ABSTRACT
OBJECTIVE: The aim of this study was to correlate several instruments currently used for the assessment of the quality of life of patients who underwent total laryngectomy and speech rehabilitation. METHODS: A cross-sectional, observational study was conducted with 38 patients after total laryngectomy and speech therapy aiming to develop oesophageal speech. The patients were divided into the following two groups (19 participants each): speakers and non-speakers. The quality of life instruments used were as follows: visual analogue scale (VAS); Voice Handicap Index (VHI); Voice-Related Quality of Life (V-RQOL); Functional Assessment of Cancer Therapy - Head & Neck (FACT-H&N); European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck (EORTC QLQ-H&N35); and University of Washington Quality of Life (UW-QOL). RESULTS: The V-RQOL global health domain exhibited a strong correlation with the VHI. The EORTC QLQ-C30 exhibited a moderate to strong correlation with the EORTC QLQ-H&N35 functional domain in both groups. The EORTC QLQ-C30 functional domain exhibited a strong to moderate correlation with all other instruments in both groups. The UW-QOL exhibited a moderate to strong correlation with the VHI and EORTC QLQ-C30 in both groups. CONCLUSION: The EORTC QLQ-C30, EORTC QLQ-H&N35 and UW-QOL were the instruments that most correlated with the remaining instruments, indicating that any of the three can be used to assess the quality of life of the target population regardless of oesophageal voice development.
Subject(s)
Humans , Quality of Life , Speech Therapy , Speech , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
Objective@#To describe a prototype improvised hand held device for alaryngeal speech.@*Methods@#Design: Instrument Innovation. Setting: Tertiary Private Hospital. Participants: Four listeners with normal hearing, were native Tagalog-speakers and had no previous experience with alaryngeal speech types participated in initial trials.@*Results@#The prototype PHONETOVOX was fabricated using a soundproofed cellphone casing with an intra-oral sound port attachment and a cellphone was loaded with Pocket Talkbox v. 1.4.0 software. The device was tested for its ability to produce intelligible speech by using the cellphone as a substitute for the larynx using oral cavity resonators and articulators, producing a synthesized sound mimicking the human voice. The PHONETOVOX produced intelligible words. Initial testing using a C-V-C Tagalog Word List had 4 listeners identify 34, 35, 47, and 54 out of 93 words (37 to 58%), with an overall average intelligibility of 46%.@*Conclusion@#Despite its restrictions in articulation and the wide range of results from the four listeners, our initial results may suggest the potential of PHONETOVOX as another modality for alaryngeal speech comparable to the 36 – 38 % intelligibility of commercially-available devices. Further trials with actual laryngectomees are needed to further establish intelligibility and acceptability.
Subject(s)
Humans , Male , Female , LaryngectomyABSTRACT
RESUMO Objetivo: analisar a qualidade de vida relacionada à voz em pacientes laringectomizados totais participantes de um grupo de apoio. Métodos: a população estudada foi constituída por 11 indivíduos laringectomizados totais, de ambos os sexos com idade compreendida entre 43 e 84 anos, falantes por meio de voz traqueoesofágica ou laringe eletrônica. Foi aplicado o protocolo Qualidade de Vida em Voz (QVV) e uma escala representada por uma régua de dez centímetros para aferição da satisfação da comunicação. Resultados: os indivíduos falantes traqueoesofágicos apresentaram melhores resultados no escore global do QVV em relação aos usuários de laringe eletrônica (p=0.026). Os sujeitos que apresentaram melhores índices globais no QVV apresentaram melhores índices de satisfação com a comunicação (p=0.001). Os índices de satisfação com a comunicação apresentaram relação com o tempo de cirurgia (p=0.050). Não foram encontradas associações entre a satisfação com a comunicação e as variáveis sociodemográficas sexo (p=0.154) e idade (p=0.303). Conclusão: pode-se observar que quanto maior o tempo de cirurgia mais satisfeito o indivíduo está com a comunicação. Observou-se ainda que o QVV é uma medida fidedigna da satisfação na comunicação de laringectomizados totais.
ABSTRACT Purpose: to analyze the voice-related quality of life in totally laryngectomized patients in speech therapy for a support group. Methods: the studied population was composed of 11 totally laryngectomized subjects of both genders between 43 and 83 years of age, who speak using a trachoesophageal prosthesis or electronic larynx. The patients answered the Brazilian Portuguese version of the Voice-Related Quality of Life (VR-QOL) questionnaire and rated their satisfaction with their communication on a 10cm visual analogic scale. Results were submitted to statistical analysis with a 5% significance level. Results: tracheoesophageal prosthesis speakers had better results in the global score of the VR-QOL when compared with electronic larynx speakers (p=0.026). The subject with higher global V-RQOL scores had higher satisfaction levels regarding their communication (p=0.001). Satisfaction levels with communication were also statistically related to time of surgery (p=0.05). There were no statistically significant associations regarding satisfaction with communication and sociodemographic variables sex (p=0.154) and age (p=0.303). Conclusion: individuals with more time since surgery are better satisfied with their communication. Satisfaction levels showed that the VR-QOL is a reliable measure of communication satisfaction of totally laryngectomized patients.
ABSTRACT
OBJECTIVES: The objective of this study was to determine the rates of nasalance for total laryngectomized users of a tracheoesophageal voice prosthesis and correlate them with the findings of auditory-perceptual assessment of nasality. METHODS: In this study, 25 total laryngectomized users, including 20 men and five women, with a mean age of 63 years old participated. All the participants had a tracheoesophageal voice prosthesis and underwent treatment for the rehabilitation of tracheoesophageal communication. These patients were submitted to nasalance assessment using nasometry and auditory-perceptual evaluation of nasality and were rated by trained speech therapists. RESULTS: The nasalance values obtained for nasal (59.92%) and oral (18.64%) sentences were within the normal limits for laryngeal speakers of Brazilian Portuguese language. It was possible to observe the presence of nasality in nasal sentences and its absence in oral sentences among most speakers. Specificity was found to be 100% for nasal sentences and sensitivity was 100% for oral sentences. It was not possible to calculate these values for the oral sentences. CONCLUSIONS: Total laryngectomized patients with tracheoesophageal voice prostheses have adequate vocal nasality compatible with nasometry rates. .
OBJETIVOS: Determinar os índices de nasalância de laringectomizados totais usuários de prótese traqueoesofágica e correlacioná-los com os achados da avaliação perceptivo-auditiva da nasalidade. MÉTODOS: Participaram do estudo 25 laringectomizados totais, com idade média de 63 anos, sendo 20 do gênero masculino e cinco do feminino. Todos eram usuários de prótese traqueoesofágica e realizaram terapia fonoaudiológica para reabilitação da comunicação traqueoesofágica. Os laringectomizados foram submetidos à avaliação da nasalância, utilizando a nasometria e avaliação perceptivo-auditiva da nasalidade, por julgamento de fonoaudiólogos treinados. RESULTADOS: Os valores encontrados da nasalância para as frases nasais (59,92%) e para as orais (18,64%) estão dentro da normalidade para falantes laríngeos do português brasileiro. Foi possível perceber, na maioria dos falantes, presença de nasalidade nas frases nasais e ausência nas orais. O valor do teste de especificidade foi de 100% para as frases nasais e de sensibilidade, 100% para as frases orais. CONCLUSÃO: O laringectomizado total usuário de prótese traqueoesofágica apresenta nasalidade vocal adequada, compatível com índices nasométricos. .
Subject(s)
Female , Humans , Male , Middle Aged , Laryngectomy/adverse effects , Speech, Alaryngeal , Laryngeal Neoplasms/surgery , Predictive Value of Tests , Sensitivity and SpecificityABSTRACT
PURPOSE: To evaluate and correlate the amplitude of esophageal contractions triggered by swallowing water with dynamic extension and habitual, strong and weak sound intensity in total laryngectomees wearing a tracheoesophageal prosthesis. METHODS: Thirty total laryngectomees using tracheoesophageal voice with a phonatory prosthesis were evaluated by measuring the amplitude of contractions in the proximal, middle and distal esophagus and the pressure of the pharyngoesophageal transition by manometry. In order to measure vocal intensity the subject was asked to emit phonation of the vowel /a/ at habitual, strong and weak intensity which was captured with a sound pressure meter. Dynamic extension was calculated by subtracting strong intensity from weak intensity. RESULTS: A positive correlation was observed between contraction amplitude and dynamic extension in the proximal (rho: 0.45; p=0.01) and distal (rho: 0.41; p=0.02) esophagus There was no correlation with other parameters.. Total laryngectomees wearing a phonatory prosthesis with a dynamic extension above 21 dBNPS had greater contraction amplitude than laryngectomees with a dynamic extension below this value. CONCLUSIONS: There was a positive correlation between pressure amplitude in the proximal and distal esophagus and increased dynamic extension. The individuals with normal dynamic extension had greater contraction amplitude in the proximal esophagus than individuals with dynamic extension lower than the expected values for age.
Subject(s)
Female , Humans , Male , Middle Aged , Esophagus/physiopathology , Larynx, Artificial , Laryngectomy/rehabilitation , Speech, Esophageal , Carcinoma, Squamous Cell/surgery , Esophagus/surgery , Laryngeal Neoplasms/surgery , Manometry , Pressure , Phonation/physiology , Statistics, Nonparametric , Trachea/physiopathology , Trachea/surgery , Voice Quality/physiologyABSTRACT
PURPOSE: To assess the effect of a program of singing training on the voice of total laryngectomees wearing tracheoesophageal voice prosthesis, considering the quality of alaryngeal phonation, vocal extension and the musical elements of tunning and legato. METHODS: Five laryngectomees wearing tracheoesophageal voice prosthesis completed the singing training program over a period of three months, with exploration of the strengthening of the respiratory muscles and vocalization and with evaluation of perceptive-auditory and singing voice being performed before and after 12 sessions of singing therapy. RESULTS: After the program of singing voice training, the quality of tracheoesophageal voice showed improvement or the persistence of the general degree of dysphonia for the emitted vowels and for the parameters of roughness and breathiness. For the vowel "a", the pitch was displaced to grave in two participants and to acute in one, and remained adequate in the others. A similar situation was observed also for the vowel "i". After the singing program, all participants presented tunning and most of them showed a greater presence of legato. The vocal extension improved in all participants. CONCLUSION: Singing training seems to have a favorable effect on the quality of tracheoesophageal phonation and on singing voice.
Subject(s)
Female , Humans , Male , Middle Aged , Larynx, Artificial , Laryngectomy/rehabilitation , Singing , Speech Therapy/methods , Voice Training , Auditory Perception , Music , Pitch Perception , Resistance Training/methods , Respiratory Muscles/physiology , Speech, Alaryngeal , Voice QualityABSTRACT
TEMA: reabilitação do laringectomizado total. OBJETIVO: correlacionar a proficiência de voz e de fala de laringectomizados totais usuários de prótese traqueoesofágica com a pressão intraluminal da transição faringoesofágica no repouso e durante a fonação. MÉTODO: foram estudados 12 laringectomizados totais com voz traqueoesofágica, usuários de prótese fonatória, submetidos à coleta e registro do material de voz e da fala, que foram avaliados por três expertos, utilizando-se um protocolo de julgamento geral da comunicação traqueoesofágica. Em seguida, os indivíduos foram encaminhados à manometria esofágica para avaliar a pressão intraluminal da transição faringoesofágica durante a fonação e no repouso. RESULTADOS: durante a fonação, os indivíduos caracterizados como bons falantes (16,7 por cento) pelos expertos apresentaram valores médios de amplitude de pressão na transição faringoesofágica de 27,48mmHg. Entre os falantes moderados (52,5 por cento), obteve-se amplitude média de 30,63mmHg e para os piores falantes (30,8 por cento), 38,72mmHg. Durante o repouso, os melhores falantes apresentaram pressão média de 14,72mmHg, os moderados, 13,04mmHg e os piores falantes, 3,54mmHg. CONCLUSÃO: os melhores falantes apresentaram os menores valores de amplitude de pressão durante a fonação. Em contrapartida, a pressão em repouso foi maior para os bons falantes e menor para os piores, sugerindo que a elevação da pressão na transição faringoesofágica durante a fonação prejudica a qualidade da comunicação traqueoesofágica com a prótese fonatória.
BACKGROUND: rehabilitation of individuals with total laryngectomy. AIM: to correlate the voice and speech proficiency of individuals with total laryngectomy, users of tracheoesophageal, prosthesis with the intraluminal pharyngoesophageal transition pressure at rest and during phonation. METHOD: twelve individuals with total laryngectomy and with tracheoesophageal voice, users of speech prosthesis, were submitted to a voice and speech sample gathering and registration. These individuals were assessed by three experts using a specific protocol for the evaluation of tracheoesophageal communication. Individuals also underwent esophageal manometry in order to evaluate the intraluminal pharyngoesophageal transition pressure during rest and phonation. RESULTS: during phonation, individuals who had been characterized by the experts as good speakers (16.7 percent) presented average values of pressure amplitude during pharyngoesophageal transition of 27.48mmHg. Average amplitude of 30.63mmHg was observed for individuals classified as moderate speakers (52.5 percent), and of 38.72mmHg for individuals classified as poor speakers (30.8 percent). During rest, the good speakers presented an average pressure of 14.72mmHg, the moderate speakers of 13.04mmHg and the poor speakers of 3.54mmHg. CONCLUSION: the good speakers presented the lowest amplitude values of pharyngoesophageal transition pressure during phonation. However, the pressure observed in the rest condition was higher for the good speakers and lower for the poor speakers, suggesting that the raise in the pharyngoesophageal transition pressure during phonation damages the quality of tracheoesophageal communication when using speech prosthesis.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Larynx, Artificial , Laryngectomy/rehabilitation , Phonation/physiology , Speech, Esophageal , Speech/physiology , Communication , Esophagus/surgery , Manometry/methods , Treatment Outcome , Trachea/surgery , Voice Quality/physiologyABSTRACT
Introdução: A primeira laringectomia total data de 1873 descrita por Billroth, e foi acompanhada pela tentativa de reabilitação vocal com a prótese externa de Gussenbauer. Nos últimos anos as formas de reabilitação vocal evoluíram e a utilização da fístula traqueoesofágica com uma prótese valvulada foi proposta por Blom e Singer, em 1980. A colocação da prótese após a laringectomia é denominada de secundária e, apesar das evoluções referente à prótese vocal, a colocação secundária utilizando anestesia geral e esofagoscópio rígido pode levar a complicações como mediastinite, celulite cervical, fratura de vértebra cervical e perfuração esofágica. Objetivo: Apresentar técnica endoscópica de passagem secundária dessa prótese. Métodos: Esse trabalho foi realizado em 72 pacientes laringectomizados reabilitados com prótese vocal do tipo Blom-Singer Indwelling low pressure com colocação secundária através de técnica cirúrgica por endoscopia digestiva alta e sedação com midazolan, no período de junho de 1999 a julho de 2006, dispensando o uso de anestesia geral e internação. Resultados: Todos os pacientes foram reabilitados com a prótese tráqueo-esofágica, sem complicações relacionadas com a técnica cirúrgica. As vantagens dessa nova técnica em relação à convencional são: 1) dispensa a anestesia geral; 2) não é necessário internação do paciente; 3) menor riscos de complicações, como: hemorragia digestiva alta; mediastinite; fratura de vértebras cervicais; perfuração esofágica; 4) visibilização direta do posicionamento da prótese no esôfago.
Introduction: The first total laryngectomy was performed in 1873 by Billroth, and it was accompanied by the attempt of vocal rehabilitation with the Gussenbauer's external prosthesis. In the last years the techniques of vocal rehabilitation developed and the use of the tracheoesophageal fistula with a valvuled prosthesis was proposed by Blom and Singer in 1980. The placement of the prosthesis after laryngectomy is called secondary, and in spite of the evolutions regarding the vocal prosthesis, the secondary placement using general anesthesia and rigid esophagoscopy can take complications as mediastinitis, cervical cellulitis, fracture of cervical vertebra, and esophageal perforation. Objective: To present an endoscopic technique for the secondary placement of such prosthesis. Methods: This work was accomplished in 72 patients undergone total laryngectomy and rehabilitated with Blom-Singer Indwelling low pressure vocal prosthesis with secondary placement through new surgical technique by digestive endoscopy and mitigation with midazolan, in the period from June, 1999 to July, 2006, releasing this way the use of general anesthesia and hospitalization. Results: All patients were rehabilitated with tracheoesophageal prosthesis, without complications related with the surgical technique. The advantages of this new technique in relation to the conventional are: 1) releases the general anesthesia; 2) it is not necessary patient hospitalization; 3) smaller risks of complications as high digestive hemorrhage; mediastinitis; fracture of cervical vertebras; esophageal perforation; 4) direct visualization of the positioning of the prosthesis in the esophagus.
ABSTRACT
0.05). There were no significant differences in sound, maximum sound intensity, breath sessions, base frequency and amplitude between the patients using artificial larynx and control group, but there were significant difference in fundamental frequency perturbation, amplitude perturbation, standardized noise energy and harmonious noise ratio(P
ABSTRACT
Objective To evaluate the results of the Groningen valve voice prosthesis in China.Methods The Groningen valve was used to date in 10 patients with a mean age at insertion of 60.2 years from January 2003 to January 2004. Seven patients underwent primary valve insertion at the time of surgery and in three patients the prosthesis was inserted at a later date. The speech quality of this group was assessed.Results The median score was 4.6(range 3.3～6.9)which compared favourably with a similar analysis of other valve.Conclusion The Groningen valve provides a highly acceptable means of obtaining vocalization after total laryngectomy in patients.
ABSTRACT
BACKGROUND AND OBJECTIVES: The esophageal voice can be a choice for alaryngeal patients. However, many patients fail to get a esophageal voice, because there are no known systematic principles nor specific training methods of producing the esophageal voice. We evaluated the difference between two vowels of the esophageal voice that have different shapes and movements of the speech apparatus. We also tried to find a relationship between the speech apparatus and the esophageal voice. MATERIALS AND METHODS: Alaryngeal patients were investigated with acoustic analysis, aerodynamic analysis and pharyngoesophagogram. We used the vowel /a/ in which the mouth is widely open and the tongue is posteriorly positioned and vowel /i/ in which the mouth is less widely open and the tongue is anteriorly positioned. We compared the results of analytic studies between two vowels. RESULTS: The esophageal voice has a higher pitch and a lower sound in the /i/ vowel. The hypopharyngeal space above the neoglottis was extended more anteriorly. The /i/ vowel made a more tight contact with the neoglottis to the anterior wall and the short length of the neoglottis. CONCLUSIONS: The results of acoustic analysis and pharyngoesophagogram showed that there were differences between the /a/ vowel and the /i/ vowel of the esophageal voice.
Subject(s)
Humans , Acoustics , Mouth , Tongue , VoiceABSTRACT
BACKGROUND AND OBJECTIVES: Acoustic parameters of maximal phonation time, sound intensity, fundamental frequency, voice range, jitter and shimmer were analyzed in order to evaluate voice quality and differences among esophageal speech (ES), tracheoesophageal shunt speech (TES), pneumatic aid speech (PA), electrolaryngeal speech (EL) according to phonetic rehabilitation methods in 16 cases of laryngectomees. MATERIALS AND METHODS: We acquired acoustic data on alaryngeal voice by different methods, and analysed each of those using specially designed programs (Laryngeal analyser V1.0 base on Matlab V5.0). RESULTS: Maximal phonation time was significantly longer in TES voice and PA speech than in ES voice (p<0.05). Jitter and shimmer were significantly regular and stable in the EL and PA speech than in the ES and TES voice (p<0.05). Voice range was significantly wider in TES voice and PA speech than in EL and ES voice (p<0.05). In two cases capable of bi-modal speech of ES and TES voice, maximal phonation time was longer with wider voice range in TES voice than in ES voice. Jitter and shimmer were regular and stable in ES voice than in TES voice. CONCLUSION: PA speech displays phonetically more natural laryngeal speech than other rehabilitation methods. But this methods is inconvenient and cosmetically unacceptable, because patients have to bite intraoral vibrator in the patient's mouth. So, we recommend TES voice rather than ES voice, without the use of speech-making device such as EL and PA speech.
Subject(s)
Humans , Acoustics , Laryngectomy , Mouth , Phonation , Rehabilitation , Speech, Esophageal , Voice Quality , VoiceABSTRACT
Alaryngeal speech(esophageal, neoglottal, shunt, and electrolaryngeal speech) differ from normal laryngeal speech primarily with regard to the sound or source of voicing. Theoretically, esophageal, tracheoesophageal, neoglottal and electrolaryngeal speech have difficulty in accomplishing the voiceless consonants. But perceptual studies often reveal that there is a clear production of voiceless consonants resulting good articulation scores in skilled alaryngeal speakers except electrolaryngeal speech. The purpose of the present study was to relate the three-way distinction of Korean voiceless stops in manner of articulation with normal speakers and skilled alaryngeal speakers in terms of the voicing distinction in consonants. Acoustic analysis were performed to investigate the acoustic characteristics of alaryngeal speech compared to the normal speech with special reference to the voiceless distinction. Electromyographic studies were performed to clarify the adjustment of neck muscle during normal and alaryngeal speech.
Subject(s)
Acoustics , Neck Muscles , Speech, AlaryngealABSTRACT
Objective To compare the alaryngeal speakers'voice acoustic parameters and intra-tracheal pressure when they spoke different vowels.Methods 24 patients after tracheo-esophageal shunt phonation by the anastomosis of the membranous portion of the tracheal section with the anterior wall of esophagus after total laryngectomy and 16 esophageal speakers enrolled in this study. The voice acoustic parameters were measured when they spoke soft /a/ and soft /i/. The intra-tracheal pressure of 20 TE speakers was measured when spoke /a/ and /i/.Results There were no significant differences between vowel /a/ and /i/ in the two alaryngeal speaker group. The pressure of TE speakers after Shang's procedrue for comfortable /i/ was higher than that for /a/, and there was significant difference.Conclusion There were the same clinical meanings in evaluating alaryngeal voice acoustic aspect. when using vowel /a/ and /i/. However when using different vowel, the intrtracheal pressure was different in TE speakers.