Current trends in laryngectomy rehabilitation: a survey of speech-language pathologists.

This study determined the perceptions of experienced speech-language pathologists regarding current practices in the speech rehabilitation of laryngectomy patients since the introduction of the tracheoesophageal puncture-voice prosthesis technique in 1980. The sample population consisted of 151 experienced speech-language pathologists, or 43% of those who were sent questionnaires. The speech-language pathologists ranked tracheoesophageal puncture-voice prosthesis as their most preferred speech rehabilitation method and the electrolarynx as their least preferred, even though the electrolarynx continues to be the most frequently used method. Variable use of the tracheoesophageal puncture procedure by otolaryngologists was reported, with only a small portion perceived as using it routinely. About 65% of the speech-language pathologists reported that more than half of the laryngectomy patients were being given choices among speech rehabilitation methods. Nearly 50% of the speech-language pathologists reported that fewer than six speech therapy sessions were necessary with tracheoesophageal puncture patients, whereas more than 20% reported the need for 10 sessions or more. Use of manual closure of the tracheostoma by tracheoesophageal puncture patients far outweighed their use of automatic speaking valves. Most speech-language pathologists reported that they were involved in teams with otolaryngologists to determine patient suitability for tracheoesophageal puncture and to troubleshoot problems. Eighteen different categories of medical and speech production problems were reported.

Prosthetic voice restoration with the tracheostomal valve: a clinical experience.

INTRODUCTION: Tracheoesophageal puncture (TEP) and use of a voice prosthesis is not a panacea for all laryngectomies. This report presents results of longitudinal treatment of 24 patients with secondary TEP followed longitudinally for 10 years in a private practice setting. Unique to this report is a focus on the use of the entire voice restoration system including both the voice prosthesis and the automatic tracheostomal valve. METHODS: All patients referred for secondary TEP between 1982 and 1992 are included. Voice quality and the longevity of vocal restoration were ascertained. Clinical problems and their solutions are reported. RESULTS: Immediate vocal restitution was achieved in 19 of 24 patients. Voicing was produced in two more patients within a few weeks. Four patients were not available for long-term follow-up because of death due to recurrent disease. Overall, 60% of patients were rated excellent and 5% rated fair in communication over a long-term period. Thirty-five percent were rated failure. DISCUSSION: TEP and the use of the voice restoration system enabled both hands to be free during speaking and is achieved by many laryngectomies. Patient evaluation, training, and follow-up with team problem-solving may increase success rates using this approach.

Perforating osteotomies in rhinoplasty.

While perforating lateral osteotomies have been previously described by other authors, most of the current literature emphasizes only sliding lateral osteotomies. Therefore, we present our experience with 106 consecutive rhinoplasties performed with perforating lateral osteotomies with a minimum 2-year follow-up. The perforating lateral osteotomy technique used in these rhinoplasties is described in detail and is compared with those techniques previously reported for perforating lateral osteotomies in rhinoplasty. Anatomical considerations are discussed. The results with the perforating lateral osteotomy technique have been excellent and are also presented. We think that perforating lateral osteotomies are an important and useful part of the rhinoplasty armamentarium.

Sudden hearing loss and acquired immunodeficiency syndrome.

We have presented a case of a male homosexual with documented acquired immune deficiency syndrome in whom sudden sensorineural hearing loss developed after a series of opportunistic infections and before a massive intracerebral hemorrhage. Two major possible causes of his hearing loss are (1) actual involvement of spiral ganglion or acoustic division of the eighth cranial nerve by HTLV III virus, or (2) cryptococcal meningitis. He ultimately died after a series of neurological complications developed. These complications, which are common in patients with AIDS, include progressive dementia, obtundation, and coma. As the number of patients with AIDS in our society increases over the next 5 years, it will become more important for the otolaryngologist to recognize the complications of this disease that involve the ear, nose, throat, head, and neck. Sudden sensorineural hearing loss is one of these complications. The acquired immune deficiency syndrome, at this point, might best be treated by an approach of preventive medicine. However, such an approach would have far-reaching social and political implications--perhaps more so than in other venereally spread diseases. In the interim, the otolaryngologist-head and neck specialist is required to recognize AIDS as it manifests itself in the head and neck. In this case, sudden-onset sensorineural hearing loss was the otolaryngologic presentation of the AIDS.

Life change stress factors in hospitalized otolaryngologic patients.

In this present era of specialty medicine and surgery, the physician should not lose sight of the total patient as he practices within the narrow limits of his specialty. Since there is evidence that stress created by life change factors may be associated with the onset of illness, we investigated life change factors in 100 patients hospitalized on an otolaryngology-head and neck surgery service to determine whether their stress scores were significantly higher than those of a nonhospitalized population of similar age and sociocultural background. The Social Readjustment Rating Scale (SRRS) was used to measure life change units (LCU) in the experimental and control groups. Nonparametric statistics used to analyze the data showed that at the .01 level of confidence hospitalized patients had stress scores significantly higher than those of the control group. We conclude that a clustering of life changes may have a significant impact on a patient's disease history. Awareness of LCU levels could be useful in detecting a patient's vulnerability to disease, and may therefore be useful in a preventive medicine approach to understanding and treating the total patient.

The acoustic stapedial reflex as a prognostic indicator in sudden onset sensorineural hearing loss.

Forty consecutive patients with sudden onset sensorineural hearing loss treated similarly over a four-year period were studied retrospectively to determine a correlation between presence or absence of the acoustic stapedial reflex (ASR) and recovery of hearing. Six patients were dropped from the study because of incomplete data. There were 42 affected ears in the remaining 34 patients. The ASR was present in 28 (67%) of the 42 affected ears that had either full or partial recovery. The ASR was not present in 11 ears (26%) in which there was no recovery. The ASR was present in three ears (7%) in which there was no recovery. There was a statistically significant association (P < .001) between presence of the ASR and eventual full or partial recovery of hearing in this series. The ASR would have been an effective prognostic indicator for 32 (94%) of our 34 patients (39 [93%] of 42 affected ears).