Objective: To investigate by means of videostoboscopy the characteristics of the neoglottis after total laryngectomy with primary or secondary voice reconstruction using a non-prosthetic tracheoesophageal fistula technique. Methods: Design: Cross-Sectional Study Setting: Tertiary Public Hospital Subjects: Twenty alaryngeal patients Results: Videostroboscopy enabled evaluation of the neoglottis in all but two patients with a pectoralis major myocutaneous flap reconstruction of the pharyngoesophageal segment. Pooling of saliva was present in the cranial neoglottic opening in all subjects, but obscured visualization in these two. A circular neoglottic shape was most commonly seen. Vibration of the neoglottis was noted in 90% of all alaryngeal patients and was associated with a regular mucosal wave. Pharyngoesophageal vibration was noted in two thirds of patients. It was associated with a strong mucosal wave, regular vibration and a longer open phase. Conclusion: Videostroboscopy confirmed that neoglottic vibration accompanies sound production while pharyngoesophageal vibration may reinforce and enhance voice production in alaryngeal patients with non-prosthetic TE voice reconstruction.
LARYNX SPEECH ; ALARYNGEAL

OBJECTIVETo study the aerodynamic characteristics of low-resistance Groningen voice prosthesis for total laryngectomees and the related clinical significance.

METHODSThree aerodynamic parameters were measured in 24 laryngectomees implanted with low-resistance Groningen voice prosthesis: the sound pressure level (SPL), intratracheal pressure (pressure) and airflow rate (flowrate). Among them, 6 cases were initially implanted with other prosthesis which was replaced by the Groningen buttons later. The parameters were measured for both old and new prosthesis. The relationship between the variables were computed with means of Pearson' s product-moment correlations.

RESULTSThe parameters were measured repeatedly among all cases, 180 group data were collected. Screening test showed that the median of sound pressure level, intratracheal pressure and airflow rate are respectively 88.0 dB, 73.6 cm H2O (1 cm H2O = 0.098 kPa) and 123.2 ml/s. Thirty times measurement of patients phonation showed that the correlation between SPL and pressure was not significant (r = -0.058, P > 0.05). The relationship between flow rate and SPL was not significant(r = -0.119, P > 0.05). The correlation between pressure and flow rate was significant(r = 0.699, P < 0.05). CONCLUSIONS When pseudoglottis vibration is produced by sub pseudoglottis air flow, pseudoglottis vibration and voice loudness can not be increased by continuous air flow.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kinetics ; Laryngeal Neoplasms ; rehabilitation ; surgery ; Laryngectomy ; rehabilitation ; Larynx, Artificial ; Male ; Middle Aged ; Prosthesis Design ; Speech Articulation Tests ; Speech, Alaryngeal

This paper presents a new kind of collecting and processing system of the sound signal of larynx where double sound cards and software filter are used. The installation of the double sound cards and processing proposal of software are mainly discussed and a new kind of ADC method of dual-channel sound signal is put forward in this paper. This system has the feature of reliable performance, simple installation and easy maintenance.
Algorithms ; Equipment Design ; Humans ; Larynx ; physiology ; Microcomputers ; Signal Processing, Computer-Assisted ; instrumentation ; Software ; Sound ; Speech Production Measurement ; instrumentation

OBJECTIVETo evaluate the extensive and degree of physical rehabilitation improvement of the quality of life in laryngectomees.

METHODSForty nine patients who underwent total laryngectomies were trained by esophageal voice rehabilitation successfully. The questionnaires of performance status scale for head and neck cancer patients (PSS-HN) and the functional assessment of head and neck cancer therapy (FACT-H&N) were answered by them before esophageal voice training and 3 months after successful vocal rehabilitation.

RESULTSTotal laryngectomy deteriorated the quality of life in laryngectomees. The mean scores of PSS-HN scale and FACT-H&N questionnaire were lower than the criteria scores after patients underwent total laryngectomy, the mean score were 131. 4,90.6 respectively, the difference was significant statistically (t =53. 673, P <0.001) , (t = 67.44, P <0.001). After successful esophageal speech training, the mean scores of the laryngectomees were improved both in PSS-HN scale and FACT-H&N which were 240.4 and 103.7 respectively, the difference was significant statistically (t = 18.209, P < 0.001) , (t = 21.389, P<0.001).

CONCLUSIONSThe quality of life in laryngectomees can be improved by physical rehabilitation and the esophageal voice training.

Adult ; Aged ; Female ; Humans ; Laryngectomy ; rehabilitation ; Larynx, Artificial ; Male ; Middle Aged ; Quality of Life ; Speech, Esophageal ; Surveys and Questionnaires ; Voice Training

BACKGROUND AND OBJECTIVES: The purpose of this study was to classify patients with unilateral vocal fold paralysis according to their fixed location and to analysis the effects of two treatment methods by early voice therapy and injection laryngoplasty. MATERIALS AND METHODS: Twenty patients who were classified as full abduction and slight abduction according to the position of paralysis were treated injection laryngoplasy, and 23 patients were treated by voice therapy. Twenty patients were treated injection laryngoplasy and 23 patients were treated voice therapy. Results were evaluated by acoustic analysis, electroglottography, cepstrum analysis before and after therapy. The voice therapy was conducted by improving the larynx movement and glottal contact, whilst removing hypertension of the supraglottic and use the breathing. RESULTS: Significant improvement was found in the acoustic parameter, cepstrum parameter, and EGG before and after treatment in both groups. There was no significant difference between the two groups when compared before and after treatment to compare the effects of injection laryngoplasty and voice therapy. CONCLUSION: The initial treatments for unilateral vocal cord paralysis are injection laryngoplasty and voice therapy. however, there is no precise standard about which method should be applied first. Therefore, in this study, we tried to classify patients according to their paralysis position and then apply two methods. The results of this study suggest that voice therapy and Injection laryngoplasty at the initial stage is a very useful method to improve voice quality of vocal fold paralysis and improve laryngeal function.
Acoustics ; Humans ; Hypertension ; Laryngoplasty* ; Larynx ; Methods ; Ovum ; Paralysis ; Respiration ; Speech Therapy ; Therapeutic Uses* ; Vocal Cord Paralysis* ; Vocal Cords ; Voice Quality ; Voice*

OBJECTIVETo discuss the clinical value of functional tracheoesophageal shunt for vocal rehabilitation after laryngectomy.

METHODSOne hundred and twenty seven cases of tracheoesophageal shunt for vocal rehabilitation after laryngectomy in Cancer Hospital of Tianjin Medical University from 1981 to 2006 were analyzed retrospectively.

RESULTSAmong 127 cases, 105 cases got successful phonation and the total success rate of vocal rehabilitation was 82.7%, all successful cases were followed up from 2 to 27 years had good phonation quality and no aspiration. Analyzing the reasons of failure in phonation of the 22 cases, 9 cases were because of improper operation (7 cases for narrow fistula and 2 cases for broad fistula), 13 cases were because of postoperative infection (10 cases for narrow fistula and 3 cases for broad fistula). The key to successful phonation was the size of fistula, the main causes of the failure in phonation were related to uncorrected operative procedure and postoperative infection.

CONCLUSIONSThis method for vocal rehabilitation after laryngectomy has high success rate of vocal rehabilitation and low complications, it is relatively simple and worth popularizing in clinical treatment.

Adult ; Aged ; Carcinoma, Squamous Cell ; surgery ; Esophagostomy ; Female ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; Larynx, Artificial ; Male ; Middle Aged ; Retrospective Studies ; Speech, Alaryngeal ; Tracheostomy ; Treatment Outcome

OBJECTIVETo evaluate the treatment outcome advanced hypopharyngeal carcinoma by surgery with laryngeal function preservation.

METHODSTwenty cases with squamous cell carcinoma of the hypopharynx who were treated by the function preserved surgery between January 2000 and March 2012 were reviewed. Of the patients 19 were males and 1 female, and their median age was 62.0 years. Eight cases were only applied with total or subtotal hypopharyngectomy, and others received total or subtotal hypopharyngectomy with partial-laryngectomy. Postoperative functional training was performed. Radiotherapy was used in all cases from 2 to 4 weeks after surgery.

RESULTSSpeech intelligibility remained in all 20 patients and 80.0% of the patients were extracted the trachea tube in the average 60 days.

CONCLUSIONSLaryngeal functions of larynx can be preserved in advanced hypopharyngeal carcinoma by total or subtotal hypopharyngectomy alone or plus partial laryngectomy with functional reconstruction, and the patients can maintain their rational speech and swallowing functions.

Carcinoma ; Carcinoma, Squamous Cell ; surgery ; Deglutition ; Female ; Head and Neck Neoplasms ; surgery ; Humans ; Hypopharyngeal Neoplasms ; Hypopharynx ; Laryngectomy ; Larynx ; Larynx, Artificial ; Male ; Postoperative Period ; Reconstructive Surgical Procedures ; Speech Intelligibility ; Treatment Outcome

INTRODUCTIONIn laryngectomised patients, tracheoesophageal speech is the gold standard for voice rehabilitation. This study evaluated complications related to the tracheoesophageal puncture (TEP) and the success rate in voice prosthesis after total laryngectomy at our institution over a 10-year period.

MATERIALS AND METHODSA retrospective review of 22 TEPs was performed between January 1998 and December 2008. The timing of TEP, type of voice prosthesis, surgical and prosthesis-related complications, and TEP closure were noted.

RESULTSEighteen percent of the patients underwent primary and 82% secondary TEP. Our patients were predominantly males (95.4%) of Chinese descent with a mean age of 62.1 years. The types of voice prostheses used were ProvoxTM (n = 15), Voicemasters (n = 6), and Blom-Singer (n = 1). Prosthesis- related complications occurred in 77.3%. Notable complications were leakage (82.5%), prosthesis displacement (41.2%), intractable aspiration (29.4%), and aspiration of prosthesis (23.5%). The most common surgical-related complication was tracheostomal stenosis. An array of interventions comprising resizing or changing prosthesis type, nasogastric catheter insertion, stomaplasty, purse string suturing, and bronchoscopic removal of bronchial aspirated prosthesis were implemented to address encountered complications. In a mean follow-up of 34.8 months, 68.2% of patients achieved functional tracheoesophageal speech (75% of primary TEP and 67% of secondary TEP). There were 7 TEP closures indicated by persistent leakage, recurrent dislodgement, phonatory failure and, in 1 patient, persistent pain.

CONCLUSIONSTEP has become an integral part in the rehabilitation of a laryngectomee. However, management of the frequent complications related to TEP requires specific efforts and specialistic commitments in order to treat them.

Academic Medical Centers ; statistics & numerical data ; Adult ; Aged ; Constriction, Pathologic ; epidemiology ; etiology ; Equipment Failure Analysis ; Female ; Humans ; Incidence ; Laryngectomy ; rehabilitation ; Larynx, Artificial ; adverse effects ; Malaysia ; epidemiology ; Male ; Middle Aged ; Punctures ; adverse effects ; Retrospective Studies ; Speech, Alaryngeal ; Trachea ; surgery