The Accuracy of Respiratory Calibration Methods for Estimating Lung Volume During Speech Breathing: A Comparison of Four Methods Across Three Adult Cohorts

Purpose This study evaluated the accuracy of respiratory calibration methods for estimating lung volume during speech breathing. Method Respiratory kinematic data were acquired via inductance plethysmography in 32 young adults, 22 older adults, and 13 older adults with Parkinson's disease (PD). Raw rib cage (RC) and abdomen (AB) signals (V) were calibrated to liters using 4 correction methods: (a) isovolume maneuvers, (b) a constant 2:1 RC-to-AB ratio, (c) least squares method with RC correction only (LsqRC), and (d) least squares method with both RC and AB corrections (LsqRC/AB). Mean percent error, the absolute difference between estimated and actual lung volumes then normalized to each speaker's vital capacity, was calculated for each method. Results For young adults, the LsqRC/AB method significantly reduced mean percent error compared to all other methods. Although LsqRC/AB also resulted in smaller errors for older adults and adults with PD, LsqRC/AB and LsqRC were not significantly different from one another in these groups. Conclusion The LsqRC/AB method reduces errors across all cohorts, but older adults and adults with PD also have reduced errors when using LsqRC. Further research should investigate both least squares methods across larger age and disease severity ranges.

Evaluation of Direct and Indirect Methods of Sub-Neoglottic Pressure Measurement in Tracheoesophageal Speakers: A Systematic Review and Meta-Analysis

OBJECTIVE

Tracheoesophageal (TE) prosthetic voice is one of the voice restoration options for individuals who have undergone a total laryngectomy. Aerodynamic analysis of the TE voice provides insight into the physiological changes that occur at the level of the neoglottis with voice prosthesis in situ. The present study is a systematic review and meta-analysis of sub-neoglottic pressure (SNP) measurement in TE speakers by direct and indirect methods.

PATIENTS AND METHODS

The screening of abstracts and titles was carried out for inclusion of articles using 10 electronic databases spanning the period from 1979 to 2016. Ten articles which met the inclusion criteria were considered for meta-analysis with a pooled age range of 40-83 years.

RESULTS

The pooled mean SNP obtained from the direct measurement method was 53.80 cm H2O with a 95% confidence interval of 21.14-86.46 cm H2O, while for the indirect measurement method, the mean SNP was 23.55 cm H2O with a 95% confidence interval of 19.23-27.87 cm H2O.

CONCLUSION

Based on the literature review, the various procedures followed for direct and indirect measurements of SNP contributed to a range of differences in outcome measures. The meta-analysis revealed that the "interpolation method" for indirect estimation of SNP was the most acceptable and valid method in TE speakers.

Laryngectomy rehabilitation: a perspective from the United States of America

PURPOSE OF REVIEW

It is important on a periodic basis to evaluate and re-evaluate the standard of care in your area and to compare it to the care provided in other parts of the world. This can result in modifications and improvement in the patient's outcome.

RECENT FINDINGS

Over the last year, additional weight has been added to the medical literature regarding the value of moisture exchangers, chronic low-risk medications, the relationship between vocal rehabilitation and esophageal reflux disease, as well as the chronic concern regarding tracheo-esophageal puncture site enlargement. Multidisciplinary input remains critical for optimum success as measured not only by the vocal outcomes, but also by the quality-of-life metrics.

SUMMARY

Optimum outcomes for vocal rehabilitation following laryngectomy suggest the need for careful multidisciplinary perioperative planning and therapy. There have been improvements in tracheo-esophageal prosthesis design, moisturization, and ease of speech generation. Additional research is needed to explore the relationship between speech and chest wall kinematics, puncture site and location, prosthesis leakage, and the potential relationships to gastro-esophageal reflux disease. Future effort should be directed toward measurable improvements in the quality of life.