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Otorhinolaryngology (ENT)
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Speech rehabilitation➣ Electrolarynx➣ Blom singer valve with tracheo-oesophageal puncture
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
In addition to the above, counselling should also include detailed information about the various options for voice production. These are oesophageal speech, the artificial larynx and surgical voice restoration (SVR). The latter involves the creation of a tracheo-oesophageal puncture (TEP) at the time of primary surgery or at a later date. The TEP is a fistula through the posterior tracheal wall into the oesophagus. This TEP is stented open with a Foley catheter or a one-way valve made of medical grade silicone. Air can pass into the oesophagus for voice production when the stomal exit is temporarily covered, but food and fluid are not aspirated (Figure 15.3).
Adult Anaesthesia
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Daphne A. Varveris, Neil G. Smart
Tracheo-oesophageal puncture allows the placement of a voice prosthesis between the trachea and the oesophagus. The voice prosthesis is a one-way valve that allows air to pass from the trachea to the pharynx when the tracheal stoma is occluded, thus preserving voice, but preventing contamination of the trachea from above.
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
Radical surgical excision is considered the first-line treatment for laryngeal and hypopharynx cancer. Total laryngectomy is still the mainstay of treatment for the advanced laryngeal cancer patients in the undeveloped countries [7]. Advanced laryngeal cancer patients from low-income countries may find chemoradiotherapy to be more expensive than surgery. Currently, several methods are available for the restoration of laryngeal function. TES is the most important mode of communication used by patients who have undergone total laryngectomy, and the placement of intraoperative voice prosthesis during primary tracheoesophageal puncture (TEP) formation is the standard of care in many institutions. However, TEP is not approved for use in our country. Unfortunately, each technique has its own pros and cons. While esophageal phonation may enable the restoration of speech function, it has a low success rate. However, TEP offers the advantages of simplicity of the procedure, minimal requirement of training, low risk of aspiration, and absence of external device. The success rates of TEP vary from 65% to 85% and may be even higher. These rates are higher than those observed in our study. However, TEP may not be affordable for patients in the developing countries [8]. Moreover, TEP is associated with complications such as obstruction, tissue maceration, fungal and/or bacterial growth on the voice prosthesis, aspiration of a dislodged prosthesis into the trachea or esophagus, tracheal stenosis, esophageal perforation, and valve failure. Therefore, the development of an alternative method is imperative in these countries.
Direct complications and routine ICU admission after total laryngectomy
Published in Acta Oto-Laryngologica, 2018
Rebecca Tosca Karsten, Adriana Jacquelina Timmermans, Julia ten Cate, Martijn Matthias Stuiver, Michiel Wilhelmus Maria van den Brekel
The following patient and tumor characteristics were extracted from the medical file: sex, age at TL, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) score, (C)RT in the head and neck region prior to the TL, tracheotomy prior to TL, preoperative hemoglobin and albumin levels, and origin- and TNM-classification of the tumor. The following data was extracted from the surgical report: duration of surgery, urgency of surgery, indication of TL, extent of neck dissection, type of pharyngeal reconstruction, extent of thyroidectomy and whether or not a primary tracheoesophageal puncture (TEP) was performed. Data collected from the records of the ICU included peri- or postoperative events of any kind that needed treatment in the ICU (e.g. mechanical ventilation or use of inotropes) and other events that do not fit the standard postoperative period (e.g. bleedings).
Surgical rehabilitation of the voice post total laryngectomy
Published in Hearing, Balance and Communication, 2021
C. M. Grillo, L. Maiolino, A. Borragan Torre, I. La Mantia
Our study was conducted at the University Hospital of Catania, and the data was collected at the ‘Otolaryngology Clinic’ Complex Operational Unit from 1 January 2010 to 31 December 2020. The patients considered eligible for the study were all candidates for total laryngectomy [25]. The inclusion criteria considered were: age over 18, tracheoesophageal speech utilising a voice prosthesis after laryngectomy procedures for laryngeal tumour (both primary and secondary TEP performed); oesophageal speech; clinical-instrumental follow-up after TEP performed ≥ 10 years, physical and cognitive capacity and willingness to perform a pre and post intervention clinical evaluation. Informed consent was obtained from all participants. When study participants withdrew or died, the assessments were completely cancelled. During the years of observation, 10 patients were excluded from the study, while 57 were enrolled. The enrolled patients were 49 males and 8 females, aged between 53 and 78 years (mean age: 64.7 years). Voice prosthesis following TEP (tracheoesophageal puncture) was performed as a primary choice in 13 cases while as a secondary procedure in 29 cases, on average 6 months after total laryngectomy (6.1 ± 1.4 months). The use of the oesophageal voice through adequate rehabilitation, on the other hand, was the choice for 15 patients. All enrolled patients, included in the two groups, underwent two types of subjective evaluation of the voice performance after the total laryngectomy surgery, i.e. the evaluation of the quality of life obtained through the administration of the Voice-Related Quality of Life (VR- QoL) and the evaluation of vocal performance through the Voice Handicap Index (VHI).