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

Alaryngeal speech(esophageal, neoglottal, shunt, and electrolaryngeal speech) differ from normal laryngeal speech primarily with regard to the sound or source of voicing. Theoretically, esophageal, tracheoesophageal, neoglottal and electrolaryngeal speech have difficulty in accomplishing the voiceless consonants. But perceptual studies often reveal that there is a clear production of voiceless consonants resulting good articulation scores in skilled alaryngeal speakers except electrolaryngeal speech. The purpose of the present study was to relate the three-way distinction of Korean voiceless stops in manner of articulation with normal speakers and skilled alaryngeal speakers in terms of the voicing distinction in consonants. Acoustic analysis were performed to investigate the acoustic characteristics of alaryngeal speech compared to the normal speech with special reference to the voiceless distinction. Electromyographic studies were performed to clarify the adjustment of neck muscle during normal and alaryngeal speech.
Acoustics* ; Neck Muscles ; Speech, Alaryngeal*

OBJECTIVETo evaluate rehabilitation effect of Amatsu's tracheoesophageal shunt operation after total laryngectomy with sphincter mechanism.

METHODSVoice rehabilitation were performed for 60 cases with Amatsu's tracheoesophageal shunt operation after total laryngectomy with sphincter mechanism, in which 20 cases were involved in post-operation radiation therapy.

RESULTSFifty two (86.7%)cases developed speech with voice and swallow rehabilitation, but 1 case of them suffered water drip from his tracheoesophageal shunt when drinking. The other 8 (11.3%) cases developed swallow rehabilitation but failed in speech rehabilitation for pharyngeal fistula (4 cases, in which 1 had pre-operative radiation therapy), tracheoesophageal shunt obstruction (2 cases), dyspnea with unknown reason (1 cases), no desire to speech (1 cases). Furthermore, all the 20 cases who were involved in post-operative radiative therapy restore their speech and swallow capability finally.

CONCLUSIONSAmatsu's tracheoesophageal shunt operation with sphincter mechanism brought effective speech rehabilitation results for total laryngectomy even with post-operation radiation therapy.

Aged ; Female ; Humans ; Laryngeal Neoplasms ; rehabilitation ; Laryngectomy ; rehabilitation ; Male ; Middle Aged ; Postoperative Period ; Speech, Alaryngeal ; methods ; Tracheostomy ; rehabilitation

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

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

Adult ; Aged ; Carcinoma, Squamous Cell ; surgery ; Esophagus ; surgery ; Humans ; Laryngeal Neoplasms ; surgery ; Laryngectomy ; Male ; Middle Aged ; Phonation ; Postoperative Period ; Reconstructive Surgical Procedures ; methods ; Speech, Alaryngeal ; Trachea ; surgery

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

No abstract available.
Laryngectomy* ; Speech, Esophageal*

Total laryngectomy remains as an important treatment option in selected patients with laryngopharyngeal cancers, which inevitably sacrifices naturally produced voice. Much effort has been devoted to voice restoration for these laryngectomized patients. Several ways of voice rehabilitation after total laryngectomy have been developed and utilized thus far, including tracheoesophageal shunt speech, esophageal speech, pneumatic speech aid, and electrolarynx. Of these, tracheoesophageal shunt speech appears to be the most effective voice restoration method, while other trials might also be useful in special situations. Nevertheless, each method has its own unique mechanisms of voice production, thus has its advantages and drawbacks in clinical setting. In this review, we discuss the currently available management options for the rehabilitation of laryngectomized voice.
Humans ; Laryngectomy* ; Methods ; Rehabilitation* ; Speech, Esophageal ; Voice*

BACKGROUND AND OBJECTIVES: Advanced laryngeal cancer is frequently treated by total laryngectomy. This operation is effective but results in gross functional disability because of the permanent loss of voice. As an alternative using voice, esophageal speech has been employed as a natural and satisfactory means of communication for laryngectomized patients. Unfortunately, during past decades the success rate has ranged 40-60%. The purpose of this study was to determine which factors contribute to the proficiency of esophageal speech. MATERIALS AND METHOD: Videofluoroscopy and voice analysis of fourteen alaryngeal male patients who had trained esophageal speech were performed. RESULTS: Aerophagia and air ejection were impossible in poor esophageal speakers. Fluent esophageal speakers had short pseudoglottis, longer maximum phonation time, more efficient jitter, shimmer and harmonic-to-noise ratio. CONCLUSION: Aerophagia and air ejection are essential for esophageal speech. Short pseudoglottis (less than 2 cm) affords better esophageal speech. Natural repetitive movements of aerophagia and air ejection with accurate articulatory motion can improve the quality of esophageal speech.
Acoustics* ; Humans ; Laryngeal Neoplasms ; Laryngectomy ; Male ; Phonation ; Speech, Esophageal ; Voice*