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Baudouin R, Amelot A, Huynh-Charlier I, Lisan Q, Hans S, Charlier P. Three-dimensional reconstruction of King Henri IV's paranasal sinuses and mastoid cells. Clin Anat 2024. [PMID: 38634327 DOI: 10.1002/ca.24172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE The preserved head of King Henri IV of France (life 1553-1610, reign 1589-1610) has survived to the present day thanks to high-quality embalming and favorable conservation conditions. The aim of this study was to examine Henry IV's upper resonant cavities and mastoids using an original and innovative forensic three-dimensional segmentation method. METHODS The paranasal sinuses and mastoid cells of King Henri IV of France were studied by cross-referencing available biographical information with clinical and flexible endoscopic examination and computed tomography (CT-scan) imaging. The paranasal sinuses and mastoid cells were delineated and their volumes were assessed using ITK-SNAP 4.0 software (open-source). Graphical representations were created using Fusion 360® (Autodesk Inc., San Rafael, CA, USA) and MeshMixer® (Autodesk Inc., San Rafael, CA, USA). RESULTS Paranasal sinus tomodensitometry revealed abnormalities in shape and number. Henri IV of France suffered from sinus aplasia. Neither the left sphenoid nor left frontal sinus contrasted sharply, and a remarkable pneumatization of the right clinoid processes extended throughout the height of the right pterygoid process. The total volumes of Henri IV's mastoid air-cells were estimated at 27 and 26 mL, respectively, for the right and left sides, exceeding the normal mean and the maximum of modern subjects by a wide margin. No sign of chronic ear or sinus condition was found. CONCLUSIONS An innovative method has been developed in forensic medicine to establish hypotheses about the growth and respiratory conditions of the face.
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Affiliation(s)
- Robin Baudouin
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, Suresnes, France
- Laboratory Anthropology, Archaeology, Biology (LAAB), UFR of Health Sciences (UVSQ/Paris-Saclay University), Montigny Le Bretonneux, France
| | - Angélique Amelot
- Phonetics and Phonology Laboratory (UMR 7018 CNRS & Université Sorbonne nouvelle), Paris, France
| | - Isabelle Huynh-Charlier
- Laboratory Anthropology, Archaeology, Biology (LAAB), UFR of Health Sciences (UVSQ/Paris-Saclay University), Montigny Le Bretonneux, France
- Department of Radiology, University Hospital Pitié-Salpétrière, AP-HP, boulevard de l'hôpital, Paris, France
| | - Quentin Lisan
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, Suresnes, France
| | - Stéphane Hans
- Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, Suresnes, France
- Phonetics and Phonology Laboratory (UMR 7018 CNRS & Université Sorbonne nouvelle), Paris, France
| | - Philippe Charlier
- Laboratory Anthropology, Archaeology, Biology (LAAB), UFR of Health Sciences (UVSQ/Paris-Saclay University), Montigny Le Bretonneux, France
- Foundation Anthropology, Archaeology, Biology (FAAB)-Institut de France, Palais de l'Institut, Paris, France
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Bianco MR, Saita V, Occhiuzzi F, Modica DM, Latella D, Azzolina A, Galfano M, Allegra E. Long-Term Complications of Tracheoesophageal Voice Prosthesis. J Clin Med 2024; 13:1912. [PMID: 38610678 PMCID: PMC11013007 DOI: 10.3390/jcm13071912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The aim of our multicenter retrospective study was to evaluate the long-term complications associated with primary and secondary tracheoesophageal puncture (TEP) in patients who underwent total laryngectomy (TL) for laryngeal cancer and were subsequently rehabilitated to phonatory function with tracheoesophageal speech (TES). Materials and Methods: To evaluate the long-term outcomes and complications of TEP, the following data were collected: mean time of prosthesis replacement, mean time of onset of complications, type of complications, and type of failure. Results: Complications occurred in 18 out of 46 patients (39.2%) with primary TEP and in 10 out of 30 patients (33.4%) with secondary TEP, out of a total of 76 enrolled patients. Common complications included prosthesis leakage, fistula leakage, granulation, and prosthesis extrusion. Prosthesis replacement due to fistula leakage or prosthesis extrusion was observed exclusively in the group of patients with primary TEP. Among the 28 patients (35.7%) who experienced complications, rehabilitation with TEP failed in 10 cases, primarily due to abandonment and spontaneous fistula closure. Conclusions: TEP, both primary and secondary, represents a valid option for vocal rehabilitation in patients undergoing TL. However, identifying prognostic factors that could influence the success of TEP would be beneficial to allow a targeted rehabilitation process.
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Affiliation(s)
- Maria Rita Bianco
- Department of Health Science, University of Catanzaro, 88100 Catanzaro, Italy; (M.R.B.); (F.O.)
| | - Vincenzo Saita
- Otolaryngology Unit, Cannizzaro Hospital, 95100 Catania, Italy; (V.S.); (A.A.)
| | - Federico Occhiuzzi
- Department of Health Science, University of Catanzaro, 88100 Catanzaro, Italy; (M.R.B.); (F.O.)
| | | | - Daniele Latella
- Department of Health Science, University of Catanzaro, 88100 Catanzaro, Italy; (M.R.B.); (F.O.)
| | - Alfio Azzolina
- Otolaryngology Unit, Cannizzaro Hospital, 95100 Catania, Italy; (V.S.); (A.A.)
| | - Mario Galfano
- Otolaryngology Unit, Villa Sofia-Cervello Hospital, 90146 Palermo, Italy; (D.M.M.); (M.G.)
| | - Eugenia Allegra
- Department of Health Science, University of Catanzaro, 88100 Catanzaro, Italy; (M.R.B.); (F.O.)
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Rodrigues A, Alves de Sousa F, Casanova MJ, Silva A, Feliciano T, Vaz Freitas S, Pinto R, Lino J. Laryngectomy: Phonation Alternatives and Their Impact on the Quality of Life. Cureus 2023; 15:e39093. [PMID: 37332417 PMCID: PMC10270312 DOI: 10.7759/cureus.39093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background The decision to consent to surgery is a life-changing moment. This study addresses the impact of total laryngectomy (TL) on phonation and its effect on the quality of life (QoL) of patients. The primary objective of this cohort study is to compare the alternatives in phonation rehabilitation, and the secondary objective is to identify concurrent predictors of vocal outcomes. Methodology To perform a comprehensive analysis, we reviewed data from patients who underwent TL with bilateral radical neck dissection in the Department of Otolaryngology, Head and Neck Surgery at Centro Hospitalar Universitário de Santo António between January 2010 and October 2022. Adult patients who consented to participate in the study and underwent subjective evaluation were included in this study. Data regarding clinical history was primarily collected. Statistical analysis was performed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Different types of vocal rehabilitation formed the subgroups to be compared. An additional analysis was performed for baseline variables collected in the clinical records, and vocal outcomes were measured using the Self-Evaluation of Communication Experiences After Laryngectomy (SECEL) questionnaire. Furthermore, linear models taking SECEL scores as the outcome were developed. Results The first search identified a total of 124 patients operated during the study period. In total, 63 patients were alive at the time of the current follow-up, with 61 deaths (49%). Overall, 26 of the 63 alive patients completed the SECEL questionnaire. All patients were male. The mean age at diagnosis was 62.2 ± 10.6 years. The mean age at the time of subjective vocal assessment with the SECEL questionnaire was 66.3 ± 10.4 years. The mean time of follow-up after the initial diagnosis was 4 ± 3.8 years. A statistically significant difference was observed in esophageal speech (ES), which was inferior to other modalities (mean SECEL total score for ES: 46.6 ± 12.2 vs. mean SECEL total score for all other modalities: 33 ± 15.1; p = 0.03). The follow-up time correlated significantly with vocal function, as measured by the SECEL questionnaire (p = 0.013). Conclusions The SECEL questionnaire can be a valuable tool to evaluate QoL in laryngectomy patients, given its usefulness in assessing the psychological impact derived from vocal functionality in this group. ES appears inferior to other modalities regarding voice-related QoL.
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Affiliation(s)
- Ana Rodrigues
- Otolaryngology - Head and Neck Surgery, Instituto de Ciências Biomédicas Abel Salazar, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Francisco Alves de Sousa
- Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Maria J Casanova
- Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Ana Silva
- Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Telma Feliciano
- Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Susana Vaz Freitas
- Speech Therapy, Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Ricardo Pinto
- Gastroenterology, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - João Lino
- Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário de Santo António, Porto, PRT
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Heirman AN, van der Noort V, van Son R, Petersen JF, van der Molen L, Halmos GB, Dirven R, van den Brekel MWM. Does Prophylactic Replacement of Voice Prosthesis Make Sense? A Study to Predict Prosthesis Lifetime. Otolaryngol Head Neck Surg 2023; 168:429-434. [PMID: 35917180 DOI: 10.1177/01945998221116815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Voice prosthesis leakage significantly affects the quality of life of patients undergoing laryngectomy, causing insecurity and frequent unplanned hospital visits and costs. In this study, the concept of prophylactic voice prosthesis replacement was explored to prevent leakages. STUDY DESIGN Retrospective cohort study. SETTING Tertiary hospital. METHODS This study included all patients who underwent laryngectomy between 2000 and 2012 in the Netherlands Cancer Institute. Device lifetimes and voice prosthesis replacements of a retrospective cohort were used to calculate the number of needed voice prostheses per patient per year to prevent 70% of the leakages by prophylactic replacement. Various strategies for the timing of prophylactic replacement were considered: adaptive strategies based on the individual patient's history of replacement and fixed strategies based on the results of patients with similar voice prosthesis or treatment characteristics. RESULTS Patients used a median 3.4 voice prostheses per year (range, 0.1-48.1). We found high inter- and intrapatient variability in device lifetime. When prophylactic replacement is applied, this would become a median 9.4 voice prostheses per year, which means replacement every 38 days, implying >6 additional voice prostheses per patient per year. The individual adaptive model showed that preventing 70% of the leakages was impossible for most patients and only a median 25% can be prevented. Monte-Carlo simulations showed that prophylactic replacement is not feasible due to the high coefficient of variation (SD/mean) in device lifetime. CONCLUSION Based on our simulations, prophylactic replacement of voice prostheses is not feasible due to high inter- and intrapatient variation in device lifetime.
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Affiliation(s)
- Anne N Heirman
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Vincent van der Noort
- Department of Biometrics and Statistics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rob van Son
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, the Netherlands
| | - Japke F Petersen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Richard Dirven
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, the Netherlands
- Department of Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Abstract
Since the first total laryngectomy was performed in the late 18th century, several improvements and variations in surgical techniques have been proposed for this procedure. The surgical techniques employed in total laryngectomy have not been comprehensively discussed to date. Thus, the main objective of this article was to address controversial aspects related to this procedure and compare different surgical techniques used for a total laryngectomy procedure from the beginning to the end. Although the management paradigms in laryngeal and hypopharyngeal squamous cell carcinomas have shifted to organ-preserving chemoradiotherapy protocols, total laryngectomy still plays a prominent role in the treatment of advanced and recurrent tumors. The increased incidence of complications associated with salvage total laryngectomy has driven efforts to improve the surgical techniques in various aspects of the operation. Loss of voice and impaired swallowing are the most difficult challenges to be overcome in laryngectomies, and the introduction of tracheoesophageal voice prostheses has made an enormous difference in postoperative rehabilitation and quality of life. Advancements in reconstruction techniques, tumor control, and metastatic management, such as prophylactic neck treatments and paratracheal nodal dissection (PTND), as well as the use of thyroid gland-preserving total laryngectomy in selected patients have all led to the increasing success of modern total laryngectomy. Several conclusions regarding the benchmarking of surgical techniques cannot be drawn. Issues regarding total laryngectomy are still open for discussion, and the technique will continue to require improvement in the near future.
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Affiliation(s)
- Adit Chotipanich
- Otolaryngology Department, Chonburi Cancer Hospital, Ministry of Public Health, Chonburi, THA
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Abstract
BACKGROUND It is important for the patients to reconstruct the voice phonic function by surgery after total laryngectomy in the developing countries. AIMS/OBJECTIVES To investigate the clinical outcomes of voice reconstruction using an infrahyoid musculocutaneous flap for patients after total laryngectomies. MATERIALS AND METHODS Eighteen male patients recruited were laryngectomized. The infrahyoid musculocutaneous flap was designed. After total laryngectomy, the lower edge of the flap was sewed with the upper edge of the tracheostomy opening. Next, the lateral and medial edges of the flap were anastomosed to create a pronunciation tube. Finally, the remaining opening of the tube was sutured with the anterolateral wall of the hypopharynx to establish a communication with the pharyngeal cavity. RESULTS A total of 17 cases of flaps were survived and only 1 necrosed. There were 17 patients without serious complications, except that 6 cases had mild irritable cough when gulping water. However, it could be relieved through blocking tracheostoma. One year after operation, all patients could more remarkably articulate clear, powerful, and consistent words. The articulatory configuration was existed under rigid laryngoscope and CT. CONCLUSIONS AND SIGNIFICANCE The use of an infrahyoid myocutaneous flap is feasible for the voice restoration in the patients undergoing total laryngectomy.
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Affiliation(s)
- Changjiang Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, China
| | - Yi Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, China
| | - Haitao Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, China
| | - Min Shu
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, China
| | - Lei Cheng
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, China
| | - Peijie He
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Fudan University, Shanghai, China
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7
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Repova B, Zabrodsky M, Plzak J, Kalfert D, Matousek J, Betka J. Text-to-speech synthesis as an alternative communication means after total laryngectomy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:192-197. [PMID: 32367081 DOI: 10.5507/bp.2020.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/06/2020] [Indexed: 11/23/2022] Open
Abstract
AIMS Total laryngectomy still plays an essential part in the treatment of laryngeal cancer and loss of voice is the most feared consequence of the surgery. Commonly used rehabilitation methods include esophageal voice, electrolarynx, and implantation of voice prosthesis. In this paper we focus on a new perspective of vocal rehabilitation utilizing alternative and augmentative communication (AAC) methods. METHODS AND PATIENTS 61 consecutive patients treated by means of total laryngectomy with or w/o voice prosthesis implantation were included in the study. All were offered voice banking and personalized speech synthesis (PSS). They had to voluntarily express their willingness to participate and to prove the ability to use modern electronic communication devices. RESULTS Of 30 patients fulfilling the study criteria, only 18 completed voice recording sufficient for voice reconstruction and synthesis. Eventually, only 7 patients started to use this AAC technology during the early postoperative period. The frequency and total usage time of the device gradually decreased. Currently, only 6 patients are active users of the technology. CONCLUSION The influence of communication with the surrounding world on the quality of life of patients after total laryngectomy is unquestionable. The possibility of using the spoken word with the patient's personalized voice is an indisputable advantage. Such a form of voice rehabilitation should be offered to all patients who are deemed eligible.
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Affiliation(s)
- Barbora Repova
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
| | - Michal Zabrodsky
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
| | - Jan Plzak
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
| | - David Kalfert
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
| | - Jindrich Matousek
- Department of Cybernetics, University of West Bohemia in Pilsen, Pilsen, Czech Republic
| | - Jan Betka
- Department of Otorhinolaryngology, Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol
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Moors T, Silva S, Maraschin D, Young D, Quinn JM, de Carpentier J, Allouche J, Himonides E. Using Beatboxing for Creative Rehabilitation After Laryngectomy: Experiences From a Public Engagement Project. Front Psychol 2020; 10:2854. [PMID: 32082203 PMCID: PMC7001741 DOI: 10.3389/fpsyg.2019.02854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 12/02/2019] [Indexed: 11/29/2022] Open
Abstract
Laryngectomy is the surgical removal of the larynx (voice box), usually performed in patients with advanced stages of throat cancer. The psychosocial impact of losing the voice is significant, affecting a person’s professional and social life in a devastating way, and a proportion of this patient group subsequently must overcome depression (22–30%) and social isolation (40%). The profound changes to anatomical structures involved in voicing and articulation, as a result of surgery, radiotherapy or chemotherapy (separately or in combination with one another), introduce challenges faced in speech rehabilitation and voice production that complicate social reintegration and quality of life. After laryngectomy, breathing, voicing, articulation and tongue movement are major components in restoring communication. Regular exercise of the chest, neck and oropharyngeal muscles, in particular, is important in controlling these components and keeping the involved structures supple. It is, however, a difficult task for a speech therapist to keep the patient engaged and motivated to practice these exercises. We have adopted a multidisciplinary approach to explore the use of basic beatboxing techniques to create a wide variety of exercises that are seen as fun and interactive and that maximize the use of the structures important in alaryngeal phonation. We herein report on our empirical work in developing patients’ skills, particularly relating to voiced and unvoiced consonants to improve intelligibility. In collaboration with a professional beatboxing performer, we produced instructional online video materials to support patients working on their own and/or with support from speech therapists. Although the present paper is focused predominantly on introducing the structure of the conducted workshops, the rationale for their design and the final public engagement performance, we also include feedback from participants to commence the critical discourse about whether this type of activity could lead to systematic underlying research and robustly assessed interventions in the future. Based on this exploratory work, we conclude that the innovative approach that we employed was found to be engaging, useful, informative and motivating. We conclude by offering our views regarding the limitations of our work and the implications for future empirical research.
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Affiliation(s)
| | | | - Donatella Maraschin
- School of Arts and Creative Industries, London South Bank University, London, United Kingdom
| | - David Young
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - John M Quinn
- First Faculty of Medicine, Institute of Hygiene and Epidemiology, Charles University, Prague, Czechia
| | | | | | - Evangelos Himonides
- UCL Institute of Education, University College London, London, United Kingdom
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9
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Rameau A. Pilot study for a novel and personalized voice restoration device for patients with laryngectomy. Head Neck 2019; 42:839-845. [PMID: 31876090 DOI: 10.1002/hed.26057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/06/2019] [Accepted: 12/10/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The main modalities for voice restoration after laryngectomy are the electrolarynx, and the tracheoesophageal puncture [Correction added on 30 January 2020 after first online publication: The preceding sentence has been revised. It originally read "The main modalities for voice restoration after laryngectomy are the electrolarynx and the tracheoesophageal puncture."]. All have limitations and new technologies may offer innovative alternatives via silent speech. OBJECTIVE To describe a novel and personalized method of voice restoration using machine learning applied to electromyographic signal from articulatory muscles for the recognition of silent speech in a patient with total laryngectomy. METHODS Surface electromyographic (sEMG) signals of articulatory muscles were recorded from the face and neck of a patient with total laryngectomy who was articulating words silently. These sEMG signals were then used for automatic speech recognition via machine learning. Sensor placement was tailored to the patient's unique anatomy, following radiation and surgery. A personalized wearable mask covering the sensors was designed using 3D scanning and 3D printing. RESULTS Using seven sEMG sensors on the patient's face and neck and two grounding electrodes, we recorded EMG data while he was mouthing "Tedd" and "Ed." With data from 75 utterances for each of these words, we discriminated the sEMG signal with 86.4% accuracy using an XGBoost machine-learning model. CONCLUSIONS This pilot study demonstrates the feasibility of sEMG-based alaryngeal speech recognition, using tailored sensor placement and a personalized wearable device. Further refinement of this approach could allow translation of silently articulated speech into a synthesized voiced speech via portable devices.
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Affiliation(s)
- Anaïs Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, Sean Parker Institute for the Voice, New York, New York
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10
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Krasavina EA, Balatskaya LN, Choynzonov EL, Kulbakin DE. [Restoration of the voice function after subtotal laryngectomy and formation of tracheopharyngeal shunt]. Vestn Otorinolaringol 2019; 84:39-43. [PMID: 31579056 DOI: 10.17116/otorino20198404139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We introduce our newly designed voice restoration technique for patients who have undergone subtotal laryngectomy for laryngeal and pharyngolaryngeal cancer. To study the efficacy of this technique, we analyzed the voice rehabilitation results in 14 patients with laryngeal and pharyngolaryngeal cancer. Voice function was restored in 13 (92.9%) patients 6-12 days after starting speech therapy. The middle voice, voice of medium timbre, long speech (phrase of 4-5 words) and speech sufficient for communication in everyday life and on the phone were formed. An acoustic analysis of spectral components of the speech signal of the formed voice revealed that the main voice parameters were reduced (the frequency of the fundamental tone was 75-130 Hz and the time of maximum phonation varied from 1.5 to 2.7 s). At a follow-up of 12 months, the frequency of the fundamental tone increased up to 120-170 Hz and the time of maximum phonation increased up to 4-4.5 s. Our technique of voice restoration after subtotal laryngectomy with the formation of a tracheopharyngeal shunt allowed us to restore voice function in a short time, return the previous social status and significantly improve the quality of life of laryngectomized patients.
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Affiliation(s)
- E A Krasavina
- Cancer Research Institute, Tomsk National Research medical Center, Tomsk, Russia, 634050
| | - L N Balatskaya
- Cancer Research Institute, Tomsk National Research medical Center, Tomsk, Russia, 634050
| | - E L Choynzonov
- Cancer Research Institute, Tomsk National Research medical Center, Tomsk, Russia, 634050
| | - D E Kulbakin
- Cancer Research Institute, Tomsk National Research medical Center, Tomsk, Russia, 634050
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11
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Abstract
Tracheoesophageal puncture with voice prosthesis placement is used to restore vocal function after total laryngectomy. However, closure of the fistula is sometimes needed. At our department, a simple and effective technique for closure was developed. It does not require interposed tissues or materials. Moreover, our procedure allows for a short rehabilitation time for swallowing and a short hospitalization. We describe advantages, pitfalls, and errors to avoid. This technique should not be performed for patients who are irradiated and those with large fistulas.
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Affiliation(s)
- Giuseppe Riva
- 1 Otorhinolaryngology Division, Santa Croce Hospital, Moncalieri, Italy
| | - Federico Dagna
- 1 Otorhinolaryngology Division, Santa Croce Hospital, Moncalieri, Italy
| | - Eugenia Ricci
- 1 Otorhinolaryngology Division, Santa Croce Hospital, Moncalieri, Italy
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12
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Petersen JF, Lansaat L, Timmermans AJ, van der Noort V, Hilgers FJM, van den Brekel MWM. Postlaryngectomy prosthetic voice rehabilitation outcomes in a consecutive cohort of 232 patients over a 13-year period. Head Neck 2019; 41:623-631. [PMID: 30614644 PMCID: PMC6590326 DOI: 10.1002/hed.25364] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/22/2018] [Accepted: 05/17/2018] [Indexed: 11/09/2022] Open
Abstract
Background With the increasing necessity for total laryngectomy (TL) after prior (chemo)radiotherapy, prosthetic vocal rehabilitation outcomes might have changed. Methods Retrospective cohort study including all patients laryngectomized between 2000 and 2012 with a voice prosthesis (VP) in the Netherlands Cancer Institute. Results Median device lifetimes of the standard Provox2 and Vega VPs are 63 and 66 days, respectively, and for the problem‐solving ActiValve Light and Strong VPs 143 and 186 days, respectively. In multivariable analysis, salvage TL and TL for a dysfunctional larynx (compared to primary TL) were associated with a shorter device lifetime. Almost half of the patients (48%) experienced tracheoesophageal puncture tract‐related problems, and this concerned 12% of all VP replacements. Conclusions Compared to historical cohorts, device lifetimes of regular Provox2 and Vega voice prostheses have decreased. Complications are not occurring more frequently but affect more patients. Nevertheless, the clinical reliability and validity of prosthetic voice rehabilitation is still sound.
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Affiliation(s)
- Japke F Petersen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Liset Lansaat
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Adriana J Timmermans
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Frans J M Hilgers
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Phonetic Sciences-Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Phonetic Sciences-Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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13
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Matsui H, Iwae S, Hirayama Y, Yonezawa K, Shigeji J. Long-term results of Amatsu tracheoesophageal shunt: Follow-up of more than 5 years. Laryngoscope 2017; 128:1395-1397. [PMID: 28988438 DOI: 10.1002/lary.26916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/11/2017] [Accepted: 08/18/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND/OBJECTIVE The Amatsu tracheoesophageal shunt (ATES) represents a nonprosthesis surgical option for voice restoration in laryngectomized patients. However, data regarding the long-term efficacy of ATES are lacking. STUDY DESIGN Retrospective, single-institution study. METHODS Between 2001 and 2010, 16 patients with laryngeal cancer underwent total laryngectomy with ATES at the Hyogo Cancer Center (Akashi, Hyogo, Japan). Of these, 11 achieved long-term tracheoesophageal speech that was maintained for a follow-up exceeding 5 years (range 75-161 months; median 95 months). All patients were male and ranged from 46 to 74 years of age at the time of ATES surgery. RESULTS Of 11 eligible patients, eight were able to speak intelligibly with ATES at last follow-up. Regarding aspiration, three patients experienced no leakage, and six experienced mild leakage of saliva without medical intervention at last follow-up. Almost all patients maintained an unchanged degree of voice quality (9 of 11) and leakage (8 of 11). CONCLUSION The favorable voice restoration and low aspiration rates achieved in this study appear to support the long-term efficacy of ATES. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1395-1397, 2018.
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Affiliation(s)
- Hidetoshi Matsui
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Shigemichi Iwae
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Yuji Hirayama
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Koichiro Yonezawa
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Jun Shigeji
- Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan
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14
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Fukushima H, Kanazawa T, Kawabata K, Mitani H, Yonekawa H, Sasaki T, Shimbashi W, Seto A, Kamiyama R, Misawa K, Asakage T. Indwelling voice prosthesis insertion after total pharyngolaryngectomy with free jejunal reconstruction. Laryngoscope Investig Otolaryngol 2017; 2:30-35. [PMID: 28894820 PMCID: PMC5510280 DOI: 10.1002/lio2.63] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/01/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives Total pharyngolaryngectomy with free jejunal reconstruction is often performed in patients with hypopharyngeal carcinoma. However, postoperative speechlessness significantly decreases patient quality of life. We investigated whether Provox® insertion could preserve speech after total pharyngolaryngectomy with free jejunal reconstruction. Study Design Retrospective chart review. Methods A total of 130 cases of secondary Provox® insertions after total pharyngolaryngectomy with free jejunal reconstruction were analyzed. Communication outcomes were compared using the Head and Neck Cancer Understandability of Speech Subscale. Outcomes and complications associated with insertion site (jejunal insertion vs. esophageal insertion) and adjuvant irradiation therapy were also evaluated. Results Provox® insertion had favorable communication outcomes in 102 cases (78.4%). Neither the insertion site nor irradiation affected the communication outcome. Complications were observed in 20 cases (15.4%). Local infection was the most common complication. Free jejunal insertion, in which the resection range was enlarged, had a lower complication rate than did esophageal insertion, and its complication rate was unaffected by previous irradiation. For all patients, the hospitalization duration and duration of speechlessness were 13.4 days and 14.6 months, respectively. Patients receiving jejunal insertions had a significantly shorter hospitalization duration than did those receiving esophageal insertions. Unlike Provox®2, Provox®Vega significantly reduced the complication rate to zero. Conclusion For jejunal inserson of a Provox® prosthetic, a sufficient margin can be maintained during total pharyngolaryngectomy and irradiation can be performed, and satisfactory communication outcomes were observed. Provox® insertion after total pharyngolaryngectomy with free jejunal reconstruction should be considered the standard therapy for voice restoration. Level of Evidence 4.
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Affiliation(s)
- Hirofumi Fukushima
- Department of Head and Neck Surgery.,Tokyo Medical and Dental University Graduate School of Medicine, Division of Head and Neck Tokyo Japan
| | - Takeharu Kanazawa
- Cancer Institute Hospital, Japanese Foundation of Cancer Research, Department of Otolaryngology-Head and Neck Surgery Tokyo Japan
| | - Kazuyoshi Kawabata
- Tokyo Medical and Dental University Graduate School of Medicine, Division of Head and Neck Tokyo Japan
| | - Hiroki Mitani
- Tokyo Medical and Dental University Graduate School of Medicine, Division of Head and Neck Tokyo Japan
| | - Hiroyuki Yonekawa
- Tokyo Medical and Dental University Graduate School of Medicine, Division of Head and Neck Tokyo Japan
| | - Toru Sasaki
- Tokyo Medical and Dental University Graduate School of Medicine, Division of Head and Neck Tokyo Japan
| | - Wataru Shimbashi
- Tokyo Medical and Dental University Graduate School of Medicine, Division of Head and Neck Tokyo Japan
| | - Akira Seto
- Tokyo Medical and Dental University Graduate School of Medicine, Division of Head and Neck Tokyo Japan
| | - Ryousuke Kamiyama
- Tokyo Medical and Dental University Graduate School of Medicine, Division of Head and Neck Tokyo Japan
| | - Kiyoshi Misawa
- Jichi Medical University, Shimotsuke, Japan, Department of Otolaryngology/Head and Neck Surgery Hamamatsu University School of Medicine Hamamatsu Japan
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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16
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Abstract
INTRODUCTION This study aimed to assess the factors that influence the longevity and replacement frequency of Provox voice prostheses following their placement. METHODS The medical records of 27 patients who received Provox voice prostheses after total laryngectomy and attended follow-up regularly between 1998 and 2012 were retrospectively reviewed. The success rate of the Provox voice prostheses (i.e. whether speech was achieved), quality of speech achieved, number and type of complications encountered, frequency of prostheses replacement and reasons for prostheses replacements were evaluated. RESULTS All 27 patients were men and their mean age was 63.0 (range 43-78) years. The mean follow-up period was 60.3 (range 1-168) months. Fluent and understandable speech was achieved in 85.0% of the patients. The mean duration before prosthesis replacement had to be performed was 17.1 (range 1-36) months. The most frequent complication was fluid leakage through the prosthesis. There was a strong positive correlation of 77.1% between the longevity of prostheses and postoperative follow-up duration (r = 0.771; p < 0.01). CONCLUSION The voice prosthesis is a tool that can be delivered in a practical fashion and replaced easily with no serious complications. It is a means by which speech can be restored, with a high success rate, after total laryngectomy. In the present study, we found that postoperative follow-up duration was the most important factor influencing the longevity of the Provox voice prosthesis.
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Affiliation(s)
- Alper Yenigun
- Department of Otorhinolaryngology, Bezmialem Vakif University, Istanbul, Turkey
| | - Sabri Baki Eren
- Department of Otorhinolaryngology, Bezmialem Vakif University, Istanbul, Turkey
| | - Murat Haluk Ozkul
- Otorhinolaryngology Clinic, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Selahattin Tugrul
- Department of Otorhinolaryngology, Bezmialem Vakif University, Istanbul, Turkey
| | - Aysenur Meric
- Department of Otorhinolaryngology, Bezmialem Vakif University, Istanbul, Turkey
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Ţiple C, Drugan T, Dinescu FV, Mureşan R, Chirilă M, Cosgarea M. The impact of vocal rehabilitation on quality of life and voice handicap in patients with total laryngectomy. J Res Med Sci 2016; 21:127. [PMID: 28331513 PMCID: PMC5348966 DOI: 10.4103/1735-1995.196609] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/13/2016] [Accepted: 08/09/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL) and voice handicap index (VHI) of laryngectomies seem to be relevant regarding voice rehabilitation. The aim of this study is to assess the impact on HRQL and VHI of laryngectomies, following voice rehabilitation. MATERIALS AND METHODS A retrospective study done at the Ear, Nose, and Throat Department of the Emergency County Hospital. Sixty-five laryngectomees were included in this study, of which 62 of them underwent voice rehabilitation. Voice handicap and QOL were assessed using the QOL questionnaires developed by the European Organisation for Research and Treatment of Cancer (EORTC); variables used were functional scales (physical, role, cognitive, emotional, and social), symptom scales (fatigue, pain, and nausea and vomiting), global QOL scale (pain, swallowing, senses, speech, social eating, social contact, and sexuality), and the functional, physical, and emotional aspects of the voice handicap (one-way ANOVA test). RESULTS The mean age of the patients was 59.22 (standard deviation = 9.00) years. A total of 26 (40%) patients had moderate VHI (between 31 and 60) and 39 (60%) patients had severe VHI (higher than 61). Results of the HRQL questionnaires showed that patients who underwent speech therapy obtained better scores in most scales (P = 0.000). Patients with esophageal voice had a high score for functional scales compared with or without other voice rehabilitation methods (P = 0.07), and the VHI score for transesophageal prosthesis was improved after an adjustment period. The global health status and VHI scores showed a statistically significant correlation between speaker groups. CONCLUSION The EORTC and the VHI questionnaires offer more information regarding life after laryngectomy.
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Affiliation(s)
- Cristina Ţiple
- Department of Otorhinolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tudor Drugan
- Department of Otorhinolaryngology, Emergency County Hospital, Cluj-Napoca, Romania
| | - Florina Veronica Dinescu
- Department of Otorhinolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Rodica Mureşan
- Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Magdalena Chirilă
- Department of Otorhinolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marcel Cosgarea
- Department of Otorhinolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Kosztyła-Hojna B, Moskal D, Falkowski D, Łobaczuk-Sitnik A, Kraszewska A, Skorupa M. [Rehabilitation of phonosurgically treated patients with edematous-hypertrophic changes of larynx]. Pol Merkur Lekarski 2016; 41:74-78. [PMID: 27591443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Advanced change of organic dysphonia are an indication for phonosurgery. Edematous-hypertrophic changes are cause of serious disturbances of voice. High-speed digital imaging (HSDI) technique is the unique method, allowing for assessment the effects of therapy and rehabilitation. AIM The aim of the study is evaluation the usefulness of vibratory method in voice rehabilitation of patients with edematous-hypertrophic changes treated phonosurgically. MATERIALS AND METHODS The group I contained 40 patients with edematous-hypertrophical changes phonosurgically treated. Type of clinical dysphonia was diagnosed with HSDI technique. Glottal closure was evaluated according to Committee on Phoniatrics of the European Laryngological Society (ELS) classification, postoperative material was pathomorphologically verified by Transmission Electron Microscopy (TEM). Patients with hyperfunction of larynx were rehabilitated for 21 days using massage device and after that visualization of larynx by HSDI technique was made again. Control group contains people with physiological voice. RESULTS Severe dysphonia with oedematous-hypertrophic changes was found by HSDI technique in group I. Postoperative material was evaluated histopathological by TEM and confirmed the existing clinical morphological changes of larynx. Hyperfunction of phonation organ were diagnosed in 30 patients (75%). After 21 days of rehabilitation using massage device, hyperfunction was reduced as confirmed by HSDI. Normalization of amplitude, regularity, synchrony of vibration and physiological glottal closure were found at 67% cases. CONCLUSIONS HSDI technique in digital sequence is useful in the diagnosis of edematous-hypertrophic changes of the larynx and monitoring the effects of the rehabilitation. Pathomorphological evaluation of postoperative material made by TEM confirmed the rightness of clinical diagnosis of the edematous-hypertrophic changes by HSDI. The consequence of phonosurgical procedures in edematous-hypertrophic changes of larynx is hyperfunction of larynx, confirmed objectively by HSDI technique. The use of massage device causes relaxation of laryngeal structures, normalizing parameters of visualizing evaluation.
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Affiliation(s)
- Bożena Kosztyła-Hojna
- Medical University of Bialystok, Poland: Department of Clinical Phonoaudiology and Logopedics, Phoniatric Clinic of the University Clinical Hospital in Bialystok, Poland
| | - Diana Moskal
- Medical University of Bialystok, Poland: Department of Clinical Phonoaudiology and Logopedics, Phoniatric Clinic of the University Clinical Hospital in Bialystok, Poland
| | - Dawid Falkowski
- Medical University of Bialystok, Poland: Department of Clinical Phonoaudiology and Logopedics, Phoniatric Clinic of the University Clinical Hospital in Bialystok, Poland
| | - Anna Łobaczuk-Sitnik
- Medical University of Bialystok, Poland: Department of Clinical Phonoaudiology and Logopedics, Phoniatric Clinic of the University Clinical Hospital in Bialystok, Poland
| | - Anna Kraszewska
- Medical University of Bialystok, Poland: Department of Clinical Phonoaudiology and Logopedics, Phoniatric Clinic of the University Clinical Hospital in Bialystok, Poland
| | - Małgorzata Skorupa
- Medical University of Bialystok, Poland: Department of Clinical Phonoaudiology and Logopedics, Phoniatric Clinic of the University Clinical Hospital in Bialystok, Poland
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Abstract
This study aimed to investigate if Jordanian school teachers perceive their voice as handicapped using the Voice Handicap Index (VHI)-Arab. The effect of teachers' age, gender, years of teaching, class taught, and education level on VHI was examined. A total of 289 teachers and a control group of 100 participants took part in the study. The teachers' group differed significantly from the control group in the physical, emotional, and functional subscales and the total score of the VHI-Arab. There was no significant difference among teachers in any of the three VHI subscales or total regarding gender, age, years of teaching experience, education level, and classes taught. Jordanian teachers have a strong perception of voice handicap. Thus, preventive and treatment vocal programs are strongly advised.
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Affiliation(s)
- Basem S Marie
- Department of Audiology and Speech Pathology, Al-Ahliyya Amman University , Amman , Jordan
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