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Doyle PC, Damrose EJ. Has Esophageal Speech Returned as an Increasingly Viable Postlaryngectomy Voice and Speech Rehabilitation Option? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4714-4723. [PMID: 36450150 DOI: 10.1044/2022_jslhr-22-00356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The literature on postlaryngectomy voice and speech rehabilitation is long-standing. Although multiple rehabilitation options have existed over the years, the acquisition and use of esophageal speech (ES) has decreased significantly over the past 40 years. This reduction coincides with the increased application of tracheoesophageal puncture (TEP) voice restoration. The literature suggests that voice acquisition failures observed secondary to TEP may represent a similar phenomenon that led to ES acquisition failures. METHOD A comprehensive review of the literature on ES and TEP voice/speech was conducted. Specific attention was directed toward information on ES and TEP speech failures. Information on pharyngoesophageal segment (PES) spasm in the context of ES and TEP voicing failures was of specific importance. RESULTS Similarities between voicing failures with both ES and TEP were identified. In order to resolve spasm in TEP speech, proactive efforts to eliminate it were undertaken, and regardless of the method used, voicing improvements were observed. These data suggest that both ES and TEP speech acquisition failures may be related to the same control mechanisms influencing the PES. CONCLUSIONS The elimination of PES spasm provides evidence that justifies the reconsideration of ES. Consequently, ES may return as an increasingly viable postlaryngectomy voice and speech rehabilitation option.
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Affiliation(s)
- Philip C Doyle
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford University, CA
| | - Edward J Damrose
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford University, CA
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Layton T, Thomas R, Harris C, Holmes S, Fraser L, Silva P, Winter SC. Functional Outcomes Following Total Laryngectomy and Pharyngolaryngectomy: A 20-Year Single Center Study. Ann Otol Rhinol Laryngol 2022; 131:1301-1309. [PMID: 35081778 DOI: 10.1177/00034894211072987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Laryngeal cancer accounts for 1% of all cancers in men and 0.3% of all cancers in women. Pharyngolaryngectomy (TPL) and total laryngectomy (TL) are central surgical techniques in the management of advanced laryngeal malignancies but are associated with significant morbidity. In addition, optimal reconstruction following TPL remains an area of active research. METHODS Here, we compared speech and swallowing outcomes following circumferential and partial pharyngeal resection alongside total laryngectomy in patients with laryngeal and hypolaryngeal tumors. We performed a systemic analysis of patient demographics, tumor characteristics, treatment modality, and pharyngeal reconstruction technique following TPL and TL, leveraging data collected over a 20-year period at a large tertiary referral center. RESULTS Analyzing 155 patients the results show circumferential pharyngeal defects and prior radiotherapy have a significant impact on surgical complications. CONCLUSION Pharyngeal resection carries a substantial risk of incurring impaired speech and swallowing in patients. Moreover, our results support poorer functional outcomes with more radical pharyngeal resections and show a clear trend toward worse swallowing outcomes in salvage surgery.
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Affiliation(s)
- Thomas Layton
- The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rachel Thomas
- Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carol Harris
- Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sam Holmes
- Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lisa Fraser
- Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Priy Silva
- Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stuart C Winter
- Bleinheim Head and Neck Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Whispering by Individuals Using Tracheoesophageal Speech. J Voice 2018; 32:127.e1-127.e13. [DOI: 10.1016/j.jvoice.2017.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/17/2017] [Indexed: 11/17/2022]
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Objective and subjective voice outcomes after total laryngectomy: a systematic review. Eur Arch Otorhinolaryngol 2017; 275:11-26. [PMID: 29086803 PMCID: PMC5754416 DOI: 10.1007/s00405-017-4790-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/24/2017] [Indexed: 11/12/2022]
Abstract
Background Esophageal speech (ES), tracheoesophageal speech (TES) and/or electrolarynx speech (ELS) are three speech rehabilitation methods which are commonly provided after total laryngectomy (TL). Methods A systematic review of the literature was conducted to evaluate comparative acoustic, perceptual, and patient-reported outcomes for ES, TES, ELS and healthy speakers. Results Twenty-six articles could be included. In most studies, methodological quality was low. It is likely that an inclusion bias exists, many studies only included exceptional speakers. Significant better outcomes are reported for TES compared to ES for the acoustic parameters, fundamental frequency, maximum phonation time and intensity. Perceptually, TES is rated with a significant better voice quality and intelligibility than ES and ELS. None of the speech rehabilitation groups reported clearly better outcomes in patient-reported outcomes. Conclusions Studies on speech outcomes after TL are flawed in design and represent weak levels of evidence. There is an urge for standardized measurement tools for evaluations of substitute voice speakers. TES is the favorable speech rehabilitation method according to acoustic and perceptual outcomes. All speaker groups after TL report a degree of voice handicap. Knowledge of caretakers and differences in health care and insurance systems play a role in the speech rehabilitation options that can be offered. Electronic supplementary material The online version of this article (doi:10.1007/s00405-017-4790-6) contains supplementary material, which is available to authorized users.
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Graville DJ, Palmer AD, Chambers CM, Ottenstein L, Whalen B, Andersen PE, Wax MK, Cohen JI. Functional outcomes and quality of life after total laryngectomy with noncircumferential radial forearm free tissue transfer. Head Neck 2017; 39:2319-2328. [DOI: 10.1002/hed.24902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/29/2017] [Accepted: 06/28/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Donna J. Graville
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
| | - Andrew D. Palmer
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
| | | | | | - Breanne Whalen
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
| | - Peter E. Andersen
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
| | - Mark K. Wax
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
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Childes JM, Palmer AD, Fried-Oken M, Graville DJ. The Use of Technology for Phone and Face-to-Face Communication After Total Laryngectomy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:99-112. [PMID: 28166547 DOI: 10.1044/2016_ajslp-14-0106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 06/22/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this article is to describe the characteristics and experiences of individuals who use technology to support telephone or face-to-face communication after total laryngectomy. METHOD An online questionnaire was used to identify potential participants. Seventeen individuals met inclusion criteria and participated in an in-depth survey. They were compared with a reference group matched for age, gender, and time postsurgery who did not use these technologies. Open-ended responses were summarized. RESULTS Compared with the matched reference group, individuals who used technology to support verbal communication had undergone more aggressive cancer treatment and used more communication methods. They were less likely to use an alaryngeal speech method, had greater difficulty over the telephone, and used more repair strategies in face-to-face communication. The 2 groups did not differ significantly in the frequency or success of their communication, however. Open-ended responses revealed great variety with regard to their reasons, purposes, and timing of technology use. CONCLUSIONS There is a subset of individuals using technology to support verbal communication very successfully after laryngectomy. Usage was not limited to those who were unable to communicate verbally and often continued long after the initial postoperative period in many settings, for various purposes, and in combination with other methods of communication.
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Affiliation(s)
- Jana M Childes
- NW Clinic for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Andrew D Palmer
- NW Clinic for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Melanie Fried-Oken
- NW Clinic for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Donna J Graville
- NW Clinic for Voice & Swallowing, Dept. of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
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Pellicani AD, Ricz H, Iqueda APD, Aguiar-Ricz L. Effect of the tracheoesophageal voice resistance test in total laryngectomees. Laryngoscope 2016; 127:405-410. [PMID: 27107400 DOI: 10.1002/lary.26031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/20/2016] [Accepted: 03/21/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To analyze tracheoesophageal voice resistance in laryngectomized patients by comparing the acoustic, perceptive-auditory and self-evaluation measures before and after the voice resistance test. STUDY DESIGN An observational, experimental study with a quantitative and descriptive approach. METHODS Nineteen total laryngectomees were submitted for capture of vocal intensity, self-assessment of signs and symptoms of voice fatigue using a visual analogue scale, and perceptive-auditory and acoustic analysis of the tracheoesophageal voice before and after the voice resistance test, which consisted of continuous repeated counting from one to 100. RESULTS The mean time of execution of the test was 33.68 minutes. Type II sound signal, voice intensity, voice quality, degree of severity of dysphonia, and the pitch and loudness parameters were maintained after the test. There were no changes in signs and symptoms of vocal fatigue. CONCLUSIONS Most of the total laryngectomees performed the voice resistance test for less than 30 minutes. However, the voice resistance test did not induce significant changes in the quality of tracheoesophageal voice of total laryngectomees or in the signs and symptoms of vocal fatigue. LEVEL OF EVIDENCE 4 Laryngoscope, 2016 127:405-410, 2017.
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Affiliation(s)
- Ariane D Pellicani
- Department of Speech Therapy, Federal University of Sergipe, Lagarto, Brazil
| | - Hilton Ricz
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Adriana P D Iqueda
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Lílian Aguiar-Ricz
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Mahalingam S, Srinivasan R, Spielmann P. Quality-of-life and functional outcomes following pharyngolaryngectomy: a systematic review of literature. Clin Otolaryngol 2016; 41:25-43. [DOI: 10.1111/coa.12466] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- S. Mahalingam
- University of Edinburgh; Edinburgh UK
- Department of Otolaryngology; Head and Neck Surgery; East Surrey Hospital; Redhill UK
| | - R. Srinivasan
- Department of Otolaryngology; Head and Neck Surgery; East Surrey Hospital; Redhill UK
| | - P. Spielmann
- Department of Otolaryngology; Head and Neck Surgery; East Surrey Hospital; Redhill UK
- Department of Otolaryngology; Head and Neck Surgery; Ninewells Hospital; University Department of Otolaryngology; Dundee UK
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Tracheoesophageal voice after total laryngopharyngectomy reconstruction: Jejunum versus radial forearm free flap. Laryngoscope 2015. [DOI: 10.1002/lary.25404] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Lee JC, Chang SH, Yang CC, Hsieh CH, Chen YJ. Elderly Patients with Laryngeal and Hypopharyngeal Cancer Undergoing Total Pharyngolaryngectomy with a Radial Forearm, Free Flap-reconstructed Phonation Tube. INT J GERONTOL 2014. [DOI: 10.1016/j.ijge.2013.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Almeida LIMD, Correia PCG. Expressões faciais emocionais em indivíduos laringectomizados totais. REVISTA CEFAC 2014. [DOI: 10.1590/1982-0216201421912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Objetivos: verificar se existem diferenças no grau de inteligibilidade de indivíduos laringectomizados totais, que utilizam diferentes formas de comunicação oral (fala murmurada, laringe eletrônica, voz esofágica e voz traqueoesofágica); verificar se existem diferenças na expressão facial (número e duração de movimentos faciais) de indivíduos laringectomizados totais, que utilizam diferentes formas de comunicação oral, durante tarefas de discurso espontâneo alegre e triste e, ainda, verificar se existem diferenças estatisticamente significantes na expressão facial (número e duração de movimentos faciais) de indivíduos com elevada e baixa inteligibilidade durante tarefas de discurso espontâneo alegre e triste. Métodos: tratou-se de um estudo exploratório, comparativo de base descritiva e de metodologia transversal, sendo que se constituiu um grupo de treze indivíduos laringectomizados totais. Os indivíduos foram filmados durante as duas tarefas de discurso espontâneo alegre e triste e avaliados quanto à inteligibilidade do discurso por pessoas sem patologia da comunicação, sendo que a análise da expressão facial foi realizada com recurso ao Sistema de Codificação de Ação Facial. A análise descritiva e inferencial foi efetuada com recurso ao SPSS19 por meio da aplicação dos testes Mann-Whitney e Kruskall-Wallis.Resultados: verificou-se que os diferentes tipos de comunicação apresentam diferentes graus de inteligibilidade no discurso e que descritivamente existem diferenças na expressão facial dos indivíduos laringectomizados totais durante o discurso espontâneo alegre e triste . Verifica-se ainda diferenças estatisticamente significantesna expressão facial nos grupos de baixa e elevada inteligibilidade, na duração média de cada unidade dos olhos no discurso espontâneo triste (p-valor=0,01).Conclusão: verificou-se que nos dois contextos emocionais, os laringectomizados, independentemente da sua forma comunicativa, são menos expressivos facialmente do que os normofalantes.
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Ward EC, Hartwig P, Scott J, Trickey M, Cahill L, Hancock K. Speech Breathing Patterns During Tracheoesophageal Speech. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/136132807805297611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ward EC, MacBean NA. Perceptual judgements of tracheoesophageal speech: the issue of listener bias. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/136132803805576336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Bohnenkamp TA, Forrest K, Klaben BK, Stager J. Chest Wall Kinematics during Speech Breathing in Tracheoesophageal Speakers. Ann Otol Rhinol Laryngol 2012; 121:28-37. [DOI: 10.1177/000348941212100106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The purpose of the present study was to determine how tracheoesophageal (TE) speakers manipulate the chest wall (rib cage and abdomen) to speak and how respiratory compromise (chronic obstructive pulmonary disease; COPD) and task variables influence those behaviors. Methods: The chest wall movements of 11 male TE speakers (5 with COPD and 6 without COPD) were measured during tidal breathing, spontaneous speech, and reading. Repeated-measures multivariate analyses were used to compare breathing behaviors across speech tasks and by respiratory health. Additional repeated-measures multivariate analyses and 1-way analyses of variance were conducted on temporal, aerodynamic, and linguistic measures. Results: There was a significant main effect of task and a significant interaction effect of COPD and task on chest wall movements. Rib cage movements varied by task, whereas abdominal movements were as predicted. There was a significant difference in utterance length by task. There were no main effects of COPD on the chest wall and no significant group differences in utterance length, aerodynamic measures, or intelligibility. The TE speakers were generally accurate in inspiring at appropriate linguistic boundaries. Conclusions: The results suggest that there is robust control for speech breathing following laryngectomy, but that there is also increased effort within the chest wall. Implications for future research considerations are discussed.
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Bohnenkamp TA, Forrest KM, Klaben BK, Stager JM. Lung Volumes Used during Speech Breathing in Tracheoesophageal Speakers. Ann Otol Rhinol Laryngol 2011; 120:550-8. [DOI: 10.1177/000348941112000811] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: The purpose of this study was to determine how tracheoesophageal (TE) speakers manipulate lung volumes to meet speech demands and how respiratory compromise (chronic obstructive pulmonary disease [COPD]) and task variables influence these behaviors. Methods: The lung volumes of 9 male TE speakers (4 with COPD, 5 without) during tidal breathing, spontaneous speech, and reading were investigated. Repeated-measures multivariate analyses of variance were used to compare lung volumes and utterance length across speech tasks and by respiratory health. A one-way analysis of variance was used to compare aerodynamic measures and intelligibility by COPD diagnosis. Results: There was a significant main effect of task and a significant interaction effect of COPD and task on lung volumes at initiation and termination of speech. The TE speakers terminated speech exclusively below the resting expiratory level (REL) in both speech tasks because of elevated RELs, which are often present after laryngectomy. There were no main effects of COPD on any lung volume measures and no significant group differences in utterance length, aerodynamic measures, or intelligibility. Conclusions: Intelligibility and aerodynamic measures were not influenced by lung volumes and were comparable to findings of previous research. Speaking past the REL might be a compensation to optimize expiratory control for speech in a compromised system and a marker for the increased effort often anecdotally described by TE speakers.
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Yang CC, Lee JC, Wu KC, Chang SH. Voice and speech outcomes with radial forearm free flap-accompanied phonation tube after total pharyngolaryngectomy of hypopharyngeal cancer. Acta Otolaryngol 2011; 131:847-51. [PMID: 21521009 DOI: 10.3109/00016489.2011.570787] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Radial forearm free flap (RFFF)-accompanied phonation tube (PT) for voice and speech restoration after pharyngolaryngectomy is promising, especially in phonation efficacy and intelligibility. It offers not only another safe surgical option but also a satisfactory result for such patients with advanced hypopharyngeal cancer. OBJECTIVES We use RFFF with RFFF-accompanied PT for one-stage reconstruction both for tissue defect and voice reconstruction in patients undergoing total pharyngolaryngectomy. METHODS Eight male patients with advanced hypopharyngeal cancer underwent total pharyngolaryngectomy. Voice restoration was done with RFFF-accompanied PT. Phonation outcomes and speech outcomes of the patients were evaluated and scored. RESULTS The mean follow-up time was 13.7 months. All free flaps were successful without perioperative mortality. All the patients were able to produce sound. Phonation efficacy ranged from 70% to >90% postoperatively and 40% to >90% at the last follow-up. The speech intelligibility was graded as moderately good.
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Wierzchowska M, Burduk PK. Powikłania wczesne i późne po implantacji protezy głosowej Provox 2 u chorych po laryngektomii całkowitej. Otolaryngol Pol 2011; 65:184-7. [DOI: 10.1016/s0030-6657(11)70672-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Reumueller A, Leonhard M, Mancusi G, Gaechter JN, Bigenzahn W, Schneider-Stickler B. Pharyngolaryngectomy with free jejunal autograft reconstruction and tracheoesophageal voice restoration: Indications for replacements, microbial colonization, and indwelling times of the Provox 2 voice prostheses. Head Neck 2010; 33:1144-53. [DOI: 10.1002/hed.21590] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 07/16/2010] [Accepted: 07/26/2010] [Indexed: 11/08/2022] Open
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Bohnenkamp TA, Stowell T, Hesse J, Wright S. Speech breathing in speakers who use an electrolarynx. JOURNAL OF COMMUNICATION DISORDERS 2010; 43:199-211. [PMID: 20193954 DOI: 10.1016/j.jcomdis.2010.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 01/26/2010] [Accepted: 01/28/2010] [Indexed: 05/28/2023]
Abstract
UNLABELLED Speakers who use an electrolarynx following a total laryngectomy no longer require pulmonary support for speech. Subsequently, chest wall movements may be affected; however, chest wall movements in these speakers are not well defined. The purpose of this investigation was to evaluate speech breathing in speakers who use an electrolarynx during speech and reading tasks. Six speakers who use an electrolarynx underwent an evaluation of chest wall kinematics (e.g., chest wall movements, temporal characteristics of chest wall movement), lung volumes, temporal measures of speech, and the interaction of linguistic influences on ventilation. Results of the present study were compared to previous reports in speakers who use an electrolarynx, as well as to previous reports in typical speakers. There were no significant differences in lung volumes used and the general movement of the chest wall by task; however, there were differences of note in the temporal aspects of chest wall configuration when compared to previous reports in both typical speakers and speakers who use an electrolarynx. These differences were related to timing and posturing of the chest wall. The lack of differences in lung volumes and chest wall movements by task indicates that neither reading nor spontaneous speech exerts a greater influence on speech breathing; however, the temporal and posturing results suggest the possibility of a decoupling of the respiratory system from speech following a total laryngectomy and subsequent alaryngeal speech rehabilitation. LEARNING OUTCOMES The reader will be able to understand and describe: (1) The primary differences in speech breathing across alaryngeal speech options; (2) how speech breathing specifically differs (i.e., lung volumes and chest wall movements) in speakers who use an electrolarynx; (3) How the coupling of speech and respiration is altered when pulmonary air is no longer used for speech.
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Affiliation(s)
- Todd A Bohnenkamp
- University of Northern Iowa, Department of Communication Sciences and Disorders, 1555 West 27th Street, 231 Communication Arts Center, Cedar Falls, IA 50614-0356, USA.
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Abstract
PURPOSE OF REVIEW Alaryngeal speech rehabilitation following a total laryngectomy is a multifactorial disorder that includes changes in phonation, respiration, and overall general health. Tracheoesophageal speech is the preferred method of rehabilitation. In this approach, pulmonary air support is diverted from the trachea into the esophagus to generate voicing. Tracheoesophageal speakers must overcome radical upper airway changes, increased resistance in the phonatory source, reduced sensory feedback from the respiratory system, and probable respiratory compromise. This review integrates previous laryngectomy research with recent studies investigating kinematics in tracheoesophageal speakers. RECENT FINDINGS Tracheoesophageal speakers are often very intelligible and communicate effectively, but little has been done to investigate the physiological demands of tracheoesophageal speech on speakers. Two recent studies have specifically investigated speech breathing behaviors in tracheoesophageal speakers. Both investigations reported increased effort and differences in speech breathing compared to laryngeal speakers; however, continued research is needed to understand the effects of a total laryngectomy on speech breathing. SUMMARY The physiological changes following a laryngectomy, especially in the ability to produce tracheoesophageal speech, are not well known. Rehabilitation for these individuals requires an understanding of the changes in respiration that might influence speech breathing behaviors.
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Bergquist H, Andersson M, Ejnell H, Hellström M, Lundell L, Ruth M. Functional and Radiological Evaluation of Free Jejunal Transplant Reconstructions After Radical Resection of Hypopharyngeal or Proximal Esophageal Cancer. World J Surg 2007; 31:1988-95. [PMID: 17676378 DOI: 10.1007/s00268-007-9162-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cancer of the pharyngoesophageal junction (PEJ) is associated with late onset of symptoms, high morbidity, and a dismal prognosis. Radical surgery with pharyngolaryngectomy and reconstruction with a free vascularized jejunal transplant has been increasingly practiced in the treatment of these patients. This strategy is not devoid of challenges, and the present study is aimed at evaluating the long-term functional outcome among patients who have undergone such surgical treatment. Ten patients (mean age 59 years) with a mean follow-up time of 54 months were included. Clinical assessment, health-related quality of life (HRQL) questionnaires, and a standardized radiography examination were used for evaluation. The Karnofsky index ranged from 60 to 90 (mean 82). Global QL scores (EORTC QLQ-C30) had a mean value of 74, and the mean scores for dysphagia-related items of the EORTC QLQ OES-18 questionnaire were within the lower range. Radiographic signs of disturbed bolus transport through the jejunal transplant were found in all patients examined despite the grading of dysphagia from 0 to 1. The Watson dysphagia score varied between 0.5 and 45.0 (mean 16.2). No correlations were found between radiographic findings and the clinical evaluations or the outcomes assessed by the HRQL questionnaires. HRQL was found to be generally good after cancer of the PEJ and jejunal transplant insertion. Most patients reported mild dysphagia. Radiologic signs of disturbed bolus passage were common, but their clinical impact seemed questionable.
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Affiliation(s)
- H Bergquist
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, 413 45, Göteborg, Sweden.
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Lewin JS, Barringer DA, May AH, Gillenwater AM, Arnold KA, Roberts DB, Yu P. Functional outcomes after laryngopharyngectomy with anterolateral thigh flap reconstruction. Head Neck 2006; 28:142-9. [PMID: 16302192 DOI: 10.1002/hed.20308] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We examined speech and swallowing outcomes and complications in patients with anterolateral thigh (ALT) flap reconstruction of cervical esophageal defects. METHODS We retrospectively reviewed 29 patients treated with laryngopharyngectomy and ALT flap reconstruction at The University of Texas M. D. Anderson Cancer Center from March 2002 to July 2004. We compared complication rates, nutritional intake, number of tracheoesophageal punctures (TEPs), speech fluency and use, operative defects, and radiotherapy effects. RESULTS Twenty-two patients had circumferential defects, and seven had partial defects. Twenty-four patients had radiotherapy. Eleven patients underwent TEP. Higher complication rates in patients after TEP compared with those without TEP were not statistically significant (p = .268). Ninety percent of patients with TEP spoke fluently. Ninety percent of all patients returned to oral alimentation without significant effect from TEP (p = 1.00), complications (p = 1.00), radiation therapy (p = 1.00), or surgical defect (p = .56). CONCLUSIONS The ALT flap successfully reconstructs laryngopharyngeal defects with excellent speech and swallowing results.
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Affiliation(s)
- Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Leu YS, Hsiao HT, Chang YC, Yang CC, Lee JC, Chen YJ, Chang YF. Ileocolic free flap reconstruction, concomitant chemotherapy and radiotherapy and assessment of speech and swallowing function during management of advanced cancer of the larynx and hypopharynx: preliminary report. Acta Otolaryngol 2005; 125:642-6. [PMID: 16076714 DOI: 10.1080/00016480510027457] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSION The new technique of ileocolic free flap reconstruction provides a better quality of life in terms of swallowing and speech for patients who have undergone laryngopharyngectomy with concomitant chemotherapy and radiotherapy (CCRT). OBJECTIVES To compare and contrast the swallowing and speech outcomes of patients who underwent total laryngopharyngectomy with ileocolic free flap reconstruction and to analyze the survival rate after surgery and CCRT. MATERIAL AND METHODS This was a follow-up study of 12 patients with advanced (stages III, IVA and IVB) laryngeal and hypopharyngeal cancer who underwent major surgery, CCRT (with one exception) and ileocolic free flap reconstruction. RESULTS All patients were able to tolerate single-stage combined management comprising total laryngopharyngectomy with or without radical neck dissection plus ileocolic free flap reconstruction and postoperative CCRT (with one exception), without immediate morbidity or mortality. Eleven patients were diagnosed with hypopharyngeal cancer and one with laryngeal cancer. The mean interval between surgery and CCRT was 34.1 days. The mean follow-up period was 16.5 months. Four patients died during the follow-up period as a result of local recurrence (n=2), distant metastasis (n=1) and suicide (n=1). One patient was alive with disease despite neck recurrence.
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Affiliation(s)
- Yi-Shing Leu
- The Department of Otolaryngology-Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan.
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Stafford FW. Current indications and complications of tracheoesophageal puncture for voice restoration after laryngectomy. Curr Opin Otolaryngol Head Neck Surg 2003; 11:89-95. [PMID: 14515085 DOI: 10.1097/00020840-200304000-00005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Surgical voice restoration by valved tracheoesophageal fistula is undoubtedly the most successful method of voice restoration for laryngectomy patients, is one of the most important developments in head and neck surgery, and has resulted in a greatly enhanced quality of life for most patients who have undergone this debilitating procedure. In developed countries, it is now unacceptable to perform laryngectomy without giving patients the opportunity to undergo surgical voice restoration. Successful voice acquisition should be achievable in approximately 80% of patients. Success rates will be highest and problems most effectively dealt with under the auspices of a properly organized surgical voice restoration program within a specialist head and neck cancer unit with a well structured specialist multidisciplinary team. This article reviews recent publications addressing indications for surgical voice restoration by tracheoesophageal puncture, expected success rates, and reasons for failure and complications and ways to manage them in the context of the author's own experience.
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Affiliation(s)
- Frank W Stafford
- Department of Otolaryngology/Head and Neck Surgery, Freeman Hospital, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK.
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