relying on the speech samples of 20 French native speakers: 10 alaryngeal speakers, solely using pseudo-WS when starting speech therapy up to six months after total laryngectomy, and 10 control speakers, recorded in the closest speech mode available, whispered speech (WS). Experts were asked to identify consonants (C) in the /a/+C+/a/ context and to rate intelligibility, unintended additive noise, and fluency on a likert-scale, while naive listeners completed a quantitative test of intelligibility. Intelligibility of WS was found to be high, with scores ranging from 46.33/54 to 53.67/54 (median 52.5, interquartile range 2.33) for the quantitative test, and segmental intelligibility ranging from 68.75% to 94.79% (median 87.5, interquartile range 17.71). Segmental confusion affected voicing in favour of unvoiced consonants, as previously reported in the literature. By contrast, intelligibility of pseudo-WS was found to be poor, with scores ranging from 1/54 (unintelligibility) to 28.33/54 (median 8.66, interquartile range 14.67) for the quantitative test, and segmental intelligibility ranging from 3.13% to 28.13% (median 9.24, interquartile range 14.58). Segmental intelligibility was not uniformly affected: stops, labials and unvoiced consonants were better identified than other categories. Finally, a significant correlation was found between global intelligibility and articulatory precision, while unintended additive noise and fluency seemed to play no role.
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Affiliation(s)
- François Mouret
- Université Rennes 2, UFR ALC, Rennes, France
- Laboratoire de Phonétique et Phonologie (LPP) UMR 7018, CNRS & Université Sorbonne Nouvelle, Institut de Linguistique et de Phonétique Générales et Appliquées, Paris, France
| | - Lise Crevier-Buchman
- Laboratoire de Phonétique et Phonologie (LPP) UMR 7018, CNRS & Université Sorbonne Nouvelle, Institut de Linguistique et de Phonétique Générales et Appliquées, Paris, France
| | - Claire Pillot-Loiseau
- Laboratoire de Phonétique et Phonologie (LPP) UMR 7018, CNRS & Université Sorbonne Nouvelle, Institut de Linguistique et de Phonétique Générales et Appliquées, Paris, France
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Bogdanov V, Posala M, Herzog M. Olfactory rehabilitation via retronasal olfaction using a tracheoesophageal voice prosthesis after total laryngectomy. HNO 2023; 71:19-25. [PMID: 36480048 DOI: 10.1007/s00106-022-01229-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 12/13/2022]
Affiliation(s)
- V Bogdanov
- Department of Otorhinolaryngology, Head and Neck Surgery, Carl-Thiem-Klinikum Cottbus gGmbH, Thiemstr. 111, 03048, Cottbus, Germany.
- Smell & Taste Clinic, Department of Otorhinolaryngology, "Technische Universität Dresden", Dresden, Germany.
| | - M Posala
- Department of Otorhinolaryngology, Head and Neck Surgery, Carl-Thiem-Klinikum Cottbus gGmbH, Thiemstr. 111, 03048, Cottbus, Germany
| | - M Herzog
- Department of Otorhinolaryngology, Head and Neck Surgery, Carl-Thiem-Klinikum Cottbus gGmbH, Thiemstr. 111, 03048, Cottbus, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University, Halle - Wittenberg, Halle (Saale), Germany
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12
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Yang S, Bunn C, Kramer S, Thorpe E. The Dynamic Tracheoesophageal Prosthesis Length. J Voice 2023; 37:633.e1-633.e6. [PMID: 34024697 DOI: 10.1016/j.jvoice.2021.03.025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE In a postlaryngectomy patient, tracheoesophageal (TE) speech is considered to be the most effective and preferred method of communication. Previous research has demonstrated that despite an appropriately sized TE prosthesis placement at the time of puncture, there are a portion of patients that require resizing postoperatively. The purpose of this study was to report on the variability of the tracheoesophageal prosthesis length. STUDY DESIGN Retrospective chart review. SETTING Tertiary care academic medical center. METHODS This was a retrospective chart review of 62 patients who underwent secondary tracheoesophageal puncture (TEP) at a tertiary care academic medical center from January 2008 to November 2019. Patient demographic information, average changes in prosthesis length, number of prosthesis adjustments, and timing of prosthesis exchanges were collected. RESULTS 62 patients met criteria for study inclusion. Mean age was 61.96 years old with 49 being male (79%) and 13 (21%) females. Overall change in prosthesis length was - 3.85 mm ± 3.58 with time to first prosthesis change at 2.29 months ± 2.73. There was an average of 4.37 changes ± 3.43 before reaching a stable length. Twenty-six patients (41.9%) had increases in their prosthesis length resulting in closure of the tracheoesophageal fistula requiring seven patients (11.3%) to return to the operating room for repuncturing. History of smoking (P = 0.02), Blom-Singer prosthesis type (P = 0.03), and larger diameter (P = 0.01) appeared to be predisposing factors for a fluctuating prosthesis length. CONCLUSION Tracheoesophageal prosthesis length decreases over time for secondary punctures, requiring adjustments with a speech language pathologist. There are a clinically significant portion that have fluctuations in prosthesis length resulting in an increased risk for requiring re-puncturing.
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Affiliation(s)
- Sara Yang
- Department of Otolaryngology Head and Neck Surgery, Loyola University Medical Center, 2160 S. First Ave, Maywood, Illinois.
| | - Corinne Bunn
- Department of Surgery, Loyola University Medical Center, 2160 S. First Ave, Maywood, Illinois; Burn and Shock Trauma Research Institute, Loyola University Chicago, 2160 S. First Ave, Maywood, Illinois
| | - Sarah Kramer
- Cardinal Bernardin Cancer Center, 2160 S. First Ave, Maywood, Illinois
| | - Eric Thorpe
- Department of Otolaryngology Head and Neck Surgery, Loyola University Medical Center, 2160 S. First Ave, Maywood, Illinois; Cardinal Bernardin Cancer Center, 2160 S. First Ave, Maywood, Illinois
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Miazaki da Costa Tourinho A, da Silva AR. An experimental model of the pharyngoesophageal segment in tracheoesophageal phonation. J Acoust Soc Am 2023; 153:3428. [PMID: 37350623 DOI: 10.1121/10.0019683] [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] [Received: 11/23/2022] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
Tracheoesophageal (TE) speech is an important method of speech rehabilitation for those who undergo a total laryngectomy. Despite the many advantages over other methods, there is still room for improvement in terms of the overall quality of the TE voice as well as its success rate. These points could be greatly assisted by an improved knowledge on the mechanics of TE speech. Here, an experimental model of the pharyngoesophageal segment (PES), based on the idea of a collapsible tube, is proposed. To implement the model, considerable simplifications had to be made, most notably in the use of a thin flexible tube to represent the PES. The model was used to assess the minimum amount of tonicity required for the onset of phonation in terms of the flow rate and longitudinal tension. Additionally, comparisons with a mathematical model [Tourinho, da Silva, dos Santos, Thomaz, and Vieira, J. Acoust. Soc. Am. 149, 1979-1988 (2021)] have been made, yielding similar trends for sufficiently large flow rates. The measurements also suggest that the phonation frequency is most affected by the tonicity of the PES, which highlights the question of which physiological mechanism is responsible for the control of the fundamental frequency of phonation.
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Affiliation(s)
- André Miazaki da Costa Tourinho
- Departamento de Engenharia Mecânica, Universidade Federal de Santa Catarina, Campus Universitário Trindade, Florianópolis, Santa Catarina 88040-900, Brazil
| | - Andrey Ricardo da Silva
- Departamento de Engenharia Mecânica, Universidade Federal de Santa Catarina, Campus Universitário Trindade, Florianópolis, Santa Catarina 88040-900, Brazil
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Doyle PC, Damrose EJ. Has Esophageal Speech Returned as an Increasingly Viable Postlaryngectomy Voice and Speech Rehabilitation Option? J Speech Lang Hear Res 2022; 65:4714-4723. [PMID: 36450150 DOI: 10.1044/2022_jslhr-22-00356] [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: 06/17/2023]
Abstract
PURPOSE The literature on postlaryngectomy voice and speech rehabilitation is long-standing. Although multiple rehabilitation options have existed over the years, the acquisition and use of esophageal speech (ES) has decreased significantly over the past 40 years. This reduction coincides with the increased application of tracheoesophageal puncture (TEP) voice restoration. The literature suggests that voice acquisition failures observed secondary to TEP may represent a similar phenomenon that led to ES acquisition failures. METHOD A comprehensive review of the literature on ES and TEP voice/speech was conducted. Specific attention was directed toward information on ES and TEP speech failures. Information on pharyngoesophageal segment (PES) spasm in the context of ES and TEP voicing failures was of specific importance. RESULTS Similarities between voicing failures with both ES and TEP were identified. In order to resolve spasm in TEP speech, proactive efforts to eliminate it were undertaken, and regardless of the method used, voicing improvements were observed. These data suggest that both ES and TEP speech acquisition failures may be related to the same control mechanisms influencing the PES. CONCLUSIONS The elimination of PES spasm provides evidence that justifies the reconsideration of ES. Consequently, ES may return as an increasingly viable postlaryngectomy voice and speech rehabilitation option.
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Affiliation(s)
- Philip C Doyle
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford University, CA
| | - Edward J Damrose
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford University, CA
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Mayo-Yáñez M, Chiesa-Estomba CM, Lechien JR, Maniaci A, van den Brekel M. Commentary on "Voice Rehabilitation by Voice Prostheses After Total Laryngectomy: A Systematic Review and Network Meta-Analysis for 11,918 Patients". J Speech Lang Hear Res 2022; 65:3452-3455. [PMID: 35868239 DOI: 10.1044/2022_jslhr-22-00137] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Miguel Mayo-Yáñez
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña, Galicia, Spain
- Clinical Research in Medicine, International Center for Doctorate and Advanced Studies, Universidade de Santiago de Compostela, Galicia, Spain
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies Study Group, Paris, France
| | - Carlos Miguel Chiesa-Estomba
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies Study Group, Paris, France
- Otorhinolaryngology - Head and Neck Surgery Department, Hospital Universitario Donostia, Gipuzkoa, Spain
| | - Jérôme R Lechien
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies Study Group, Paris, France
- Anatomy and Cell Biology Department, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons, Belgium
- Otorhinolaryngology Department, Elsan Hospital, Paris, France
| | - Antonino Maniaci
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies Study Group, Paris, France
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Italy
| | - Michiel van den Brekel
- Department of Head and Neck Surgery & Oncology, The Netherlands Cancer Institute Amsterdam, Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Netherlands
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Mayo-Yáñez M, Chiesa-Estomba C, Lechien JR, Calvo-Henríquez C, Vaira LA, Cabo-Varela I. Long-term outcomes and cost-effectiveness of a magnet-based valve voice prosthesis for endoprosthesis leakage treatment. Eur Arch Otorhinolaryngol 2022; 279:4167-4172. [PMID: 35217904 DOI: 10.1007/s00405-022-07313-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Tracheoesophageal speech is considered the gold standard for rehabilitation following total laryngectomy. The main reason of voice prosthesis failure is the endoprosthesis leakage. Provox ActiValve® incorporates a magnet-based valve system to achieve active closure of the valve to treat these leakages, with the drawback of being significantly more expensive. The aim of the study was to compare the Provox Vega® and Provox ActiValve® duration and costs in patients with replacements increase due to endoprosthetic leakage. METHODS Prospective case-crossover study in laryngectomized patients with Provox Vega® and endoprosthesis leakage to whom a Provox ActiValve® was placed. Survival and possible factors that affect voice prosthesis were studied using Kaplan-Meier curves and Cox Proportional Hazards Regression. Cost-effectiveness analysis from the perspective of the Spanish Public National Health System with incremental cost-effectiveness calculation was performed. RESULTS A total of 159 prostheses were evaluated. The most frequent reason for replacement was the endoprosthesis leakage (N = 129; 83.77%) in both models. The mean duration-time of Provox Vega® was 44.77 ± 2.82 days (CI 95%, 39.18-50.35; median 36 days), and 317.34 ± 116.8 days (CI 95% 86.66-548; median 286 days) for the Provox ActiValve® (p < 0.000). For every replacement not made thanks to the Provox ActiValve® there was saving of 133.97€ CONCLUSIONS: The Provox ActiValve® is a cost-effective solution in patients with increased prosthesis replacements due to endoprosthetic leakage, reducing the number of changes and cost compared to Provox Vega®.
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Affiliation(s)
- Miguel Mayo-Yáñez
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), As Xubias 84, 15006, A Coruña, Galicia, Spain.
- Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), 15782, Santiago de Compostela, Galicia, Spain.
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France.
| | - Carlos Chiesa-Estomba
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, 20014, Donostia, Euskadi, Spain
| | - Jérôme R Lechien
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France
- Otolaryngology Department, Elsan Hospital, Paris, France
- Otorhinolaryngology and Head and Neck Surgery Department, Foch Hospital, Paris Saclay University, Paris, France
| | - Christian Calvo-Henríquez
- Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), 15782, Santiago de Compostela, Galicia, Spain
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario Santiago de Compostela (CHUS), 15706, Santiago de Compostela, Galicia, Spain
| | - Luigi A Vaira
- Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) Study Group, Paris, France
- Maxillofacial Surgery Operative Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Irma Cabo-Varela
- Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), As Xubias 84, 15006, A Coruña, Galicia, Spain
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Molteni G, Fulco G, Gazzini L, Laura E, Paiola G, Giacopuzzi S, Marchioni D, Pighi GP. Prosthetic voice rehabilitation after laryngoesophagectomy: surgical and functional outcomes. Eur Arch Otorhinolaryngol 2022; 279:4085-4092. [PMID: 35034188 DOI: 10.1007/s00405-022-07251-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/01/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Quality of Life (QoL) after extensive head and neck resections is of paramount importance, especially after pharyngolaryngectomy or pharyngolaryngoesophagectomy where complex digestive tract reconstruction is required (with gastric pull-up or colon transposition). Tracheodigestive puncture (TDP) is the only vocal restoration option in this group of patients. The aim of this study is to evaluate postoperative complications, vocal outcomes, voice-related and swallowing-related QoL after secondary TDP in this cohort of patients. METHODS A retrospective study was conducted in the tertiary referral center of Verona Hospital between June 2014 and June 2020. Patient demographics, clinical and surgical data were assessed. Speech objective and subjective evaluation was performed. QoL was assessed with Voice Handicap Index-10 (VHI-10) and M.D. Anderson Dysphagia Inventory (MDADI) questionnaires. RESULTS Seven patients met the inclusion criteria, but two had died before questionnaires were administered. No intraoperative complications were noted after TDP surgery. There were delayed complications in four cases (57.1%) and all were treated with restoration. Intelligible voice was restored in all patients. Maximum phonation time and maximal voice intensity recorded were 5.42 ± 3.27 s and 65.20 ± 5.45 dB, respectively. Acceptable average VHI-10 and MDADI scores were obtained in all patients. CONCLUSIONS Secondary TDP performed after gastric pull-up or colon transposition reconstructions are feasible and effective procedures. An intelligible voice was restored in all patients, with satisfactory patient-perceived voice-related and dysphagia-related quality-of-life outcomes.
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Affiliation(s)
- Gabriele Molteni
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Gianfranco Fulco
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Luca Gazzini
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Elisa Laura
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
| | - Giuliana Paiola
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, University Hospital of Verona, Verona, Italy
| | - Daniele Marchioni
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Gian Paolo Pighi
- Otolaryngology-Head and Neck Surgery, Department of Surgery, Dentistry, Gynecology, and Pediatrics, University of Verona, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
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Bozec A, Boscagli M, Serris M, Chamorey E, Dassonville O, Poissonnet G, Culié D, Scheller B, Benezery K, Gal J. Long-term functional and quality of life outcomes in laryngectomized patients after successful voice restoration using tracheoesophageal prostheses. Surg Oncol 2021; 38:101580. [PMID: 33862577 DOI: 10.1016/j.suronc.2021.101580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess long-term functional and quality of life (QoL) outcomes and their predictive factors in laryngectomized patients after successful voice restoration using tracheoesophageal prostheses (TEP). METHODS This cross-sectional study was conducted in alive and disease-free patients at least 1 year after total laryngectomy ± partial pharyngectomy. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) Core (QLQ-C30) and Head and Neck Cancer (QLQ-H&N35) QoL questionnaires, the Voice Handicap Index (VHI-10) questionnaire and the Hospital Anxiety and Depression Scale (HADS). The level of dysphagia was evaluated using the Dysphagia Handicap Index (DHI) and the Dysphagia Outcomes and Severity Scale (DOSS). Predictive factors of these clinical outcomes were determined in univariate and multivariate analysis. RESULTS A total of 48 patients were included in this study. Long-term QoL and functioning scales scores were all superior to 70%. Main persistent symptoms were fatigue, dyspnea, senses, speech and coughing problems. A DOSS score ≥6, indicating normal/subnormal swallowing function, and a VHI-10 score ≤20, representing light to medium voice disorders, were found in at least 75% of patients. An anxiodepressive disorder (HADS global score ≥ 15) was reported by 15 (31%) patients and represented the main predictor of QoL and voice outcomes. A strong correlation was found between VHI-10 and global QoL scores. CONCLUSIONS After successful voice restoration, laryngectomized patients achieved satisfactory QoL and functional outcomes. Psychological distress was the main determinant of long-term QoL and is therefore of critical importance in the multidisciplinary management of laryngectomized patients.
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Affiliation(s)
- Alexandre Bozec
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France.
| | - Maxime Boscagli
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Marilou Serris
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Emmanuel Chamorey
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Olivier Dassonville
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Gilles Poissonnet
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Dorian Culié
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Boris Scheller
- Institut Universitaire de La Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Jocelyn Gal
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
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Hancock KL, Ward EC, Hill AE. Factors contributing to clinician training and development in the clinical area of laryngectomy and tracheoesophageal voice. Int J Lang Commun Disord 2020; 55:690-701. [PMID: 32654424 DOI: 10.1111/1460-6984.12553] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND It has long been recognized that tracheoesophageal speech (TES) rehabilitation after laryngectomy is a specialized area of practice for speech and language therapist (SLTs) due to the complex nature of patient presentation and the invasive components of the SLT's role in this area. Therefore, postgraduate experience and training is required to work competently and safely in this clinical area. However, it is generally acknowledged that the steps and processes followed by individual clinicians to achieve this training and clinical skill development are inconsistent and vary widely across services. There is a need to identify critical elements deemed most beneficial to clinical skill development in order to inform future training models. AIMS To explore clinicians' perceptions of factors that contribute to training and clinical skills development in the area of TES rehabilitation post-laryngectomy. METHODS & PROCEDURES All participants were SLTs working in an Australian clinical service, with a current or recent clinical caseload that included patients using TES. A total of 36 SLTs were recruited and then grouped by level of experience (novice n = 15, intermediate n = 7, experienced n = 14). Each participant took part in one small focus group with other participants of similar experience level. Ten focus groups were conducted, each of approximately 60 min in duration. A semi-structured interview guide was used to facilitate the discussion of issues relating to training in this area. Thematic analysis was used to analyse transcripts and identify themes. OUTCOMES & RESULTS Interviews identified six key themes, including: Learning with and from others; Formal programmes; Hands-on learning; Processes that influence training; and Individual influences. SLTs reported both positive issues and elements that were challenging across all five themes. The final (sixth) theme was identified regarding clinician perceptions of how this area differed to specialized training in other areas of the profession. The majority of themes were discussed equally by clinicians across all three experience levels. CONCLUSIONS & IMPLICATIONS Participants across all experience levels identified that multiple factors contributed to clinicians successfully gaining skills, understanding and competency when working in TES rehabilitation post-laryngectomy. These factors, when fully considered and incorporated into future SLTs training pathways and opportunities, have the potential to optimize competency, skill acquisition and maintenance in this area. What this paper adds What is already known on this subject While studies have considered the training, preparation and knowledge base of SLTs working in the clinical area of TES, the focus has predominantly been at the immediate postgraduate level or assessment of university course work. No studies have used a qualitative methodology to consider the reflections and perceptions of clinicians' training pathways and training needs across all levels of experience for this clinical area. What this paper adds to existing knowledge The results of this study build upon the existing body of literature regarding education and training in this area, determining factors SLTs feel are required to successfully gain skills, understanding and competency when working in TES rehabilitation. The findings highlight that training pathways and methods in this clinical area are an ongoing consideration for SLTs regardless of experience level and have the ability to impact on future competency programmes, training opportunities and delivery methods in this area. What are the potential or actual clinical implications of this work? Effective and ongoing postgraduate training programmes and professional development opportunities have the potential to positively impact on professional competence and confidence, patient safety and overall service delivery. Hence, the themes generated from this research highlight essential factors to include within training and professional development programmes for SLTs in TES rehabilitation. This information can be used to help optimize current training pathways for all experience levels.
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Affiliation(s)
- Kelli L Hancock
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, QLD, Australia
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia
| | - Anne E Hill
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia
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van Sluis KE, Kornman AF, Groen WG, van den Brekel MWM, van der Molen L, Hoffman-Ruddy B, Stuiver MM. Expiratory Muscle Strength Training in patients After Total Laryngectomy; A Feasibility Pilot Study. Ann Otol Rhinol Laryngol 2020; 129:1186-1194. [PMID: 32527195 DOI: 10.1177/0003489420931889] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Expiratory muscle strength training (EMST) is a threshold based device-driven treatment for improving expiratory pressure. EMST proved to be effective in different patient groups to improve cough function. To date, EMST has not been tested in the total laryngectomy population (TL). METHODS This prospective, randomized case-series study examined feasibility, safety, and compliance of EMST in a group of TL participants and its effects on pulmonary function, physical exertion, fatigue, and vocal functioning. Ten TL participants were included in the study to perform a 4 till 8 weeks of EMST. Objective and subjective outcome measures included manometry, spirometry, cardio pulmonary exercise testing (CPET), voice recordings, and patient reported outcome measures. Group means were reported and estimates of the effect are shown with a 95% confidence interval, using single sample t-tests. RESULTS Nine participants completed the full study protocol. Compliance to the training program was high. All were able to perform the training, although it requires adjustments of the device and skills of the participants. Maximum expiratory pressure (MEP) and vocal functioning in loudness improved over time. After EMST no changes were seen in other objective and subjective outcomes. CONCLUSIONS EMST appears to be feasible and safe after total laryngectomy. MEP improved over time but no improvement in the clinically relevant outcome measures were seen in this sample of relatively fit participants. Further investigation of the training in a larger group of participants who report specifically pulmonary complaints is recommended to investigate if the increase in MEP results in clinical benefits. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Klaske E van Sluis
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Noord-Holland, The Netherlands
- Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne F Kornman
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Noord-Holland, The Netherlands
| | - Wim G Groen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Noord-Holland, The Netherlands
- Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
- Department of Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Noord-Holland, The Netherlands
| | - Bari Hoffman-Ruddy
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA
| | - Martijn M Stuiver
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Noord-Holland, The Netherlands
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
- ACHIEVE, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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van Sluis KE, Kornman AF, van der Molen L, van den Brekel MWM, Yaron G. Women's perspective on life after total laryngectomy: a qualitative study. Int J Lang Commun Disord 2020; 55:188-199. [PMID: 31674722 PMCID: PMC7079180 DOI: 10.1111/1460-6984.12511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/11/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Physical and psychosocial challenges are common after total laryngectomy. The surgery leads to lifelong changes in communication, airway, swallowing and appearance. As we move towards health models driven by patient-centred care, understanding the differential impacts of surgical procedures on subgroups of patients can help improve our care models, patient education and support systems. This paper discusses the experiences of women following total laryngectomy. AIMS To gain an insight into the impact of total laryngectomy on women's daily life while identifying their specific rehabilitation needs. METHODS & PROCEDURES This paper is based on in-depth, semi-structured interviews with eight women who had undergone total laryngectomy. These interviews were conducted with women at least 1 year after they had undergone total laryngectomy, and the participants did not have recurrent disease. Using an interview guide, participants were encouraged to discuss their everyday experiences, while also focusing on issues typical to women. The transcribed interview data were analysed by thematic analysis, taking interpretative phenomenological analysis as a lead. OUTCOMES & RESULTS The interviews revealed three main themes: disease and treatment as a turning point, re-establishing meaningful everyday activities, and persistent vulnerability. Participants reported experiencing challenges in their rehabilitation process due to physical disabilities, dependency on others and experienced stigma. Women-specific challenges arose in dealing with the altered appearance and voice, performing care activities, and the spousal relationship (including intimacy). CONCLUSIONS & IMPLICATIONS Women who undergo total laryngectomy are likely to experience issues in returning to work, the performance of informal care-work, the spousal relationship, intimacy and social interaction due to stigmatization. Medical pretreatment counselling and multidisciplinary rehabilitation programmes should help patients form realistic expectations and prepare them for the changes they will face. A gender- and age-matched laryngectomized patient visitor can contribute to this process. Rehabilitation programmes should incorporate the partner and offer psychosocial support for women following total laryngectomy to return to their former roles in family life, social life and work-related activities.
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Affiliation(s)
- Klaske E. van Sluis
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
- Amsterdam Center for Language and CommunicationUniversity of AmsterdamAmsterdamthe Netherlands
| | - Anne F. Kornman
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
| | - Michiel W. M. van den Brekel
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
- Amsterdam Center for Language and CommunicationUniversity of AmsterdamAmsterdamthe Netherlands
| | - Gili Yaron
- Department of Head and Neck Oncology and SurgeryNetherlands Cancer Institute‐Antoni van LeeuwenhoekAmsterdamthe Netherlands
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
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22
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Heutte N, Abouzayd M, Plisson L, Trocmé M, Seillier M, Christophe V, Guittet L, Grandazzi G, Babin E. French Therapeutic Education Programme Aimed at Improving the Quality of Life of Laryngectomised Patients and their Close Relations: the Three Stages (Observational and Interventional Randomised) of the Study "PETAL". J Cancer Educ 2019; 34:823-830. [PMID: 29926431 DOI: 10.1007/s13187-018-1380-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The therapeutic education of patients and their close relations is, as yet, poorly developed in France in the field of oncology. Total laryngectomy is a mutilating surgical procedure having a major impact on the patient's life, due to its physical and functional sequelae. Its psychosocial consequences are also important and alter the quality of life of patients and their close relations. Currently, care for laryngectomised patients consists essentially in informing and educating them on some technical procedures during hospital admission. The intervention of a speech therapist, often serves as the link between the patient and the hospital care team. These healthcare modalities often insufficiently account for the social, environmental and personal factors that interact in health-related problems. This report presents the therapeutic education programme protocol "PETAL" for laryngectomised patients and their close relations to improve their quality of life. The trial will be conducted over three phases: (1) the "pilot" phase aims at developing knowledge on the consequences of laryngectomy on the quality of life of patients and their close relations and developed a pluridisciplinary therapeutic education program, (2) the prospective intervention "replication" phase aims at evaluating the programme's transferability in three centres and (3) the cluster-randomised multicentric comparative intervention phase, will assess the benefits of the developed programme. Phase I identified nine themes of workshops related to therapeutic education, training and coordination of care. The developed programme should reinforce town-hospital links to improve help, follow-up and support for patients and their close relations.
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Affiliation(s)
- Natacha Heutte
- UNIROUEN, CETAPS EA 3832, University of Normandy, Mont Saint-Aignan, France.
| | | | - Laetitia Plisson
- UMR 1086 INSERM « ANTICIPE » and University of Normandy, Caen, France
| | - Mélanie Trocmé
- Lille University, UMR CNRS 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Rue du Barreau 59653, 60149, Villeneuve d'Ascq cedex, BP, France
| | | | - Véronique Christophe
- Lille University, UMR CNRS 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Rue du Barreau 59653, 60149, Villeneuve d'Ascq cedex, BP, France
| | - Lydia Guittet
- UMR 1086 INSERM « ANTICIPE » and University of Normandy, Caen, France
| | | | - Emmanuel Babin
- UMR 1086 INSERM « ANTICIPE » and University of Normandy, Caen, France
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van Uden-Kraan CF, Jansen F, Lissenberg-Witte BI, Eerenstein SEJ, Leemans CR, Verdonck-de Leeuw IM. Health-related and cancer-related Internet use by patients treated with total laryngectomy. Support Care Cancer 2019; 28:131-140. [PMID: 30993449 PMCID: PMC6892363 DOI: 10.1007/s00520-019-04757-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/18/2019] [Indexed: 01/28/2023]
Abstract
Objectives To investigate among patients treated with a total laryngectomy (TL) (1) Internet-use and Internet use to search for information on health and cancer (content); (2) which patients are most likely to use the Internet in general, for health-related and cancer-related purposes; (3) which other types of eHealth (community, communication, care) are used; and (4) preferences towards future use. Methods Patient members of the Dutch TL patient society were asked to complete a questionnaire on Internet use, health-related and cancer-related Internet use, types of eHealth, preferences towards future use, socio-demographics, clinical factors, and quality of life (QOL). Factors associated with Internet use and health-related and cancer-related Internet use were investigated using stepwise logistic regression analysis. Results In total, 279 TL patients participated, of whom 68% used the Internet. Of these, 63% used the Internet to search for information on health and 49% on cancer. Younger and higher educated TL patients and those with better QOL used the Internet more often. Patients with worse QOL searched more often for health-related information. Younger patients and those with shorter time since TL searched more often for cancer-related information. The current use of eHealth for communication, community, and care purposes among Internet users was limited (range, 2 to 15%). Many were interested in using these types of eHealth in the future (range, 21 to 72%). Conclusion The majority used the Internet, especially to search for information on health and cancer, but only few for communication, community, or care purposes. Many were interested in future use.
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Affiliation(s)
- Cornelia F van Uden-Kraan
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Femke Jansen
- Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Simone E J Eerenstein
- Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - C René Leemans
- Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.
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Affiliation(s)
- Stephen Kang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA.
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25
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Coffey MM, Tolley N, Howard D, Hickson M. Double Blind Study Investigating the Effect of Different Voice Prostheses on Ease of Swallowing and Residue Post Laryngectomy. Dysphagia 2018; 33:616-626. [PMID: 29460049 PMCID: PMC6132872 DOI: 10.1007/s00455-018-9880-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 05/03/2017] [Accepted: 01/30/2018] [Indexed: 11/25/2022]
Abstract
Voice prostheses have been examined for their effect on voice production but there is little datum on their effect on swallow function. This study investigated the difference between six commonly available voice prostheses in terms of swallowing. Laryngectomy patients had up to six voice prostheses placed in a random order over two visits. Swallowing was evaluated for each prosthesis using FEES (Fibreoptic Endoscopic Evaluation of Swallowing). After each prosthesis trial, patients self-evaluated their experience of swallowing. Three independent experts indicated which prosthesis they considered best for swallowing for each patient and judged residue on the voice prosthesis and in the upper esophagus. Raters were blinded to participant details, voice prosthesis type and scores of other raters. On patient self-evaluation, scores were equally distributed across all prostheses for swallowing. Experts most frequently chose the Blom Singer Low pressure and Blom Singer Classic Indwelling voice prostheses as best for swallowing but consensus was poor for most patients. Experts found that the Blom Singer Classic Indwelling and the Provox Vega had least residue on the voice prosthesis on thin liquid (p ≤ 0.001) and soft (p = 0.001), respectively. Experts also found that the Blom Singer Low Pressure had least residue in the upper esophagus on soft consistency (p ≤ 0.001). While self-evaluation by patients did not identify a consistently preferred prosthesis for swallow, many patients expressed personal preferences, suggesting benefits to involving patients in the choice of prosthesis. Some voice prostheses may be associated with lower levels of residue on the prosthesis and upper esophagus with certain consistencies.
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Affiliation(s)
- Margaret M Coffey
- Imperial College Healthcare Trust, SLT Department, Charing Cross Hospital, Ground Floor, South Wing, Fulham Palace Road, London, W6 8RF, UK.
| | - Neil Tolley
- Imperial College Healthcare Trust, ENT Department, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - David Howard
- Imperial College Healthcare Trust, ENT Department, Charing Cross Hospital, Fulham Palace Road, London, W6 8QX, UK
| | - Mary Hickson
- Institute of Health and Community, Plymouth University, Drake Circus, Plymouth, Devon, PL4 8AA, UK
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26
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Rosa VM, Fores JML, da Silva EPF, Guterres EO, Marcelino A, Nogueira PC, Baia WRM, Kulcsar MAV. Interdisciplinary interventions in the perioperative rehabilitation of total laryngectomy: an integrative review. Clinics (Sao Paulo) 2018; 73:e484s. [PMID: 30208167 PMCID: PMC6113851 DOI: 10.6061/clinics/2018/e484s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/26/2018] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to use the scientific literature to identify interdisciplinary interventions for rehabilitation during the perioperative period for cancer patients who underwent total laryngectomy. We systematically researched controlled descriptors: laryngectomy, patient care team/education, patient care team/manpower, patient care team/methods, patient care team/utilization and rehabilitation. We performed a qualitative narrative synthesis and identified 549 articles. Of these, 113 were duplicates, 398 were excluded during the analysis of the title and abstract, 1 was excluded for unfeasibility of access, and 4 were excluded after reading the article in full, resulting in 33 included articles. The articles addressed different types of interdisciplinary actions, such as vocal, olfactory, pulmonary and alimentary rehabilitation; comparisons of prosthetic devices; and descriptions of practices for total laryngectomized patient rehabilitation. Although the interventions found in the literature were effective in the rehabilitation of the total laryngectomized patient, their interdisciplinarity was not evidenced but was highlighted in these studies as a factor for improvement in terms of practical assistance and quality of life.
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Affiliation(s)
- Vitor Modesto Rosa
- Servico de Nutricao e Dietetica, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Joselia Maria Lira Fores
- Enfermagem, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Erika Priscila Ferreira da Silva
- Fisioterapia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Elizeteh Oliveira Guterres
- Servico de Nutricao e Dietetica, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Endoscopia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Aline Marcelino
- Enfermagem, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | | | - Marco Aurélio Vamondes Kulcsar
- Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Li W, Zhaopeng Q, Yijun F, Haijun N. Design and Preliminary Evaluation of Electrolarynx With F0 Control Based on Capacitive Touch Technology. IEEE Trans Neural Syst Rehabil Eng 2018. [PMID: 29522407 DOI: 10.1109/tnsre.2018.2805338] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An electrolarynx (EL) is one of the most popular voice rehabilitation technologies used after laryngectomy. However, most ELs generate monotonic EL speech, which has been shown to create a particular deficit in speech intelligibility, especially for Chinese Mandarin (Mandarin). Mandarin is a tonal language that makes lexical distinctions using variations in tone. Our purpose is to design an EL that can produce the four Mandarin tones, and to evaluate its performance. We designed a fundamental frequency (F0) control method for Mandarin EL speech and manufactured a touch-controlled electrolarynx (T-EL) prototype. Using monosyllables, disyllabic words, and frequently used phrases, we evaluated speech produced with a T-EL, as well as with monotone (M-EL) and variable-frequency modes (P-EL) of a commercially available TruTone EL. A male native Mandarin speaker with laryngectomy volunteered to be the speaker. Results show that the normal speech pitch contours of the four Mandarin tones were most closely matched by the characteristics produced with T-EL. The statistical accuracy of the T-EL's tone and word perception was significantly higher than that of the other EL types. Moreover, the confusion matrix indicates that the listeners could correctly identify the tones of monosyllables and disyllabic words in T-EL speech. Accurate tone judgment can improve the intelligibility of EL speech in Mandarin. The mean opinion score was used to evaluate the listeners' acceptability of EL speech. The scores of the T-EL and M-EL were very close, and the score of the P-EL was significantly lower than that of the other two ELs. However, the results from a single speaker cannot provide sufficient data to conclude which EL has a higher acceptability. The evaluation of multiple EL speakers with different EL types at difference levels of proficiency should be studied in future research.
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Silveira HSL, Simões-Zenari M, Kulcsar MA, Cernea CR, Nemr K. Combined Vocal Exercises for Rehabilitation After Supracricoid Laryngectomy: Evaluation of Different Execution Times. J Voice 2017; 32:723-728. [PMID: 29111339 DOI: 10.1016/j.jvoice.2017.09.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/08/2017] [Accepted: 09/12/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The supracricoid partial laryngectomy allows the preservation of laryngeal functions with good local cancer control. OBJECTIVE To assess laryngeal configuration and voice analysis data following the performance of a combination of two vocal exercises: the prolonged /b/vocal exercise combined with the vowel /e/ using chest and arm pushing with different durations among individuals who have undergone supracricoid laryngectomy. METHODS Eleven patients undergoing partial laryngectomy supracricoid with cricohyoidoepiglottopexy (CHEP) were evaluated using voice recording. Four judges performed separately a perceptive-vocal analysis of hearing voices, with random samples. For the analysis of intrajudge reliability, repetitions of 70% of the voices were done. Intraclass correlation coefficient was used to analyze the reliability of the judges. For an analysis of each judge to the comparison between zero time (time point 0), after the first series of exercises (time point 1), after the second series (time point 2), after the third series (time point 3), after the fourth series (time point 4), and after the fifth and final series (time point 5), the Friedman test was used with a significance level of 5%. The data relative to the configuration of the larynx were subjected to a descriptive analysis. RESULTS In the evaluation, were considered the judge results 1 which have greater reliability. There was an improvement in the general level of vocal, roughness, and breathiness deviations from time point 4 [T4]. CONCLUSION The prolonged /b/vocal exercise, combined with the vowel /e/ using chest- and arm-pushing exercises, was associated with an improvement in the overall grade of vocal deviation, roughness, and breathiness starting at minute 4 among patients who had undergone supracricoid laryngectomy with CHEP reconstruction.
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Affiliation(s)
- Hevely Saray Lima Silveira
- Faculdade de Medicina-Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Marcia Simões-Zenari
- Faculdade de Medicina-Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Marco Aurélio Kulcsar
- Faculdade de Medicina-Universidade de São Paulo, Departamento de Cirurgia, Disciplina de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Claudio Roberto Cernea
- Faculdade de Medicina-Universidade de São Paulo, Departamento de Cirurgia, Disciplina de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Kátia Nemr
- Faculdade de Medicina-Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo, SP, Brazil.
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Serra A, Spinato G, Spinato R, Conti A, Licciardello L, Di Luca M, Campione G, Tonoli G, Politi D, Castro V, Maniaci A, Maiolino L, Cocuzza S. Multicenter prospective crossover study on new prosthetic opportunities in post-laryngectomy voice rehabilitation. J BIOL REG HOMEOS AG 2017; 31:803-809. [PMID: 28958139] [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: 06/07/2023]
Abstract
The aim of this study was to assess the clinical experience of three Italian centers using the third generation Provox Vega prosthesis, in terms of device life and voice outcome, comparing the results with the second generation Provox 2 prosthesis in the same sample. A prospective multicenter crossover study was performed in three phases. In the first phase we performed a reassessment, for enrollment purposes, of patients who were categorized into four different groups [normal – group A; radio-treated – group B; gastroesophageal reflux disease (GERD) – group C; and elderly subjects – group D]. In the second and third phases, all patients were monitored for prosthetic device life and assessed for objective and subjective voice characteristics after introducing Provox 2 and Provox Vega prostheses. In patients with Provox 2 prosthesis, the mean life was 165 days in group A, 148 days in group B, 91 days in group C and 188 days in group D. In Provox Vega patients, mean in situ prosthesis life was 213 days in group A, 182 days in group B, 118 days in group C and 227 days in group D. The perceptual voice data showed a better rating across all parameters for the Provox Vega samples compared to those of Provox 2. In this paper, we report the first multicenter crossover study comparing different prosthetic models in the same patients, categorized in relation to different typologies of tracheoesophageal rehabilitative status. Result analyses confirmed an optimal stability of the Provox Vega compared to the Provox 2, in terms of device life and perceptual voice parameters.
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Affiliation(s)
- A Serra
- ENT Department of University of Catania, Italy
| | - G Spinato
- ENT Department, Rovigo Provincial Hospital, Italy
| | - R Spinato
- Provincial ENT Department of Venice, Mestre, Italy
| | - A Conti
- ENT Department of University of Catania, Italy
| | | | - M Di Luca
- ENT Department of University of Catania, Italy
| | - G Campione
- ENT Department of University of Catania, Italy
| | - G Tonoli
- ENT Department, Rovigo Provincial Hospital, Italy
| | - D Politi
- Provincial ENT Department of Venice, Mestre, Italy
| | - V Castro
- ENT Department of University of Catania, Italy
| | - A Maniaci
- ENT Department of University of Catania, Italy
| | - L Maiolino
- ENT Department of University of Catania, Italy
| | - S Cocuzza
- ENT Department of University of Catania, Italy
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Childes JM, Palmer AD, Fried-Oken M, Graville DJ. The Use of Technology for Phone and Face-to-Face Communication After Total Laryngectomy. Am J Speech Lang Pathol 2017; 26:99-112. [PMID: 28166547 DOI: 10.1044/2016_ajslp-14-0106] [Citation(s) in RCA: 2] [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] [Received: 07/25/2014] [Accepted: 06/22/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this article is to describe the characteristics and experiences of individuals who use technology to support telephone or face-to-face communication after total laryngectomy. METHOD An online questionnaire was used to identify potential participants. Seventeen individuals met inclusion criteria and participated in an in-depth survey. They were compared with a reference group matched for age, gender, and time postsurgery who did not use these technologies. Open-ended responses were summarized. RESULTS Compared with the matched reference group, individuals who used technology to support verbal communication had undergone more aggressive cancer treatment and used more communication methods. They were less likely to use an alaryngeal speech method, had greater difficulty over the telephone, and used more repair strategies in face-to-face communication. The 2 groups did not differ significantly in the frequency or success of their communication, however. Open-ended responses revealed great variety with regard to their reasons, purposes, and timing of technology use. CONCLUSIONS There is a subset of individuals using technology to support verbal communication very successfully after laryngectomy. Usage was not limited to those who were unable to communicate verbally and often continued long after the initial postoperative period in many settings, for various purposes, and in combination with other methods of communication.
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Affiliation(s)
- Jana M Childes
- NW Clinic for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Andrew D Palmer
- NW Clinic for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Melanie Fried-Oken
- NW Clinic for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Donna J Graville
- NW Clinic for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
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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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Mäkitie AA, Niemensivu R, Juvas A, Aaltonen LM, Bäck L, Lehtonen H. Postlaryngectomy Voice Restoration Using a Voice Prosthesis: A Single Institution's Ten-Year Experience. Ann Otol Rhinol Laryngol 2016; 112:1007-10. [PMID: 14703101 DOI: 10.1177/000348940311201202] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 11/17/2022]
Abstract
We describe the speech rehabilitation outcome of patients treated with total laryngectomy or total laryngopharyngectomy and insertion of Provox voice prostheses (Atos Medical AB, Hörby, Sweden) at the Helsinki University Central Hospital. We performed a retrospective chart review of 95 patients (88 men and 7 women; mean age, 63.5 years) who underwent insertion of a voice prosthesis in the period 1992 to 2002. Eighty-one percent (77/95) of the patients underwent a primary prosthesis insertion at the time of laryngectomy. A head and neck surgeon, a laryngologist, and a speech therapist rated the long-term tracheoesophageal speech of 78% (74/95) of the patients as good or average. The main causes for replacement of the device were obstruction, leakage or inadequate size of the prosthesis, and granulation or leakage around the fistula. According to our 10-year experience, use of the Provox prosthesis is an effective method of postlaryngectomy voice rehabilitation, and it continues to be our preferred method of voice restoration in the majority of cases.
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Affiliation(s)
- Antti A Mäkitie
- Department of Otolaryngology-Head and Neck Surgery, Helsinki University Central Hospital, Helsinki, Finland
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Büntzel J, Büntzel H, Mücke R, Besser A, Micke O. Sport in the Rehabilitation of Patients After Total Laryngectomy. Anticancer Res 2016; 36:3191-3194. [PMID: 27272847] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/20/2016] [Indexed: 06/06/2023]
Abstract
AIM Laryngectomy due to cancer leads to decreased physical activity of patients. Rehabilitation programs focus on the improvement of voice and swallowing but the role of rehabilitation sports for such patients is unknown. PATIENTS AND METHODS We interviewed all 38 patients (five women, 33 men; median age 56 years) of our patient's advocacy group. All had undergone laryngectomy because of cancer. We asked them to report their sporting activities and summarized their descriptions. RESULTS Overall, 12 patients were members of our swimming group and had performed aqua gymnastics and swimming training in order to stabilize or improve the muscle structures of the neck and backbone. A further four patients only took part in swimming training. The training frequency was twice per month; when patients were introduced to the program, they increased this frequency to 4-5/month. Three patients started cycling with mountain bikes covering distances of between 30 and 50 km. A further two patients were able to follow our cycling program using e-bikes. Twenty patients reported walking weekly between 10 and 16 km. All patients summarized the positive impact of sports on their personal well-being. CONCLUSION Swimming, aqua-fitness, cycling and (Nordic) walking are favourable sport disciplines for patients after laryngectomy for laryngeal cancer. Special training programs should be developed and included in rehabilitation procedures for patients after multimodal therapy of laryngeal cancer.
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Affiliation(s)
- Jens Büntzel
- Department of Otolaryngology, Südharz Hospital Nordhausen, Nordhausen, Germany
| | - Heike Büntzel
- Department of Palliative Care, Südharz Hospital Nordhausen, Nordhausen, Germany
| | - Ralph Mücke
- Department of Radiotherapy, Lemgo Hospital, Lemgo, Germany
| | - Antje Besser
- Department of Otolaryngology, Südharz Hospital Nordhausen, Nordhausen, Germany
| | - Oliver Micke
- Department of Radiotherapy, Franziskus Hospital Bielefeld, Bielefeld, Germany
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Lorenz KJ, Kraft K, Graf F, Pröpper C, Steinestel K. [Importance of cellular tight junction complexes in the development of periprosthetic leakage after prosthetic voice rehabilitation]. HNO 2015; 63:171-2, 174-8, 180-1. [PMID: 25515126 DOI: 10.1007/s00106-014-2951-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 01/07/2023]
Abstract
BACKGROUND The use of voice prostheses is currently the gold standard in voice rehabilitation after total laryngectomy. This method combines low complication rates and excellent rehabilitation results; however, approximately 30% of patients show periprosthetic leakage or severe fistula enlargement after laryngectomy and prosthetic voice restoration within the first 4 years. The development of this enlargement is controversially discussed in the literature but recently published studies have shown that high esophageal reflux plays a key role in this process, which leads to an inflammatory reaction and disturbs the intercellular tight junctions in the sense of an epithelial mesenchymal transition (EMT). MATERIAL AND METHODS A total of 44 patients underwent 24 h pH monitoring, a sample biopsy from the region of the fistula and a subsequent biomolecular examination for intracellular junction proteins as well as a correlation between the severity of reflux and tracheoesophageal fistula problems before and after antireflux therapy with proton pump inhibitors (PPI). RESULTS Immunohistochemical staining revealed decreases in membrane E-cadherin and β-catenin and a significant increase in the cytoplasmic fraction, depending on the severity of inflammation in the fistula tissue. In patients with an improvement of clinical fistula problems under oral PPI treatment an increase of membrane E-cadherin could be shown, whereas patients with persisting fistula enlargement demonstrated a further decrease of E-cadherin. CONCLUSION The data indicate a central role of EMT in the development of fistula enlargement after total laryngectomy. Patients with periprosthetic leakage showed a loss of membrane bound E-cadherin and β-catenin with an up-regulation of vimentin expression. In patients with mild or no leakage problems EMT could be resolved by aggressive antireflux treatment, whereas patients without any effect of PPI treatment on the fistula showed no reversal of EMT. These data contribute to the understanding of treatment resistant fistula enlargement after total laryngectomy.
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Affiliation(s)
- K J Lorenz
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Chirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland,
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Abstract
The undesired dilatation of the tracheooesophageal shunt after surgical implantation of voice prosthesis is a typical complication of this procedure. Temporary removal of the prosthesis and reinsertion after a short period of time is a first-line therapeutical option aiming shrinkage of the shunt. Failure of this measure generally is an indication of revision surgery. We present first experiences treating leakage problems with novel modified voice prosthesis without surgical intervention in specified cases. 11 patients (1 female, 10 male) aging between 51 and 71 years were presented with shunt leakage between 11/2008 and 11/2012 in the ENT-Department of the University Hospital of Homburg/Saar after a custom built voice prosthesis had been used initially successfully. A "Provox 2"(®) voice prosthesis was modified with two discs made of silicone each on the tracheal and oesophageal side and additionally reinforcing the diameter of the prosthesis by a silicone tube. The modified prosthesis was inserted in a retrograde way under general anesthesia, analogical to the approach used with the "Provox 1"(®)-prosthesis. The period of observation ranged between 12 and 48 months. As a measure of control swallowing of methylene blue was used. In all cases leakage suspended. Durability of the modified prosthesis ranged between 2 and 6 months. Neither the patients' complained about, nor did the physicians notice subjectively an impairment of the voice quality. Modifications of "Provox 2"(®)-prosthesis should be regarded in individual cases and constitute a reasonable alternative to revision surgery. A surgical approach is more intricate and costly, more taxing for the patient and susceptible to failure. We regard the necessity of general anesthesia for the insertion of the modified prosthesis as a disadvantage.
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Affiliation(s)
- Basel Al Kadah
- Department of Otorhinolaryngology, University Medical Center Homburg/Saar, Kirrberger Straße, 66421, Homburg/Saar, Germany.
| | - George Papaspyrou
- Department of Otorhinolaryngology, University Medical Center Homburg/Saar, Kirrberger Straße, 66421, Homburg/Saar, Germany
| | | | - Bernhard Schick
- Department of Otorhinolaryngology, University Medical Center Homburg/Saar, Kirrberger Straße, 66421, Homburg/Saar, Germany
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Cnossen IC, van Uden-Kraan CF, Eerenstein SEJ, Jansen F, Witte BI, Lacko M, Hardillo JA, Honings J, Halmos GB, Goedhart-Schwandt NLQ, de Bree R, Leemans CR, Verdonck-de Leeuw IM. An online self-care education program to support patients after total laryngectomy: feasibility and satisfaction. Support Care Cancer 2015; 24:1261-8. [PMID: 26306518 PMCID: PMC4729815 DOI: 10.1007/s00520-015-2896-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/09/2015] [Indexed: 12/23/2022]
Abstract
Purpose The purpose of this study was to investigate the feasibility of an online self-care education program supporting early rehabilitation of patients after total laryngectomy (TLPs) and factors associated with satisfaction. Methods Health care professionals (HCPs) were invited to participate and to recruit TLPs. TLPs were informed on the self-care education program “In Tune without Cords” (ITwC) after which they gained access. A study specific survey was used (at baseline T0 and postintervention T1) on TLPs’ uptake. Usage, satisfaction (general impression, willingness to use, user-friendliness, satisfaction with self-care advice and strategies, Net Promoter Score (NPS)), sociodemographic, and clinical factors were analyzed. Results HCPs of 6 out of 9 centers (67 % uptake rate) agreed to participate and recruited TLPs. In total, 55 of 75 TLPs returned informed consent and the baseline T0 survey and were provided access to ITwC (73 % uptake rate). Thirty-eight of these 55 TLPs used ITwC and completed the T1 survey (69 % usage rate). Most (66 %) TLPs were satisfied (i.e., score ≥7 (scale 1–10) on 4 survey items) with the self-care education program (mean score 7.2, SD 1.1). NPS was positive (+5). Satisfaction with the self-care education program was significantly associated with (higher) educational level and health literacy skills (P = .004, P = .038, respectively). No significant association was found with gender, age, marital status, employment status, Internet use, Internet literacy, treatment modality, time since total laryngectomy, and quality of life. Conclusion The online self-care education program ITwC supporting early rehabilitation was feasible in clinical practice. In general, TLPs were satisfied with the program.
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Affiliation(s)
- Ingrid C Cnossen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Cornelia F van Uden-Kraan
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands
| | - Simone E J Eerenstein
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Birgit I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Martin Lacko
- Department of Otorhinolaryngology-Head and Neck Surgery, Maastricht University Medical Center (MUMC), PO Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - José A Hardillo
- Department of Otorhinolaryngology-Head and Neck Surgery, Erasmus University Medical Center (Erasmus MC), PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center (Radboud UMC), PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen (UMCG), PO Box 30001, 9700, RD, Groningen, The Netherlands
| | - Noortje L Q Goedhart-Schwandt
- Department of Otolaryngology-Head and Neck Surgery, Medical Center Leeuwarden (MCL), PO Box 888, 8901, BR, Leeuwarden, The Netherlands
| | - Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center (UMCU), PO Box 85500, 3508, GA, Utrecht, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center (VUmc), PO Box 7057, 1007, MB, Amsterdam, The Netherlands.
- Department of Clinical Psychology, VU University, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands.
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Vincent C. [The Bell Labs contributions to (singing) voice engineering]. Rev Laryngol Otol Rhinol (Bord) 2015; 136:193-196. [PMID: 29400044] [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: 06/07/2023]
Abstract
While in «art» and «traditional» music, the nimbleness of the voice and the mastering of the vocal tone are put into perspective, in «popular» music, sound engineering takes the lead, and relegates the vocal virtuosity of the interpreter to second place. We propose to study here three technologies with contributions to music. All are developed and patented by the Bell Labs: The artificial larynx (and its derivatives, Sonovox and TalkBox), the vocoder and the speech synthesis. After a presentation of the source-filter theory, vital to these innovations, the principle of these three technologies is explained. A brief historical is outlined and is complemented by examples of films and musical selections depicting these processes. In light of these elements, we conclude: Sound engineering, and in particular the modification of voice sonority, has become an indispensable component in the process of «pop» artistic musical creation.
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Risberg-Berlin B, Karlsson TR, Tuomi L, Finizia C. Effectiveness of olfactory rehabilitation according to a structured protocol with potential of regaining pre-operative levels in laryngectomy patients using nasal airflow-inducing manoeuvre. Eur Arch Otorhinolaryngol 2014; 271:1113-9. [PMID: 24077871 DOI: 10.1007/s00405-013-2719-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 09/18/2013] [Indexed: 11/29/2022]
Abstract
This pilot study aims to evaluate the effectiveness of the Nasal Airflow-Inducing Manoeuvre (NAIM) when employing a structured protocol as well as investigate if early rehabilitation has the potential to return olfaction to pre-operative levels in patients undergoing laryngectomy following laryngeal cancer. Prospective study of cases conducted during 1 year, 2009–2010, at the Department of Ear-, Nose and Throat at Sahlgrenska University Hospital, Gothenburg, Sweden. Ten patients with laryngeal cancer and about to undergo laryngectomy were identified, of which four were included in the study. The remaining six patients were unfit to participate (n = 4) or declined participation (n = 2). Testing was conducted pre- and post-operatively and at each NAIM training session. Patients received three initial NAIM sessions followed by reinforcement training at 3, 6 and 12 months. Measures included Scandinavian Odour-Identification Test (SOIT), a semi-structured interview and questionnaires including European Organisation for Research and Treatment of Cancer, QLQ-C30 and QLQ-H&N35. All patients were normosmic smellers according to SOIT at the study end-point. One patient reported higher SOIT scores at 12 months follow-up compared to pre-operatively. Remaining patients had scores close to that reported pre-operatively. Using subjective measures, olfaction improved in all patients with one patient’s final score surpassing pre-operative scores. By implementing a structured protocol consisting of three training sessions early following laryngectomy with additional reinforcement sessions at 3, 6 and 12 months, NAIM is effective in terms of improving smelling ability. There also appears to be potential for restoring olfaction to a patient’s pre-operative level as reflected by both olfactory testing and PRO instruments. However, larger studies are needed to further explore the findings highlighted by this study.
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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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Abstract
A total laryngectomy removes the vocal folds which are fundamental in forming voiced sounds that make speech possible. Although implanted prosthetics are commonly used in developed countries, simple handheld vibrating electrolarynxes are still common worldwide. These devices are easy to use but suffer from many drawbacks including dedication of a hand, mechanical sounding voice, and sound leakage. To address some of these drawbacks, we introduce a novel electrolarynx that uses vibro-acoustic interference of dual ultrasonic waves to generate an audible fundamental frequency. A 3D simulation of the principles of the device is presented in this paper.
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Affiliation(s)
- Patrick Mills
- School of Engineering & Applied Science, The George Washington University, Washington, DC, United States of America
- * E-mail:
| | - Jason Zara
- School of Engineering & Applied Science, The George Washington University, Washington, DC, United States of America
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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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Icuspit P, Yarlagadda B, Garg S, Johnson T, Deschler D. Heat and moisture exchange devices for patients undergoing total laryngectomy. ORL Head Neck Nurs 2014; 32:20-23. [PMID: 24724345] [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: 06/03/2023]
Abstract
Patients undergoing total laryngectomy face the challenge of an altered anatomy with the resultant changes in quality of life and significant requirements for post-operative care. Increased production of secretions and sputum, the need for ongoing suctioning, and the formation of stomal crusting require meticulous post-operative care. The use of Heat and Moisture Exchange (HME) devices has been shown to decrease the effect of these factors. This article describes the nature of these devices and their use. The literature is reviewed regarding the long term benefits and new data are presented suggesting an immediate post-operative benefit as well. Finally, costs and other considerations for successful use of HME devices are presented.
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Zocratto OB, Vieira MBM, Maia AF, Ferreira AC, Larangeira LT, Penido MNR, Silva LLA. The Amatsu's tracheoesophageal shunt: analysis of 84 cases. J Voice 2013; 28:512-4. [PMID: 24321585 DOI: 10.1016/j.jvoice.2013.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/11/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Amatsu's tracheoesophageal shunt can be indicated for vocal rehabilitation in candidates to total laryngectomy. It is performed in the period of the procedure of total laryngectomy and has been indicated due to its technical facility, exemption from the use of voice prosthesis, and lack of additional costs for its maintenance. OBJECTIVE To evaluate the results obtained with the Amatsu's tracheoesophageal shunt, along 14 years of experience, in two Brazilian hospitals. STUDY DESIGN Clinical retrospective. MATERIAL AND METHOD From 1991 to 2005, eighty-four patients were submitted to the Amatsu's tracheoesophageal shunt. Seventy-seven (91.7%) were male and seven (8.3%) female, aged between 30 and 82 years, mean age of 57.5 years, and an average age of 52 years. All patients had squamous cell carcinoma of larynx and/or hypopharynx. Sixty-eight (81.0%) were stage III or IV. They were submitted to total laryngectomy and the Amatsu's tracheoesophageal shunt was performed during the tumor removal surgery. The following variables were analyzed: acquisition of intelligible speech, vocal recovery time after surgery, and the occurrence of specific surgical complications of the shunt (pulmonary aspiration). RESULTS Seventy-six patients were evaluated with respect to the effectiveness of the technique. Fifty-three patients (70.0%) presented vocalization by the shunt; in 46 patients (60.5%), the speech was fully intelligible. The time required for restoration of speech was 12-87 postoperative days. Of the 83 patients evaluated in relation to the development of complications, 25 (30.1%) presented aspiration by the shunt during oral ingestion. In 23 patients (27.7%), the aspiration was managed conservatively without complications. Two patients (2.4%) required surgical closure of the shunt due to intractable aspiration. CONCLUSION Vocal rehabilitation with the Amatsu's tracheoesophageal shunt is effective in most patients who underwent total laryngectomy. It can be evidenced by the acquisition of intelligible speech in most patients. The aspiration, although often, is not shown to be a limiting complication.
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Affiliation(s)
- Orlando Barreto Zocratto
- Department of Surgery, School of Medicine, Federal University of Ouro Preto - UFOP, Ouro Preto, Minas Gerais, Brazil.
| | - Mauro Becker Martins Vieira
- Clinic of Otorhinolaryngology and Head and Neck Surgery, Felicio Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Amélio Ferreira Maia
- Clinic of Otolaryngology and Head and Neck Surgery, Felicio Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
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Abstract
CONCLUSION A procedure with no exploratory puncture using an endotracheal tube, sharp-tipped trocar, flexible fiberscope, and flexible guidewire is useful for inserting the Provox(®)2 prosthesis. OBJECTIVES The purpose of the present study was to examine the necessity of exploratory puncture in consideration of operating time, complications, and voice rehabilitation. METHODS Insertion of the Provox(®)2 was conducted using an endotracheal tube, sharp-tipped trocar, flexible fiberscope, and flexible guidewire under general anesthesia. This was performed in conjunction with exploratory puncture in the first 7 patients, and without exploratory puncture in the following 15 patients. RESULTS Operating time was 10 min in the group with exploratory puncture and 6 min in the group without exploratory puncture. Although a shorter size had to be substituted in one patient without exploratory puncture on the day following the procedure due to difficulty with eating, no complications due to the procedure were observed in any patients. Speech production was possible in all patients on the following day.
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Affiliation(s)
- Kiyoaki Tsukahara
- Department of Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center , Tokyo , Japan
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Manestar D, Tićac R, Manestar K, Linsak Z, Corak D, Kavanagh MM, Prgomet D, Starcević R. Postlaryngectomy olfactory rehabilitation and swimming. Coll Antropol 2013; 37:1147-1152. [PMID: 24611327] [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: 06/03/2023]
Abstract
The aim of the study was to determine the influence of swimming on postlaryngectomy olfactory rehabilitation. This prospective open interventional trial at a tertiary academic hospital included 100 laryngectomised patients; 17 were swimmers and 83 were nonswimmers. Participants practiced the polite yawning technique (PYT) for postlaryngectomy olfactory rehabilitation. Rhinomanometry was used to measure air quantity in the right and left nostrils, respectively; to test sense of smell, we applied the smell diskettes olfaction test (SDOT). Swimmers used swimming aids and swam only in a pool accompanied by another person trained in the rescue and resuscitation of a laryngectomee. Measures were made at three time points. Following PYT initiation, the number of accurately guessed odours was higher among swimmers (SDOT1 = 5.29, SDOT2 = 6.40, SDOT3 = 6.76) than nonswimmers (SDOT1 = 3.73, SDOT2 = 5.48, SDOT3 = 5.60) as were airflows through the left (swimmers: FL1 = 40.82, FL2 = 137.71, FL3 = 172.80; nonswimmers: FL1 = 13.05, FL2 = 104.63, FL3 = 113.00) and right nostrils (swimmers: FR1 = 46.82, FR2 = 115.41, FR3 = 145.40; nonswimmers: FR1 = 13.70, FR2 = 92.77, FR3 = 106.43). The number of odours identified by laryngectomised patients increased with the volume of nasal airflow, but this number and the efficiency of olfactory rehabilitation were higher in swimmers compared to nonswimmers. Swimming with a swimming aid improved the quality of life after surgery and may facilitate resocialisation of laryngectomised patients.
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Affiliation(s)
- Dubravko Manestar
- University of Rijeka, University Hospital Rijeka, Clinic of Otorhinolaryngology, Head and Neck Surgery, Rijeka, Croatia.
| | - Robert Tićac
- University of Rijeka, University Hospital Rijeka, Clinic of Otorhinolaryngology, Head and Neck Surgery, Rijeka, Croatia
| | - Koraljka Manestar
- University of Rijeka, University Hospital Rijeka, Pediatric Clinic, Rijeka, Croatia
| | - Zeljko Linsak
- Teaching Institute of Public Health, Rijeka, Croatia
| | - Davor Corak
- Teaching Institute of Public Health, Rijeka, Croatia
| | - Marcel Marjanović Kavanagh
- University of Zagreb, University Hospital Zagreb, Clinic of Otorhinolaryngology, Head and Neck Surgery, Zagreb, Croatia
| | - Drago Prgomet
- University of Zagreb, University Hospital Zagreb, Clinic of Otorhinolaryngology, Head and Neck Surgery, Zagreb, Croatia
| | - Radan Starcević
- University of Rijeka, University Hospital Rijeka, Clinic of Otorhinolaryngology, Head and Neck Surgery, Rijeka, Croatia
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Liu B, Zheng L. [The acoustic comparison of different voice rehabilitation after total laryngectomy]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013; 27:1025-1027. [PMID: 24459935] [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: 06/03/2023]
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Leuin SC, Deschler DG. The missing tracheoesophageal puncture prosthesis: evaluation and management. Ear Nose Throat J 2013; 92:E14-E16. [PMID: 23460220] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Placement of a tracheoesophageal puncture prosthesis in the post-laryngectomy patient has significantly improved voice rehabilitation in this population. Rarely, the prosthesis may become dislodged, necessitating medical evaluation. We present the case of a 61-year-old man who presented to our Emergency Department with a missing prosthesis. We describe the evaluation and management of this patient and review the relevant literature. We conclude with the following algorithm: When a patient presents with a missing prosthesis, evaluation of the tracheobronchial tree must be performed. Once the pulmonary system is cleared, the prosthesis can be presumed in the gastrointestinal tract and allowed to pass. A new prosthesis or catheter should be placed in the tract to prevent aspiration.
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Affiliation(s)
- Shelby C Leuin
- Division of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, CA 92123, USA.
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Ferrat K, Guerti M. A study of sounds produced by Algerian esophageal speakers. Afr Health Sci 2012; 12:452-8. [PMID: 23515561 DOI: 10.4314/ahs.v12i4.9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Total Laryngectomy is a mode of treatment of patients with advanced laryngeal cancer. It affects the voice and the speech communication. OBJECTIVE To present an acoustic analysis of the new voice after total laryngectomy in Algerian hospital environment. METHODS A corpus of sounds was collected from October 2008 to September 2009 and pronounced by eight male speakers who have undergone total laryngectomy. Minimum age of patients was 47 years and maximum age was 59 years with mean age 54.87 years. Recordings were made before the beginning of reeducation and after three, six, and eleven months using esophageal voice. The acoustic analysis includes the Pitch F0 (Hz), Formants, intensity, Jitter (%), Shimmer (dB), harmonic to noise ratio HNR (dB), and degree of unvoiced frames DUF (%). RESULTS We note a restriction in F0, increasing of Jitter and Shimmer, decreasing of HNR values, and reduced intensity compared to the voice of normal laryngeal speakers. In addition, we note a higher percentage of DUF during the pronunciation of sustained vowels. CONCLUSION Some deficiencies were reported in the taking care of patients. Therefore, the acoustic analysis may be used in evaluating the reliability of the technique of reeducation.
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Affiliation(s)
- K Ferrat
- National Polytechnic School (ENP), El-Harrach, Algiers, Algeria.
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Boci B, Isufi R, Thomai K. Postlaryngectomy vocal rehabilitation in Albania. J BUON 2012; 17:478-482. [PMID: 23033285] [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
PURPOSE To assess short and midterm results with consistent use of indwelling voice prostheses (Provox 1 and Provox 2 valves) for vocal rehabilitation after total laryngectomy. METHODS From May 2008 to June 2010 106 patients (104 men, 2 women, median age 62.32 years) with total laryngectomy underwent vocal prosthesis insertion and replacement procedures as needed. Patients were prosthesized primarily or secondarily and follow-up was performed monthly. RESULTS Median patient-device follow-up was 279 days (range 184-995). Leakage through the prosthesis, mainly caused by Candida deposits on the valve, was the most common cause of failure of the Provox valves. CONCLUSION Compared to other European countries, like the Netherlands (100 days) and France (150 days) Albania has the longest device half life. This relatively long prosthesis' lifetime in our country is perhaps related with the use of spicy food (a common custom in our country), and the use of antifungal and antacid agents.
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Affiliation(s)
- B Boci
- ENT Department, University Hospital Centre, Tirana, Albania.
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Abstract
In patients with advanced laryngeal or hypopharyngeal cancer, or in cases when the disease recurs after treatment with (chemo)radiation, a total laryngectomy (TLE) is performed. For them to be able to function properly, speech rehabilitation is of the utmost importancefor these patients. For voice rehabilitation, voice prostheses or an electrolarynx can be used. Esophogus-speech can also be applied. In recent decades, voice prostheses in particular have undergone significant development. They can be considered the standard technique for rehabilitation. For dentists, it is important to realise that the anatomy of these patients has changed. In addition, many have a prior history of radiotherapy and thus an increased risk of xerostomia and osteoradionecrosis. In cases where maxillofacial surgery is indicated, the chance of osteoradionecrosis is higher. If extraction is considered, consultation with a head and neck oncology centre is necessary.
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Affiliation(s)
- A J Timmermans
- Uit de afdeling Hoofd-Halschirurgie van het Antoni van Leeuwenhoek Ziekenhuis in Amsterdam
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