Impact of tracheoesophageal puncture prosthesis airway resistance on in-vivo phonatory performance

Substantial differences have been established among in-vitro airway resistance properties of tracheoesophageal (TE) puncture prostheses (Weinberg & Moon, 1984). In this report, the impact of these in-vitro differences on the actual, in-vivo process of TE voice production is made explicit. Variation in in-vitro airway resistance among TE puncture prostheses is shown to exert substantial effects upon in-vivo phonatory mechanism opposition to flow, aerodynamic power required to initiate and sustain TE voice production, and TE phonatory efficiency. Individuals responsible for defining TE puncture options for laryngectomized patients are encouraged to consider these effects in clinical practice.

Two simplified methods for estimating velopharyngeal orifice area

Two simplified methods for obtaining estimates of the area of the velopharyngeal orifice using nasal airflow and orifice differential pressure measures are described. In these methods, orifice areas are estimated by merely coordinating points on a graph or by interpolating values from a table. The accuracy of orifice area estimation by these methods compares favorably with estimation by other currently used methods. These simplified methods were developed to enlarge the application of hydraulic techniques by practicing clinicians.

Production of intonation and contrastive stress in electrolaryngeal speech

Acoustical investigations of intonation and contrastive stress patterns in speech produced with electronic artificial larynges were completed. High-quality tape recordings of sentences spoken by 4 normal speakers, 3 users of the Western Electric 5A electrolarynx, and 2 users of the Servox electrolarynx were subjected to acoustic analysis. All electrolarynx users distinguished stressed from unstressed syllables by varying the duration of syllables and contiguous pauses. One Western Electric 5A speaker also controlled fundamental frequency. This speaker distinguished statements from questions by varying the rate and extent of the initial rising portion of fundamental frequency contours. Findings are interpreted in relation to their implications for clinical intervention and in terms of suggestions for improved design of artificial larynges.

Aerodynamic properties of four tracheoesophageal puncture prostheses

Airway resistance calculations were completed for two tracheoesophageal puncture prostheses (American V. Mueller Blom-Singer Voice Prosthesis and BIVONA Low Resistance Voice Prosthesis), which have recently become available on a commercial basis. These calculations were compared with those made previously for two, existing prostheses: the Blom-Singer duckbill and the Panje Voice Button. Substantial differences in airway resistance properties exist among these four devices. BIVONA Low Resistance devices exhibited the lowest resistance (less than 50 cm H2O/liters per second [LPS]); Panje Voice Buttons exhibited the highest (180 to 200 cm H2O/LPS); and Blom-Singer devices exhibited intermediate values (110 to 125 cm H2O/LPS) of opposition.

Esophageal insufflation testing in nonlaryngectomized adults

Esophageal insufflation testing has been advocated for laryngectomized patients considered for tracheoesophageal puncture. The present work was undertaken to document the degree to which nonlaryngectomized individuals were able to produce and sustain esophageal voice in association with esophageal insufflation testing. Fifteen young, healthy adults were tested in a uniform way. Results were interpreted to support the views that (a) normal function of the pharyngoesophageal segment represents an influence detrimental to the ultimate acquisition of functionally serviceable esophageal or tracheoesophageal speech and (b) laryngectomized patients having airtight closure of the pharyngoesophageal segment during insufflation testing exhibit a normal esophageal response. Implications for completing air insufflation testing and selective myotomy are discussed.

The effects of increased nasal airway resistance on modeled velopharyngeal orifice area estimation

Research has shown that cleft lip and palate individuals have higher nasal airway resistance than normal subjects (Warren, Duany, and Fischer, 1969). The present work examined the predictive nature of modeled velopharyngeal orifice area calculations obtained using the hydrokinetic equation (Warren and DuBois, 1964) under conditions simulating increased degrees of nasal obstruction. The results of this project suggested that Warren's hydrokinetic method can be used to obtain accurate estimates of velopharyngeal orifice area under conditions of increased nasal airway resistance when airflow rates are nonvariant.

Perception of lexical stress in alaryngeal speech

This project was a perceptual investigation of lexical stress in alaryngeal speech. The ability of alaryngeal speakers to signal lexical stress in American English was assessed by obtaining high-quality tape recordings of noun-verb oppositions (e.g., 'insult vs. in'sult) from four normal and 16 laryngectomized speakers using four different types of alaryngeal speech. The recordings of these words were presented to 30 listeners for perceptual evaluation using a two-interval-forced-choice procedure. As expected, the four normal speakers achieved high (93% or above) levels of stress contrast. Lexical stress contrasts were also achieved at a high level of proficiency (88% or above) by all four esophageal speakers, all four tracheoesophageal speakers, one of four users of the Western Electric electrolarynx, and two of four users of the Servox electrolarynx. Lexical stress contrasts were realized in a less (82-86%) but reasonably effective manner by one Western Electric user and two Servox users. The findings were interpreted to highlight the contributions that study of clinical samples may make to investigations of speech production and speech perception.

Evaluations of Blom-Singer tracheoesophageal puncture prostheses performance

Empirical and theoretical approaches to the assessment of Blom-Singer tracheoesophageal puncture prosthesis performance are described in this paper. The results of empirical studies provide new insights about the behavior of Blom-Singer devices. Namely, the overall average resistance (about 126 cm H2O/LPS) of these devices stems from two major factors: air entrance and air exit effects. The magnitudes of airway resistance for each of these factors and the relative contribution each factor makes to the total airway resistance of these prostheses are delineated. The performance of these devices and modifications thereof are shown to be characterized and predicted quite well using a one-dimensional, spring-constant mathematical model.

Perception of intonational contrasts in alaryngeal speech

The achievement of intonational contrasts by 4 normal and 16 laryngectomized speakers was assessed in this project. The laryngectomized subjects represented four clinical subgroups of alaryngeal speech: esophageal, tracheoesophageal, Western Electric #5 electrolarynx, and Servox electrolarynx. High-quality tape recordings of each subject's productions of two pairs of sentences (Bev loves Bob) spoken in statement and question from were presented to 40 listeners for evaluation using a two-interval-alternative-forced-choice procedure. Intonational contrasts were achieved in a highly effective manner by the normal, esophageal, and tracheoesophageal speakers. In contrast, users of electronic artificial larynges were generally unable to achieve these intonational distinctions except for one user of the Western Electric #5 electrolarynx.

Unrecognized aspiration of an oropharyngeal airway

A case of unsuspected aspiration of an oropharyngeal airway causing dysphagia is described. Visualization of this airway on plain film would be facilitated if radio-opaque material were included at manufacture.

Velopharyngeal orifice area prediction during aerodynamic simulation of fricative consonants

The present work examined the predictive nature of modeled velopharyngeal orifice area calculations obtained using the hydrokinetic equation (Warren and DuBois, 1964) during conditions simulating voiceless fricative production. Results indicated that accurate estimates of velopharyngeal orifice area can be obtained during aerodynamic events like those known to exist during fricative production. These findings were interpreted to lend support to the view that aerodynamic assessment incorporating hydrokinetic principles provides a useful, noninvasive method for clinical testing and research investigation of velopharyngeal function.

Molecular cloning and regulation of expression of the genes for initiation factor 3 and two aminoacyl-tRNA synthetases

A 22-kilobase fragment of the Escherichia coli chromosome which contains the genes for translation initiation factor 3, phenylalanyl-tRNA synthetase, and threonyl-tRNA synthetase was cloned into plasmid pACYC184. The hybrid plasmid (designated pID1) complements a temperature-sensitive pheS lesion in E. coli NP37. pID1-transformed NP37 overproduce initiation factor 3 and phenylalanyl-tRNA synthetase. Gene expression from pID1 was studied in vitro in a coupled transcription-translation system and in minicells. The results suggest that the genes for initiation factor 3 and phenylalanyl- and threonyl-tRNA synthetase are regulated by different mechanisms.

Airway resistance of the voice button

Airway resistance calculations were completed for Voice Button prostheses. Resistance of these devices ranged from about 285 to 440 cm H2O/L/s, revealing that the opposition these prostheses offer to airflow through them is substantial. In this circumstance, a reduction inthe efficiency with which tracheoesophageal voice is produced would be expected.

Prediction of modeled velopharyngeal orifice areas during steady flow conditions and during aerodynamic simulation of voiceless stop consonants

Results of a small number of studies (Warren and DuBois, 1964; Lubker, 1969; Smith and Weinberg, 1980; Horii and Lang, 1981) have led to expression of divergent views concerning the accuracy of modeled velopharyngeal orifice area estimates obtained on the basis of hydrokinetic principles. In this work, the hydrokinetic equation (Warren and DuBois, 1964) was subjected to experimentation: (1) in which flow rates through a vocal tract model were not varied and (2) in which flow rates were varied to simulate pressure/flow events found during voiceless, stop consonant production. With consideration given to instrumental and procedural factors, results indicated that accurate estimates of modeled velopharyngeal orifice areas can be obtained during steady flow conditions and during alternating flow conditions when measurements are made at airflow peaks. Results were interpreted to provide strong support for clinical and research use of the hydrokinetic equation to predict velopharyngeal orifice areas during stop consonant production.

Airway resistance during esophageal phonation

Prosthesis airway resistance calculations were completed for five Blom-Singer prostheses and esophageal source airway resistance estimates were made of five laryngectomized patients using the Singer-Blom voice restoration method. Airway resistance of the Blom-Singer prostheses ranged from 46 to 121 cmH20/LPS, while source airway resistance in these-subjects ranged from about 155 to 270 cmH20/LPS. These results revealed that the opposition of the voicing sources used in esophageal speech production to airflow through them is substantial and larger than that established for the normal, laryngeal source. Findings are interpreted to highlight major advantages the Singer-Blom (1980) method of speech/voice restoration has over esophageal speech/voice produced on a conventional basis and to reveal specific reasons for the failure of many laryngectomized patients to develop consistent voice and functionally serviceable speech.

Unusual radiographic findings in ectopic ureterocele

A case of an ectopic ureterocele with a cystic dysplastic upper pole and atretic proximal ureter was studied. A four-month follow-up showed marked decrease in the size of the dysplastic upper pole which is explained on an embryologic and pathophysiologic basis.

Evaluation of speech following prosthetic obturation of surgically acquired maxillary defects

The speech intelligibility of patients who have undergone partial surgical resection of the maxilla was investigated. The intelligibility characteristics of connected discourse in each patient were compared under three experimental conditions: presurgical, postsurgical with immediate prosthetic obturation, and postsurgical with definitive prosthetic obturation. The ability of untrained listeners to differentiate between presurgical speech and postsurgical speech following definitive prosthetic treatment was also studied. Each subject recorded a standard passage of connected discourse, the Rainbow Passage, under the three conditions stated above. Each of the 24 recordings was then segmented into 23 phrases and presented over earphones to listeners. A group of 10 listeners evaluated each recording, or a total of 240 listeners was used. The recordings were graded by the number of words correctly written. Analysis of variance showed no significant loss in intelligibility across the three conditions. A group of 50 listeners than evaluated sentence pairs containing samples of presurgical speech and speech produced following surgery and definitive prosthetic obturation. Their task was to judge whether there was a difference between the two speech samples. This was done in a classroom over loudspeakers. Sign-test procedures revealed that listeners could differentiate presurgical speech samples from postsurgical speech with definitive prosthetic obturation in four of the eight patients studied.