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Data and Picture Interpretation Stations: Cases 1–45
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
Oesophageal speech is when swallowed air is regurgitated producing vibrations in the neopharynx that can be articulated by the tongue and lips. It is difficult to learn but can be very effective in some patients.
The Head and Neck
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
The main complication after a partial laryngectomy is aspiration; if the patient cannot control aspiration, this necessitates total laryngectomy. Total laryngectomy has a 25% complication rate in the form of pharyngocutaneous fistula. This incidence increases to 75% if partial or total pharyngectomy is added to the laryngectomy.37 Preplanned reconstruction by myocutaneous flaps may decrease the incidence of this complication. Furthermore, it is of utmost importance that laryngectomy patients be rehabilitated by learning esophageal speech or by learning to use one of the external or implantable speech devices.
Rehabilitation After Total Laryngectomy
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Oesophageal speech requires air to be taken into the top of the oesophagus either by injection or inhalation,14 and then forced out again causing the newly reconstructed pharynx, the PE or vibratory segment, to vibrate in response to the flow of air and produce sound. As in normal laryngeal voice production, this sound is amplified by the resonating cavities above and modified into speech by the articulators, tongue, teeth, lips and soft palate. The electrolarynx produces a sound that is then transmitted into the resonating cavities either by direct pressure of the machine against the skin of the upper neck or through a tube directly into the oral cavity. SVR has largely replaced these other methods, being easier to learn and producing better quality voice (Table 15.2).
Potential colonization of provox voice prosthesis by Candida spp. with no sign of failure for approximately 10 years exploitation time
Published in Acta Oto-Laryngologica Case Reports, 2021
Jakub Spałek, Piotr Deptuła, Bonita Durnaś, Grzegorz Król, Szczepan Kaliniak, Robert Bucki, Sławomir Okła
A 69-year-old man presented to the Otolaryngology Head and Neck Surgery Outpatient Clinic in Holly-Cross Cancer Centre (Kielce, Poland) for choking while drinking liquids. The choking was caused by transprosthetic leakage through voice prosthesis. Patient’s treatment history was shortly presented on the timeline (Figure 1). In 2001, the patient had undergone total laryngectomy, selective neck dissection on the right side (SND), and partial thyroid resection due to diagnosed squamous cell carcinoma of the larynx (stage T3N0M0). For a year, the patient used inefficient esophageal speech. In 2002, secondary surgical voice prosthesis implantation was performed and a Provox 2 8 mm voice prosthesis was inserted. The first replacement in 2004 was due to prosthesis dislocation of the esophageal flange and loss of voicing. Due to the thickening of the vocal fistula walls in the sagittal plane, the voice prosthesis was replaced with a longer one (12.5 mm). Over the next five years (2004–2009), the patient underwent eight voice prostheses replacements, the majority of which were due to transposition of the VP into the fistula canal (5), while the others were due to central leakage through the prosthesis (3). It is worth to noting that each time measurement of the fistula was performed and there were no doubts about the fitting of the VP.
Listener impressions of alaryngeal communication modalities
Published in International Journal of Speech-Language Pathology, 2021
Stephanie M. Knollhoff, Stephanie A. Borrie, Tyson S. Barrett, Jeff P. Searl
Oesophageal speech is an alaryngeal communication mode that does not rely on anything other than the person’s body to produce (i.e. no manufactured devices required). The primary components of this method involve the movement of air from the upper vocal tract into the oesophagus, and then the return of that air through the pharyngoesophageal segment which is set into vibration to create the new voice. The sound created by the pharyngoesophageal segment can then be shaped via the lips, teeth and tongue for speech production (Boone, McFarlane, Von Berg, & Zraick, 2014; Şahin et al., 2016). With appropriate professional intervention and practice, individuals may become proficient with ES and produce verbal communication that allows for variation in pitch, rate and volume. A primary limitation of ES is that timeframe for attaining proficiency can be long. As the pharyngoesophageal segment is the vibratory mechanism, some people are unable to utilise this type of communication as medical treatment such as surgery and radiation resulted in the pharyngoesophageal segment not being optimal or viable for ES.
Voice rehabilitation after total laryngectomy with the infrahyoid musculocutaneous flap
Published in Acta Oto-Laryngologica, 2021
Changjiang Li, Yi Fang, Haitao Wu, Min Shu, Lei Cheng, Peijie He
Total laryngectomy is probably the most effective therapy for advanced laryngeal cancer and hypopharyngeal carcinoma. However, complete extirpation of the larynx results in permanent loss of speech function. Effective voice rehabilitation after total laryngectomy is essential to maintain the patient’s quality of life and facilitate resocialization [1]. There are many methods of voice function reconstruction following total laryngectomy in clinic. As a whole, the methods of voice restoration can be divided into two categories: nonsurgical and surgical ways. With regards to the nonsurgical methods, options include electronic larynx and esophagus phonation. For the surgical means, modifying tracheal replacement of larynx or creating a trachea-esophageal fistula or a neoglottis using the adjacent musculocutaneous flap is available [2]. The ideal method would be one that could simultaneously restore phonation, respiration, and swallowing functions, but such a method is yet to be unidentified despite the availability of several methods. Each of the currently recognized approaches has its own advantages and disadvantages, and no single method has been identified to be universally applicable in all cases. For example, the sounds made by the electronic larynx are monotonous and unnatural, whereas the acquisition of esophageal speech is very arduous. Many investigators have attempted surgical reconstruction of phonological structures for patients undergoing total laryngectomy. Several surgical methods have been discussed, and these methods chiefly focus on the establishment of tracheoesophageal speech (TES), whereby phonic function is restored by the creation of a fistula and placement of tracheoesophageal voice prosthesis. This method is currently the preferred treatment protocol for voice rehabilitation. However, one of the drawbacks of this method is the need for periodic replacement of the voice prosthesis, which may be highly inconvenient for patients in the developing countries. Arslan et al. [3] first reported tracheopharyngeal anastomosis for voice restoration in patients who underwent total laryngectomy; however, this method is associated with a high incidence of aspiration. Subsequently, this method was further developed to overcome its drawbacks, but the results remain unsatisfactory. The use of artificial articulating devices can overcome the weakness of the electronic larynx and esophagus phonation [4]. Unfortunately, these devices are expensive and they may not be widely available in developing countries.