Tracheoesophageal Voice Prosthesis Use and Maintenance in Laryngectomees

Abstract Tracheoesophageal speech is the most common voicing method used by laryngectomees. This method requires the installation of tracheoesophageal prosthesis (TEP), which requires continuous maintenance to achieve optimal speaking abilities and prevent fluid leakage from the esophagus to the trachea. The present manuscript describes the available types of TEPs, the procedures used to maintain them, the causes for their failure due to fluid leakage, and the methods used for their prevention. Knowledge and understanding of these issues can assist the otolaryngologist in caring for laryngectomees who use tracheoesophageal speech.

The effect of the public welfare training of esophageal speech on the psychological condition of the laryngectomees / 中国实用护理杂志

Objective@#To explore the effect of the public welfare training of esophageal speech on the psychological condition of the laryngectomees.@*Methods@#Using experimental research method and convenient sampling method to select 96 laryngectomees as research object by inclusion and exclusion criteria in Hubei province. The public welfare training was used to guide the laryngectomees to learn the esophageal speech. Then, laryngectomees' restoring vocalization, self-rating anxiety and self-rating depression would be assessed in a month before training, a month after training and half a year after training. The results were analyzed by descriptive analysis, chi-square test, F-test and so on.@*Results@#Ninety-six laryngectomees participated in the public service esophageal language training one month before, one month after and half a year after the training. The number of patients recovered completely from 3 to 39 to 72 in the recovery of pronunciation function. There was significant difference in the distribution (χ2=195.579, P < 0.01). The score of anxiety and depression was (54.84±9.19), (47.41±8.16), (42.92±7.16) points and (59.00±8.87), (52.48±8.16), (47.56±7.41) points. There were significant differences (χ2=79.772, 82.705, P<0.01).@*Conclusions@#Most laryngectomees have the different degrees of anxiety and depression after surgery. By carrying out the public welfare training of esophageal speech on laryngectomees, the psychological state of the laryngectomees can be effectively improved.

The effect of the pubLic weLfare training of esophageaL speech on the psychoLogicaL condition of the Laryngectomees / 中国实用护理杂志

Objective To explore the effect of the public welfare training of esophageal speech on the psychological condition of the laryngectomees. Methods Using experimental research method and convenient sampling method to select 96 laryngectomees as research object by inclusion and exclusion criteria in Hubei province. The public welfare training was used to guide the laryngectomees to learn the esophageal speech. Then, laryngectomees′ restoring vocalization, self-rating anxiety and self-rating depression would be assessed in a month before training, a month after training and half a year after training. The results were analyzed by descriptive analysis, chi-square test, F-test and so on. ResuLts Ninety-six laryngectomees participated in the public service esophageal language training one month before, one month after and half a year after the training. The number of patients recovered completely from 3 to 39 to 72 in the recovery of pronunciation function. There was significant difference in the distribution (χ2=195.579, P<0.01). The score of anxiety and depression was (54.84±9.19), (47.41±8.16), (42.92 ± 7.16) points and (59.00 ± 8.87), (52.48 ± 8.16), (47.56 ± 7.41) points. There were significant differences (χ2=79.772, 82.705, P＜0.01). ConcLusions Most laryngectomees have the different degrees of anxiety and depression after surgery. By carrying out the public welfare training of esophageal speech on laryngectomees, the psychological state of the laryngectomees can be effectively improved.

Paciente laringectomizado total: perspectivas para a ação clínica do psicólogo / Total laryngectomized patient: perspectives for the psychologist's clinical action / Paciente laringectomizado total: perspectivas para la acción clínica del psicólogo

A cirurgia de laringectomia total implica a necessidade de procedimentos agressivos e provoca lesões estéticas e funcionais irrecuperáveis, acarretando repercussões biopsicossociais. Por meio de pesquisa de natureza qualitativa foram investigadas as repercussões psicossociais na construção subjetiva de pacientes laringectomizados e de seus cuidadores. O percurso do adoecimento é vivido como um momento de crise em que predomina o sentimento de desamparo e desalojamento. A perda da fala pode levar o paciente a isolar-se socialmente, afastar-se de suas funções profissionais, com sentimentos de vergonha e culpa, provocando intensa angústia e sofrimento. Os cuidadores sofrem diante da possibilidade da perda de um ente querido e, também, por tentativas, nem sempre bem sucedidas, de dar suporte e oferecer ambiência para as novas necessidades que se apresentam. Os resultados evidenciam que conhecer as repercussões psicossociais dessa experiência pode fornecer importantes subsídios para a psicologia clínica.

Total laryngectomy surgery implies aggressive procedures that cause irretrievable esthetic and functional injuries, causing a series of biopsychosocial implications. Through a qualitative research, we have investigated psychosocial repercussions in the subjective construction of laryngectomized patients and their caregivers. The path through illness is experienced as a moment of crisis in which abandonment and destitution feelings prevail. The loss of speech may lead patients to social isolation, deviation from professional functions, with feelings of shame and guilt, leading to anguish and suffering. Caregivers suffer not only due to the possibility of a loss, but also because of their attempts, nor always successful, to give support and offer ambience for new necessities that appear. Results show that knowing psychosocial repercussions of this experience may provide important subsidies to clinical psychology.

La cirugía de laringectomía Total implica la necesidad de procedimientos agresivos que causan lesiones estéticas y funcionales irrecuperables y una serie de consecuencias biopsicosociales. Por una metodología cualitativa investigamos las repercusiones psicosociales posibles en la construcción subjetiva de pacientes laringectomizados y sus cuidadores. Todo el pasaje alrededor de la enfermedad es vivido como un momento de crisis donde el sentimiento de abandono predomina. La pérdida de la habla asume prioridad, conduciendo el paciente para aislarse de su cordialidad social, marcharse de sus funciones profesionales, con sentimientos inadecuados, estima propia baja, vergüenza y culpa. La familia sufre doblemente: de un lado por la percepción de la fragilidad y el temor de la pérdida y de otro por tentativas, ni siempre exitosas, para dar apoyo y ofrecer el ambiente para las nuevas necesidades que se presentan. Conocer las repercusiones psicosociales de esa experiencia puede traer importantes subsidios para la psicología clínica.

A Comparative Acoustic Study of Voice Rehabilitation After Total Laryngectomy / 대한이비인후과학회지

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.

The Characteristics of Nasal Cycle and Nasal Cavity Volume inLaryngectomees Using Acoustic Rhinometry / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The nasal cycle of laryngectomized patients has been thought to be far different from the normal subjects. This study was performed to evaluate the difference in the patterns and activities of nasal cycles, the total nasal cavity volume, and the degree of change in the nasal cavity volume between laryngectomees (LG) and normal controls. MATERIALS AND METHODS: Twentythree laryngectomized patients and twenty-three normal controls were studied. Acoustic rhinometry measurements were taken 3 times from each nostril at intervals of 30 minutes during 8 hrs. The total nasal cavity volume was measured from the first 7 cm of nostril. RESULTS: There were four types of nasal cycle patterns in both laryngectomees and controls: classical pattern in 6 (26.1%) LG and 5 (21.7%) controls, in concert pattern in 3 (13.1%) LG an 8 (34.8%) controls, mixed pattern in 4 (17.4%) LG and 3 (13.0%) controls, irregular pattern in 11 (47.8%) LG and 6 (26.1%) controls. In laryngectomees, the total nasal cavity volume was increased (p0.05). CONCLUSION: Although the afferent input from the airflow receptor in the nasal cavity may play a role in modulating the pattern of nasal cycle, we suggest that the central nervous system is more important than the feedback mechanism for regulation and control of nasal cycle.

Olfaction in Laryngectomees

Knowledge about the mechanism and factors that influence olfaction in laryngectomees remains unclear. The aims of this study were to determine the effect of nasal airflow on olfactory ability, as measured by sniff alone and laryngeal bypass with sniff ; to evaluate varying olfactory abilities according to the status of the speech mechanisms in esophageal speakers (ES) and tracheoesophageal shunt speakers (TES) ; and to assess the relationship between speech acceptability and olfactory ability in laryngectomees. Two laryngectomee groups, consisting of ES and TES, and age-matched controls were analyzed through questionnaires, tests applying a Japanese T&T olfactometer to measure thresholds of odor detection and recognition, intravenous alinamin injection tests, and measures of speech acceptability. The findings that laryngeal bypass with sniff and the TES group demonstrated lower olfactory thresholds and shorter latent times than sniff alone and the ES group was informative about the importance of nasal airflow to the olfactory ability in laryngectomees. Furthermore, the close relationship found between olfactory threshold and speech acceptability showed that the ability to transport airflow through the nasal cavity during speech had a strong influence on olfactory ability in laryngectomees.