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Kozhanov AL, Kozhanov LG. [Historical and modern aspects of rehabilitation of voice function after laryngectomy]. Vestn Otorinolaringol 2023; 88:64-70. [PMID: 36867146 DOI: 10.17116/otorino20228801164] [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: 03/04/2023]
Abstract
The literature review presents historical and modern aspects of the rehabilitation of vocal function after laryngectomy, in particular, external devices, tracheopharyngeal bypass surgery, esophageal speech, tracheoesophageal bypass surgery without the use of a prosthetic device, voice prostheses are described. The advantages and disadvantages of each voice restoration technique, functional results, complications, prosthesis designs, their service life, bypass techniques, methods of prevention and treatment of damage to the valve apparatus of the prosthesis by colonies of microorganisms, fungal flora are analyzed.
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Affiliation(s)
- A L Kozhanov
- City Clinical Oncological Hospital No. 1, Moscow, Russia
| | - L G Kozhanov
- City Clinical Oncological Hospital No. 1, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
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The relationship between biomechanics of pharyngoesophageal segment and tracheoesophageal phonation. Sci Rep 2019; 9:9722. [PMID: 31278355 PMCID: PMC6611845 DOI: 10.1038/s41598-019-46223-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 06/13/2019] [Indexed: 12/19/2022] Open
Abstract
This study examined the relationship between biomechanical features of the pharyngoesophageal (PE) segment, acoustic characteristics of tracheoesophageal (TE) phonation, and patients’ satisfaction with TE phonation. Fifteen patients using TE phonation after total laryngectomy completed the Voice Symptom Scale (VoiSS) and underwent acoustic voice analysis for cepstral peak prominence (CPP) and relative intensity. High resolution manometry (HRM) combined with videofluoroscopy was used to evaluate PE segment pressure and calculate the pressure gradient (ΔP), which was the pressure difference between the upper oesophagus and a point two centimetres above the vibrating PE segment. The upper oesophageal sphincter (UOS) minimal diameters were measured by Endolumenal Functional Lumen Imaging Probe (EndoFLIP). HRM detected rapid pressure changes at the level of the 4th – 6th cervical vertebra. CPP, relative intensity, and ΔP were significant predictors of satisfactory TE phonation. ΔP was a significant predictor of CPP and intensity. Minimal UOS diameter was a significant predictor of relative intensity of TE phonation. In two patients with unsuccessful TE phonation, endoscopic dilatation subsequently restored TE phonation. These findings suggest that sufficient ΔP and large UOS diameter are required for satisfactory TE phonation. Endoscopic dilatation increasing UOS diameter may provide a new approach to treat unsuccessful TE phonation.
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Coffey MM, Tolley N, Howard D, Drinnan M, Hickson M. An Investigation of the Post-laryngectomy Swallow Using Videofluoroscopy and Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Dysphagia 2018; 33:369-379. [PMID: 29352357 PMCID: PMC5958146 DOI: 10.1007/s00455-017-9862-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/07/2017] [Indexed: 12/14/2022]
Abstract
This study investigates the post-laryngectomy swallow. Presence and degree of residue on the post-laryngectomy swallow as observed on videofluoroscopy and FEES is described. In addition, videofluoroscopy and FEES are assessed for reliability and inter-instrument agreement. 30 laryngectomy subjects underwent dysphagia evaluation using simultaneous videofluoroscopy and FEES. These were reviewed post-examination by three expert raters using a rating scale designed for this purpose. Raters were blinded to subject details, type of laryngectomy surgery, pairing of FEES and videofluoroscopy examinations and the scores of other raters. There was a finding of residue in 78% of videofluoroscopy ratings, and 83% of FEES ratings. Comparison of the tools indicated poor inter-rater reliability and poor inter-instrument agreement. Dysphagia is an issue post laryngectomy as measured by patient self-report and by instrumental evaluation. However, alternative dysphagia rating tools and dysphagia evaluation tools are required to enable accurate identification and intervention for underlying swallow physiology post laryngectomy.
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Affiliation(s)
- Margaret M Coffey
- Imperial College Healthcare Trust, SLT Department, Charing Cross Hospital, Ground Floor, South Wing, Fulham Palace Road, London, W6 8RF, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Neil Tolley
- Imperial College Healthcare Trust, ENT Department, St Mary's Hospital, Praed Street, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Howard
- Imperial College Healthcare Trust, ENT Department, Charing Cross Hospital, Fulham Palace Road, London, W6 8QX, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Michael Drinnan
- Regional Medical Physics Dept, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN, UK
| | - Mary Hickson
- Institute of Health and Community, Plymouth University, Derriford Road, Plymouth, Devon, PL6 8BH, UK
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Lorenz KJ. Rehabilitation after Total Laryngectomy-A Tribute to the Pioneers of Voice Restoration in the Last Two Centuries. Front Med (Lausanne) 2017; 4:81. [PMID: 28695120 PMCID: PMC5483444 DOI: 10.3389/fmed.2017.00081] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/31/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The most severe consequence of laryngectomy for patients is the loss of their voice. For this reason, voice rehabilitation has been an integral aspect of treatment after total laryngectomy from the very beginning. A wide variety of different technical and surgical approaches are available and reflect the problems associated with the rehabilitation of communication and swallowing after the removal of the larynx. METHODS We used Internet search engines and libraries to conduct a search of the current medical literature and historical sources of medical information in order to identify and summarize landmark work on this subject. DISCUSSION Four types of methods have been used to restore the voices of patients, i.e., external devices, esophageal speech, internal voice prostheses, and surgically created tracheo-esophageal fistulas that do not involve the use of a prosthetic device.
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Affiliation(s)
- Kai J. Lorenz
- Department of Otolaryngology/Head and Neck Surgery, German Armed Forces Hospital, Ulm, Germany
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[A novel puncture instrument: the Provox-Vega® puncture set. Its use in voice prosthesis insertion following laryngectomy]. HNO 2012; 61:30-7. [PMID: 22767197 DOI: 10.1007/s00106-012-2551-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The use of voice prostheses has been considered the gold standard in voice rehabilitation following laryngectomy for the last 20 years. Insertion is generally performed as a primary procedure during laryngectomy or as a secondary procedure with a re-usable trocar or rigid esophagoscope, a guidewire and anatomic hemostatic forceps. The use of these instruments requires a certain level of experience on the one hand, while on the other use of a trocar and subsequent manipulation with the hemostatic forceps can lead to tissue trauma around the membranous wall or damage to the voice prosthesis. We present the results of a phase I/II study using a novel atraumatic puncture set for primary and secondary insertion of voice prostheses. PATIENTS AND METHODS Once patients had been fully informed and given their consent, the Provox-Vega® puncture set was used in 21 patients in either a primary (16) or a secondary (5) procedure. All procedures were documented on video, while approach, complications and surgical success were recorded using a questionnaire. RESULTS The average surgical time was 83.5 (± 19.12) s for primary voice prosthesis insertion and 212.57 (± 93.03) s in secondary procedures. The prosthesis could be inserted without complication in 19 patients, while a longer prosthesis needed to be selected intraoperatively in two patients due to a thick membranous wall. No serious complications were observed. One patient incurred a discrete injury to the mucosa of the esophageal posterior wall. CONCLUSION The Provox-Vega® puncture set proved itself to be a safe aid in the insertion of voice prostheses. It is significantly easier to use than other systems and tissue trauma is minimal. In most cases, no further instruments were required.
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Balm A, van den Brekel M, Tan I, Hilgers F. The indwelling voice prosthesis for speech rehabilitation after total laryngectomy: a safe approach. Otolaryngol Pol 2011; 65:402-9. [DOI: 10.1016/s0030-6657(11)70731-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 09/14/2011] [Indexed: 11/15/2022]
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Schwarz R, Huttner B, Döllinger M, Luegmair G, Eysholdt U, Schuster M, Lohscheller J, Gurlek E. Substitute voice production: quantification of PE segment vibrations using a biomechanical model. IEEE Trans Biomed Eng 2011; 58:2767-76. [PMID: 21558056 DOI: 10.1109/tbme.2011.2151860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
After total larynx excision due to laryngeal cancer, the tracheoesophageal substitute tissue vibrations at the intersection between the pharynx and the esophagus [pharyngoesophageal segment (PE segment)] serve as voice generator. The quality of the substitute voice significantly depends on the vibratory characteristics of the PE segment. For improving voice rehabilitation, the relationship between the PE dynamics and the resulting substitute voice quality is a matter of particular interest. Precondition for a comprehensive analysis of this relationship is an objective quantification of the PE vibrations. For quantification purposes, a method is proposed, which is based on the reproduction of the tissue vibrations by means of a biomechanical model of the PE segment. An optimization procedure for an automatic determination of appropriate model parameters is suggested to adapt the model dynamics to tissue movements extracted from high-speed (HS) videos. The applicability of the optimization procedure is evaluated with ten synthetic data sets. A mean error of 8.2% for the determination of previously defined model parameters was achieved as well as an overall stability of 7.1%. The application of the model to six HS recordings presented a mean correlation of the vibration patterns of 82%.
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Affiliation(s)
- Raphael Schwarz
- Healthcare Sector and the Imaging & Therapy Division Magnetic Resonance, Siemens AG, 91052 Erlangen, Germany.
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Prosthetic voice rehabilitation after total laryngectomy. Indian J Surg Oncol 2010; 1:146-50. [PMID: 22930629 DOI: 10.1007/s13193-010-0028-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 04/30/2010] [Indexed: 10/18/2022] Open
Abstract
Loss of voice is a major concern after total laryngectomy. Tracheo-esophageal prosthesis was described in 1980 by Blom and Singer as a method of postlaryngectomy voice rehabilitation. Since then it has seen many phases of developments. Now it has evolved into highly effective method with success rates more than 90% and better quality of voice than other modalities. It also gives good quality of life and voice related quality of life. Though it is associated with some complications, they are easy to manage. All these have made tracheo-esophageal prosthesis the 'Gold Standard' of post-laryngectomy voice rehabilitation.
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van Rossum MA, van As-Brooks CJ, Hilgers FJM, Roozen M. Quality of 'glottal' stops in tracheoesophageal speakers. CLINICAL LINGUISTICS & PHONETICS 2009; 23:1-14. [PMID: 19148810 DOI: 10.1080/02699200802394856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Glottal stops are conveyed by an abrupt constriction at the level of the glottis. Tracheoesophageal (TE) speakers are known to have poor control over the new voice source (neoglottis), and this might influence the production of 'glottal' stops. This study investigated how TE speakers realized 'glottal' stops in abutting words that end and begin with the same vowel. Ten phoneticians rated seven TE speakers' attempts to convey 'glottal' stops less favourably than two laryngeal control speakers' 'glottal' stops. Acoustic analyses showed that TE speakers relied on more gradual changes, but in 25% of realizations, a constriction at the neoglottis, similar to the constriction found in normal speakers, was produced. It was concluded that control over the neoglottis might be greater than is generally assumed. It might be possible to improve TE speakers' awareness and control over the neoglottis through training, using such tools as digital high-speed imaging.
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Affiliation(s)
- M A van Rossum
- Leiden University Medical Centre, Leiden, the Netherlands.
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Kazi R, Singh A, Mullan GPJ, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Can objective parameters derived from videofluoroscopic assessment of post-laryngectomy valved speech replace current subjective measures? An e-tool-based analysis. Clin Otolaryngol 2006; 31:518-24. [PMID: 17184458 DOI: 10.1111/j.1365-2273.2006.01320.x] [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: 11/30/2022]
Abstract
OBJECTIVES The primary purpose of this study was to assess the pharyngoesophageal segment in total laryngectomy patients using a videofluoroscopy e-tool. STUDY DESIGN Cross-sectional study. SETTING Head and Neck Oncology Unit, Tertiary Referral Centre. PATIENTS Forty-two patients following total laryngectomy. INTERVENTION Videofluoroscopy using an e-tool (JRuler). MAIN OUTCOME MEASURES Subjective and objective videofluoroscopy parameters correlated with the GRBAS scale and treatment variables. RESULTS Of 32 men and 10 women, mean age 63.5 years (10.8) the majority (64.3%) had a reasonable voice (good = 11 and poor = 4 patients). Comparing subjective and objective parameters, significant correlations were only seen with a smaller minimal neoglottic distance at phonation with no regurgitation of barium at phonation (P = 0.05) and a type 1 shape of neoglottis at phonation (P = 0.02). There were also significant correlations between smaller maximum sub-neoglottic distance at phonation and type 1 shape of neoglottis (P = 0.02), smaller maximum sub-neoglottic distance at rest and absence of stasis of barium at phonation (P = 0.05) and the length of neoglottis at phonation and type 1 shape of neoglottis (P = 0.01). For perceptual evaluation, significant correlation was seen only between G1 voice and a smaller minimal neoglottic distance at phonation (P = 0.03) amongst the subjective and objective parameters. There were no correlations between visual parameters and the clinical parameters. CONCLUSIONS Our observations suggest that this interesting concept has limitations. While objective and quantifiable data can be obtained using videofluoroscopy in laryngectomees, only a few correlate with each other and with voice quality.
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Affiliation(s)
- R Kazi
- Head and Neck Unit, Royal Marsden Hospital, The Institute of Cancer Research, London, UK.
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Saito M, Imagawa H, Sakakibara KI, Tayama N, Nibu KI, Amatsu M. High-speed digital imaging and electroglottography of tracheoesophageal phonation by Amatsu's method. Acta Otolaryngol 2006; 126:521-5. [PMID: 16698703 DOI: 10.1080/00016480500415613] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Our previous findings have indicated that the thyropharyngeal muscles form a retropharyngeal prominence during alaryngeal phonation via the TE fistula. This prominence forms a so-called 'neoglottis', which is thought to function as the vibratory source. To better understand the mechanism of TE phonation, we analyzed the vibration of the neoglottis using electroglottography (EGG) and a high-speed digital imaging system. PATIENTS AND METHODS Two volunteers who use TE phonation for their daily speech communication were subjected to this study. The vibrations of the neoglottis were recorded simultaneously as EGG and high-speed imaging with acoustic signals. RESULTS The vibrations of the neoglottis, recorded by means of high-speed digital imaging, were exactly synchronized with the waveforms of the acoustic signals and EGG. CONCLUSIONS These results further confirm the neoglottis as the source of vibration during tracheoesophageal (TE) phonation.
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Affiliation(s)
- Miki Saito
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe
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van As-Brooks CJ, Hilgers FJM, Koopmans-van Beinum FJ, Pols LCW. Anatomical and Functional Correlates of Voice Quality in Tracheoesophageal Speech. J Voice 2005; 19:360-72. [PMID: 15936923 DOI: 10.1016/j.jvoice.2004.07.011] [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] [Accepted: 07/21/2004] [Indexed: 11/29/2022]
Abstract
The purpose of the current study was to assess the anatomic and functional correlates of voice quality in tracheoesophageal speech, with dynamic imaging studies of the neoglottis. Videofluoroscopy (providing a lateral view), digital high-speed endoscopy (providing a "birds-eye" view), and their relationships with perceptual evaluations of voice quality were investigated. Several significant relationships were found. Imaging with videofluoroscopy revealed that the following anatomic and functional parameters (established during phonation) are related to voice quality: presence of a neoglottic bar, regurgitation of barium, tonicity of the neoglottis, and minimal neoglottic distance. Furthermore, the index of the increase of the maximal subneoglottic distance from rest to phonation also showed a significant relationship with voice quality. Imaging with digital high-speed endoscopy revealed features relevant to voice quality, including amount of saliva, visibility of the origin of the neoglottis, shape of the neoglottis, and regularity of the vibration. Knowledge of the anatomic and functional correlates of tracheoesophageal voice quality provides prerequisite information for future (phono-) surgical and/or clinical improvements to the voice quality of postlaryngectomy (prosthetic) voice production.
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Affiliation(s)
- Corina J van As-Brooks
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam
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Hertegård S. What have we learned about laryngeal physiology from high-speed digital videoendoscopy? Curr Opin Otolaryngol Head Neck Surg 2005; 13:152-6. [PMID: 15908812 DOI: 10.1097/01.moo.0000163451.98079.ba] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe recent developments in high-speed videoendoscopy. The applications of this technique are highlighted and important findings regarding vocal fold physiology and voice pathology are discussed. RECENT FINDINGS The number of applications for digital high-speed imaging has increased during recent years because of the development of camera image sensor systems with increased image resolution of video and television quality. Other improvements are related to computer processing speed and storage capacity and the development of automatic algorithms for quantification and measurements both in time and room dimensions. This is enhanced by combining high-speed videoendoscopy with laser-based measurement systems, acoustic analyses or other glottographic methods, such as flow glottography or electroglottography. High-speed videoendoscopy is currently used in studies of voice mechanisms of phonation (e.g., the voice source can be examined with a high sampling rate, from 1000 to over 8000 frames per second), and in phonation onset or offset. High-speed imaging is also useful in linguistic studies and in the examination of different artistic singing styles, such as extremely high-pitched singing, throat singing, or different pop and rock styles. High-speed videoendoscopy is also used in the examination of patients with voice disorders, particularly with irregular vocal fold vibrations, ventricular phonation, or the phonation of individuals who have had a laryngectomy. SUMMARY Findings from studies of normal voice physiology and of voice disorders using high-speed imaging are presented and their relevance is discussed.
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Affiliation(s)
- Stellan Hertegård
- Karolinska Institute, Department of Logopedics and Phoniatrics, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
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