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*

BACKGROUND AND OBJECTIVES: The two most important methods for voice rehabilitation after total laryngectomy are tracheoesophageal speech and esophageal speech. The former can be obtained in several ways, for example, by the primary Amatsu tracheoesophageal (T-E) shunt operation or by the use of a low-resistance valve such as the Provox prosthesis. The purpose of this investigation was to study the anatomy and physiology of the neoglottis and to evaluate the vocal quality of tracheoesophageal speech. MATERIALS AND METHODS: A total of 12 patients, who had undergone the Amatsu T-E shunt operation after total laryngectomy, were analyzed using the stroboscopy, laryngofiberscopy, videofluoroscopy, and computerized speech lab. RESULTS: With stroboscopy, the neoglottis was split from left to right in 3 patients and in 9 patients, the direction of opening and closure of rheeoglottis was anterior-posterior. The regular vibratory features were observed in patients with a shortened visible vibratorvsegment. The results of videofluoroscopy indicate that the location of the vibration was mostly situated between C3 and C5. The cervical esophagus closure during tracheoesophageal phonation was located at a level between C7-T2. CONCLUSION: The anatomical and morphological characteristics of the neoglottis was related to the healing process after operation. The neoglottis was considered to be formed by the thyropharyngeal muscle, and concentric contraction under subneoglottic extension was formed by the contraction of the cervical esophagus.
Acoustics* ; Esophagus ; Humans ; Laryngectomy ; Phonation ; Physiology ; Prostheses and Implants ; Rehabilitation ; Speech, Esophageal ; Stroboscopy ; Vibration ; Voice

BACKGROUND AND OBJECTIVES: Acoustic parameters of maximal phonation time, sound intensity, fundamental frequency, voice range, jitter and shimmer were analyzed in order to evaluate voice quality and differences among esophageal speech (ES), tracheoesophageal shunt speech (TES), pneumatic aid speech (PA), electrolaryngeal speech (EL) according to phonetic rehabilitation methods in 16 cases of laryngectomees. MATERIALS AND METHODS: We acquired acoustic data on alaryngeal voice by different methods, and analysed each of those using specially designed programs (Laryngeal analyser V1.0 base on Matlab V5.0). RESULTS: Maximal phonation time was significantly longer in TES voice and PA speech than in ES voice (p<0.05). Jitter and shimmer were significantly regular and stable in the EL and PA speech than in the ES and TES voice (p<0.05). Voice range was significantly wider in TES voice and PA speech than in EL and ES voice (p<0.05). In two cases capable of bi-modal speech of ES and TES voice, maximal phonation time was longer with wider voice range in TES voice than in ES voice. Jitter and shimmer were regular and stable in ES voice than in TES voice. CONCLUSION: PA speech displays phonetically more natural laryngeal speech than other rehabilitation methods. But this methods is inconvenient and cosmetically unacceptable, because patients have to bite intraoral vibrator in the patient's mouth. So, we recommend TES voice rather than ES voice, without the use of speech-making device such as EL and PA speech.
Acoustics* ; Humans ; Laryngectomy* ; Mouth ; Phonation ; Rehabilitation* ; Speech, Esophageal ; Voice Quality ; Voice*

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

Cerebral Palsy ; complications ; Child ; Child Nutrition Disorders ; complications ; Deglutition Disorders ; Equipment and Supplies ; Esophageal Motility Disorders ; etiology ; therapy ; Humans ; Speech Disorders ; etiology