Mecanismos de comunicación en pacientes laringectomizados / Communication mechanisms in laringectomized patients

RESUMEN El cáncer laríngeo representa el 25% de las neoplasias de cabeza y cuello. Para los carcinomas laríngeos T1 tratados con radioterapia o cirugía láser, no existe diferencia significativa en cuanto a la calidad de voz percibida por el paciente entre ambas formas terapéuticas. La laringectomía total sigue siendo utilizada como la alternativa terapéutica en carcinomas avanzados. La pérdida de la capacidad de fonación es una consecuencia de esta cirugía, por lo que existe un variado abanico de mecanismos de comunicación que ofrecerle al paciente. Las alternativas clásicas comprenden: erigmofonación, laringe electrónica y válvula traqueoesofágica. Dentro de este escenario, han surgido nuevas alternativas en los últimos años como son conversión estadística de voz GMM (Gaussian Mixture Model), proyecto SWARA y el proyecto "Mi propia voz".

ABSTRACT Laryngeal cancer accounts for 25% of head and neck cancers. For T1 laryngeal carcinomas treated with radiotherapy or laser surgery, there is no significant difference in terms of quality of voice perceived by the patient between both therapeutic forms. The total laryngectomy is still used as the therapeutic alternative in advanced carcinomas. The loss of the phonation ability is a consequence of the surgery, so there is a diverse range of communication mechanisms to offer to the patient. Classical approaches include: esophageal speech, electrolarynx and tracheoesophageal valve. In this scenario, new alternatives have emerged: statistical voice conversion GMM (Gaussian Mixture Model), SWARA project and "Mi propia voz" project.

Rehabilitación vocal en un paciente con cáncer de laringe tratado con radioterapia / Vocal rehabilitation in a patient with laryngal cancer treated with radiotherapy / Reabilitação vocal em paciente com câncer de laringe tratado com radioterapia

INTRODUCCIÓN: La mayoría de la población con cáncer de laringe experimenta alteraciones persistentes en la voz por causa de los efectos fisiopatológicos de la radioterapia, provocando un gran impacto a nivel funcional y psicosocial. Los objetivos son: Determinar los momentos de la intervención fonoaudiológica en pacientes con cáncer de laringe tratados con radioterapia, describir la metodología de evaluación clínica y objetiva de la función fonatoria, identificar los factores que colaboran en la mejoría de la calidad vocal, comunicación y calidad de vida del paciente. MATERIAL Y MÉTODO: Diseño: Caso clínico. Paciente femenino, de 78 años con diagnóstico de carcinoma escamoso moderadamente diferenciado, infiltrante de laringe EI (T1bN0M0). Realizó radioterapia de intensidad modulada. Entrevista pre e intratratamiento, postratamiento de radioterapia y rehabilitación vocal propiamente dicha. Estudio objetivo de la voz (PRAAT). Valoración perceptual de la voz (GRBAS). Encuesta de calidad de vida (VHI).

INTRODUCTION: The majority of the population with laryngeal cancer experiences persistent alterations in the voice because of the pathophysiological effects of radiotherapy, provoking a great impact at functional and psychosocial level. The objectives are to determine the moments of the speech-language intervention in patients with laryngeal cancer treated with radiotherapy, describe the methodology of clinical and objective evaluation of phonatory function, identify the factors that contribute to the improvement of vocal quality, communication and quality of life of the patient. MATERIAL AND METHOD: Design: Clinical case. Female patient, 78 years old with diagnosis of moderately differentiated squamous carcinoma, infiltrating larynx EI (T1bN0M0). She performed modulated intensity radiotherapy. Pre and intra-treatment interview, post-treatment of radiotherapy and vocal rehabilitation proper. Objective study of voice (PRAAT). Perceptual perception of voice (GRBAS). Quality of Life Survey (VHI).

INTRODUÇÃO: A maioria da população com câncer de laringe sofre alterações persistentes na voz devido aos efeitos fisiopatológicos da radioterapia, causando um grande impacto no nível funcional e psicosocial. Os objetivos são determinar os momentos da intervenção fonoaudiológica em pacientes com câncer de laringe tratados com radioterapia, descreva a metodologia de avaliação clínica e objetiva da função fonatória, identificar os fatores que contribuem para a melhoria da qualidade vocal, comunicação e qualidade de vida do paciente. MATERIAL E MÉTODO: Design: Caso clínico. Paciente do sexo feminino, 78 anos com diagnóstico de carcinoma escamoso moderadamente diferenciado, infarto da laringe EI (T1bN0M0). Eu executo radioterapia de intensidade modulada. Entrevista pré e intra-tratamento, pós-tratamento de radioterapia e reabilitação vocal própria. Estudo objetivo da voz (PRAAT). Percepção perceptiva da voz (GRBAS). Inquérito à qualidade de vida (VHI)

A brief review of voice restoration following total laryngectomy.

Despite advances in conservative laryngeal surgery and radiotherapy, total laryngectomy still remains the procedure of choice for advanced-stage (UICC T3 and T4) laryngeal carcinoma, around the world. The functional rehabilitation of the laryngectomized patients has been a concern of head and neck surgeons and speech therapists. Significant developments in speech rehabilitation over the past three decades have led to substantial improvements in the quality of life of these patients. The tracheoesophageal (TE) voice prosthesis has become the gold standard in various centers for voice rehabilitation since its introduction in 1980. Successful tracheoesophageal voice restoration in laryngectomy patients can be very rewarding and patients no longer have to live in silence while they await the results of their cancer treatments. They can face the challenges of life with the knowledge that a near normal quality of life is very much possible.In this article, we present a brief review of voice restoration following laryngectomy.

Análise da qualidade de vida e voz de pacientes laringectomizados em fonoterapia participantes de um grupo de apoio / Analysis of quality of life and voice of laryngectomized patients on speech therapy participants in a support group

Introdução: a laringectomia causa diversas alterações anatomofi siológicas e socioemocionais.O comprometimento da comunicação devido à perda da voz demanda um atendimento global aolaringectomizado. Objetivo: analisar a qualidade de vida em voz de pacientes laringectomizados emfonoterapia participantes de um grupo de apoio. Método: participaram da pesquisa 16 laringectomizadostotais do Grupo de Apoio ao Laringectomizado localizado no Hospital Santa Rita do Complexo HospitalarSanta Casa de Misericórdia de Porto Alegre. Foram aplicados o Protocolo de Levantamento de Dados deLaringectomizados de um Grupo de Apoio para caracterização dos sujeitos da pesquisa, e o Protocolode Qualidade de Vida em Voz para análise da autopercepção vocal dos sujeitos laringectomizados.Resultados: no Protocolo de Levantamentos de Dados de Laringectomizados de um Grupo de Apoio, osignifi cado do grupo foi assinalado com maior freqüência (30) como “Apoio”, enquanto nas escalas,atribuiu-se com maior freqüência nota 10 (68,8) para a importância dos exercícios fonoaudiológicose 8 (37,5) para a autopercepção de qualidade de vida dos sujeitos laringectomizados. Os resultadosdo Protocolo de Qualidade de Vida em Voz, domínio físico e socioemocional, apresentaram média 66,66e 73,04, respectivamente. Conclusão: os laringectomizados do grupo de apoio apresentaram maiordesconforto no Domínio Físico, o que parece afetar diretamente a qualidade de vida. Apresentaramtambém respostas satisfatórias referentes ao trabalho fonoaudiológico e ao papel do grupo na reabilitaçãofísica e socioemocional pós-laringectomia, revelando que o trabalho realizado em grupo tem grandeinfl uência na recuperação da qualidade de vida.

Introduction: laryngectomy causes several anatomical, physiological and socio-emotional changes.Impaired due to loss of voice demands a global service to the laryngectomy. Objective: to analyze thequality of life and voice of laryngectomized in speech therapy for a support group. Method: the survey of 16 laryngectomized Support Group located at the Santa Casa Hospital in Porto Alegre. We usedthe Protocol Survey Data Laryngectomized a Support Group for the characterization of the researchsubjects, and Life Quality Protocol for Voice self-perception analysis of laryngectomized. Results: inthe Protocol Survey Data of Laringectomized of a Support Group the question of the meaning of thegroup had “support” more often (56.3), while the scales of importance of speech therapy exercisesand self-perceived of quality’s life had more often 10 (68.8) and 8 (37.5) respectively. The resultsof the Protocol Voice Quality of life had an average 66.66 in the physical domain, and 73.04 in thesocio-emotional domain. Conclusion: the laryngectomy support group showed greater discomfort inthe physical domain, which affects the quality of life. They also showed satisfactory answers regardingthe work and role of the speech group physical rehabilitation and socio-emotional post laryngectomy,revealing that the group has great infl uence on the recovery of life’s quality.

Introducción: la laringectomía causa varios cámbios anatomofi siológicos y socioemocionales. Eldeterioro de la comunicación debido a la pérdida de la voz exige un atendimiento global al pacientelaringectomizado. Objetivo: analizar la calidad de vida y de voz en pacientes laringectomizados enfonoterapia participantes de un grupo de apoyo. Método: participaron del estudio 16 laringectomizadostotales del Grupo de Apoyo al Laringectomizado ubicado en el Hospital Santa Rita del ComplejoHospitalario Santa Casa de Misericordia de Porto Alegre. Fueron utilizados el Protocolo de Recolecciónde Datos de Laringectomizados de un Grupo de Apoyo para caracterizar los sujetos investigados y elProtocolo de Calidad de Vida y Voz para analizar la autopercepción vocal de los sujetos laringectomizados.Resultados: en el Protocolo de Recolección de Datos de Laringectomizados de un Grupo de Apoyo elsignifi cado del grupo fue señalado con mayor frecuencia (30) como “Apoyo” mientras el las escalasse atribuyó con mayor frecuencia nota 10 (68,8) a la importancia de los ejercicios fonoaudiológicosy 8 (37,5) para la auto-percepción de calidad de vida de los sujetos laringectomizados. Los resultadosdel Protocolo de Calidad de Vida y Voz, dominio físico y socioemocional presentaron media de 66,66y 73,04 respectivamente. Conclusión: los laringectomizados del grupo de apoyo presentaron mayormalestar en el Dominio Físico, lo que parece afectar directamente la calidad de vida. Presentarontambién respuestas satisfactorias con respecto al trabajo fonoaudiológico y la función del grupo en larehabilitación física y socioemocional después de la laringectomía, revelando que el trabajo realizadoen grupo tiene grande infl uencia en la recuperación de la calidad de vida.

Comportamiento de laringectomía total: Provincia Holguín 2004-2009 / Behavior of the total laryngectomy: Holguin Province: 2004-2009

Realizamos un estudio retrospectivo longitudinal, sobre el comportamiento de la laringectomía total y sus principales complicaciones en nuestro hospital durante 6 años. Existió un predominio del sexo masculino con 85,2% y en la década de 60-70 años, el 91,3% de los pacientes refirieron algún hábito tóxico, siendo los síntomas clínicos predominantes la Disfonía y Disnea con un 46,9%, el tiempo de evolución de los síntomas en la primera consulta fue de 7-9 meses para el 31,1%, el 60,5% de lospacientes tenían nódulos linfáticos cervicales en el momento del diagnóstico. La más temida de las complicaciones del paciente laringectomizado los faringostomas sólo se presentaron en un 3,7%, lo que representa un verdadero logro de la cirugía laríngea de nuestro trabajo.

We conducted a retrospective longitudinal study on the behavior of the total laryngectomy and its major complications in our hospital for 6 years. There was a predominance of males with 85.2% and in the decade from 60-70 years, 91.3% of the patients reported any toxic habits, being predominantclinical symptoms of dysphonia and dyspnea 46.9%, the time evolution of symptoms at the first visit of 7-9 months was 31.1%, 60.5% of patients had cervical lymph nodes at diagnosis. The most feared complications of the laryngectomized patient pharyngostoma only occurred in 3.7%, which representsa real achievement for laryngeal surgery in our work.

Surgical voice restoration after total laryngectomy: An overview.

Total laryngectomy is potentially a debilitative surgery resulting in compromise of some of the most basic functions of life including speech and swallowing. This may have a profound adverse effect on the patient's physical, functional, and emotional health, and may result in a decreased quality of life (QOL). Until the 1980s, total laryngectomy was regarded as a dreadful, but often, life-saving procedure for which there was little alternative, and was used as a last resort. At that time survival at any cost in terms of QOL was paramount and many laryngectomies were forced into an isolated life as a mute and dysphasic recluse. Most attempts at voice restoration produced inconsistent results and often techniques were laborious, expensive, and ineffective, particularly when carried out as a salvage procedure after failed radiotherapy. Progress in voice rehabilitation, following total laryngectomy, over the last 30 years, has made an enormous difference in the whole concept of the management of laryngeal cancers. Currently there are several options available for these patients, namely, esophageal speech, artificial larynx, and tracheoesophageal speech. The choice of speech rehabilitation varies from patient to patient, but tracheoesophageal voice has become the preferred method. This article provides a brief account of surgical voice restoration after total laryngectomy. Special emphasis has been given to the surgical technique, special considerations, complications, and the prevention / treatment of tracheoesophageal voice restoration.

Current status and future prospects in prosthetic voice rehabilitation following laryngectomy.

Total laryngectomy or laryngopharyngectomy remains the procedure of choice for advanced-stage (UICC T3 and T4) laryngeal carcinoma around the world despite advances in conservative laryngeal surgery and radiotherapy. However, it has profound effects on respiration and deglutition, in addition to the most disabling effect-the loss of verbal communication. Successful voice restoration can be attained with any of three speech options, namely esophageal speech, electrolarynx, and tracheoesophageal (TO) speech using an artificial valve. Although, no single method is considered the best for every patient, the tracheoesophageal puncture has become the preferred method in the past decade. Several types of voice prostheses have been produced since the first prosthesis was introduced in 1980 by Blom and Singer. However, eventually all prostheses are confronted by the same problem, i.e., the development of a biofilm, leading to deterioration and ultimately to dysfunction of the prostheses, necessitating replacement. This article attempts to sum up the historical background as well as the current state of surgical voice rehabilitation following laryngectomy; we review the recent major advances as well as the future prospects. Data was collected by conducting a computer-aided search of the MEDLINE and PubMed databases, supplemented by hand searches of key journals. Over 50 articles published in the last three decades on the topic have been reviewed, out of which about 20 were found to be of relevance for this article.

Câncer de laringe: quando suspeitar, como diagnosticar e encaminhar o tratamento / Laryngeal neoplasms: when to suspect, diagnose and treat it

Os autores fazem revisão bibliográfica sobre o câncer de laringe, enfatizando aspectos importantes do diagnóstico e tratamento

Utilizacao do estomago e grande epiploon em reconstrucao cervical / Use of gastro-omental transference in cervical reconstruction

Sao apresentados dois casos de pacientes con cancer recidivado de laringe, envolvendo a regiao cutanea cervical. Num primeiro tempo foi realizada ampla resseccao de toda a massa tumoral. A reconstrucao de toda a extensa perda foi realizada com um retalho livre microcirugico de estomago e grande epiploon. Apos 45 dias houve a completa cicatrizacao e os pacientes tiveram condicoes de alimentar-se por via oral em 20 e 23 dias respectivamente. Este retalho de livre estomago e grande epiploon pode ser usado para este tipo de reconstrucao em casos selecionados

Primary tracheo oesophageal puncture our initial experience.

Our initial experience of 9 primary tracheo oesophageal punctures with Blom Singer prosthesis is reported. Patient selection was based on motivation, intelligence and socioeconomic status. Excellent speech resulted in 7 out of 9 patients (77%), with 2 failures (23%). There were no major complications. The results are encouraging, but a larger study is required to determine the role of this procedure in our conditions.

Tratamento quirúrgico radical y rehabilitación en pacientes con cáncer de laringe (1980-1984) / Radical surgical treatment and rehabilitation in patients with laryngeal neoplasm (1980-1984)

En el presente estudio se revisó lo relacionado con el tema de la laringectomía total en pacientes con cáncer de laringe; su indicación, la preparación pre-operatoria y lo referente a la reabilitación foniátrica. Se procedió a investigar los expedientes de pacientes laringectomizados desde 1980 a 1984 y de ellos se seleccionó los que mantienen controles clínicos periódicos. Se consignó diagnóstico histopatológico, sitios del cáncer, clasificación T.N.M., tratamientos concomitantes, síntomas iniciales, complicaciones y resultados de la rehabilitación foniátrica. Se constató el predominio del carcinoma escamoso como etiología y del área glótica, como la más afectada. La mayoría de los casos eran avanzados lo cual apunta a la importancia del diagnóstico precoz. De los pacientes estudiados un 68% tuvo buenos resultados en la terapia de la voz. Se concluye que es importante la preparación integral del paciente incluyendo aspectos médicos y de rehabilitación foniátrica