Aerodynamic characteristics of the slit-like trachea-esophagus puncture for voice rehabilitation following total laryngectomy.

CONCLUSIONS: The slit-like trachea-esophagus puncture is a reliable procedure to restore the voice in the patient who has undergone a total laryngectomy. The new voice quality could be similar to normal and could meet the patient's daily needs. OBJECTIVES: We report a new method of tracheoneoesophageal (TE) voice rehabilitation. A slit-like trachea-esophagus puncture was made in the tracheoesophageal wall after the total laryngectomy. No voice prosthesis was used. The purpose of this study was to observe its aerodynamic characteristics. METHODS: All 60 patients received voice rehabilitation with the slit-like fistula after total laryngectomy. All patients' voices were evaluated as excellent. The aerodynamic characteristics of trachea-esophagus voices were observed. RESULTS: When a patient attempted to phonate, the upper esophagus was closed. Then, the hypopharyngeal cavity expanded. Just before phonating, the upper esophagus was full of air as a ball. The air flow escaped through the segment of the trachea-esophagus slit and entered the pharyngoesophageal segment (PES). The esophageal meatus opened. It was vibrated together with nearby mucus and mucosa to form the voice. The maximum phonation time of the slit-like fistula voice was not significantly different from the Blom-Singer prosthesis voice. Its sound intensity was similar to the normal voice.

[Olfactory acuity and improvement of olfaction after total laryngectomy].

OBJECTIVE: To test and evaluate the olfactory function of patient after total laryngectomy, seek to a practical method to ameliorate olfactory function and rise the qualitative character of these patients. METHODS: Using the T&T olfactory examination to evaluate the olfactory function of 60 cases. Four cases olfactory mucosae were observed by electron microscope. Observing relation among the remains olfaction, the time after operation and whether or not undergone the voice reconstruction. And analyse the reasons of the above hyposomnia. Using the closing-mouth and nasal out-word airflow maneuver (CNOAM) as the intervention in the patients of tracheoesophageal fistula voice reconstruction after total laryngectomy to observe the amelioration after intervention. RESULTS: It shows various degree of hyposmia and anosmia in the cases after total laryngectomy with or without tracheoesophageal fistula voice reconstruction, with significant deference (P < 0.01) compared to the normal person respectively. There are precisely correlation among the time after operation and whether or not undergone the voice reconstruction. The longer time leads to less remaining olfaction. The patients after total laryngectomy without tracheoesophageal fistula voice reconstruction have lost their olfaction thoroughly within 5 years. But for the patients after total laryngectomy with tracheoesophageal fistula voice reconstruction, they have a middle hyposmia within 5 years, with significant deference (P < 0.01) between the patients in 5 years and after 5 years. There were significant differences (P < 0.01) between the values of patients with and without tracheoesophageal fistula voice reconstruction. The ultrastructure of 4 cases of olfactory epithelium shows the apoptosis change. After the treatment of CNOAM, the remaining olfaction of most patients were improved, with significant deference (P < 0.01) compared to those before the treatment of CNOAM. CONCLUSIONS: The proceed hypofunction of olfaction may be influenced by the reform of respiratory air, the extinction of air velocity bypass the nasal cavity and the apoptosis of epithelial cells in the patients after total laryngectomy. But if we give an early intervention study such as tracheoesophageal fistula voice reconstruction and CNOAM, the olfactory function may be maintenance. During the intervention, the ending of olfactory nerves may be get uninterrupt stimulation. This may help the patients keep a better existing quality than those fail to accept the interventions.

[The observation on the mechanism of speech forming by slit-like trachea-esophagus puncture after total laryngectomy].

OBJECTIVE: To observe the mechanism of the rehabilitated speech using slit-like fistula between trachea and esophagus after total laryngectomy. METHOD: Forty patients after total laryngectomy all come from the fourth central hospital of Tianjin. They all reconstructed voice using slit-like fistula between trachea and esophagus primary or secondary stage. We use teleradiography and laryngotroboscope to observe its mechanism of store gas stage, deliver gas stage and phonation stage. RESULT: While inspiratory, the pulmonary enlarged, and the upper esophagus was closed and circulus invension. After this, the infra-pharyngeal cavity expanded, looks like a downward triangular taper. The upper end of the esophagus opened suddenly. Phonation begin, the superior esophagus was full of air as a ball. The air escape through the segment of trachea-esophagus. The meatus of esophagus opened in coronal position and turn over like lip. It is vibrated together with nearby mucus, mucosa to form voice. After that, thorax shrink, the meatus of esophagus turn in again, the voice behavior is over. CONCLUSION: The power organ of trachea-esophagus voice is lung. It is crucial for the trachea-esophagus fistula unobstructed and smooth to forming voice. When phonation, the mucosa, mucus of infra-pharyngeal and esophageal meatus take part in vibration.

[Acoustic analysis of the voice restored by using a tracheoesophageal slit-like fistula].

OBJECTIVE: To evaluate the quality of voice restored by using a tracheoesophageal slit-like fistula objectively through acoustic analysis. METHODS: Seven objective voice parameters (fundamental frequency, intensity, duration, formant F1, F2, F3 and their energy, jitter, and shimmer) of esophageal speech, Blom-Singer prosthesis voice, tracheoesophageal slit-like fistula voice, primary or modified surgical restored, and normal voice were analyzed and compared. RESULTS: T test was used for statistical analysis. The maximum phonation time of slit-like fistula voice was shorter than that of normal voice, longer than that of esophageal voice, no significant difference compared with that of Blom-Singer prosthesis voice. Its sound intensity of it was similar to that of normal voice and Blom-Singer voice, better than that of esophageal voice. Its fundamental frequency was lower than that of normal voice. Its shimmer and jitter was more than that of normal voice, less than that of esophageal voice, and similar to that of Blom-singer one. Compared with esophageal voice, all formants but F1 of it were not statistically different. No statistical difference between the 2 groups of slit-like fistula patients, i.e., the instant slit-like fistula construction after total laryngectomy and the second stage slit-like fistula construction. CONCLUSION: The voice quality of the patients with tracheoesophageal slit-like fistula is similar to that of the normal and could meet the needs of daily life.