Method Of Voice Rehabilitation Research Articles

Evolution of the quality of life of total laryngectomy patients using electrolarynx.

Therapy and vocal rehabilitation in laryngeal cancer impact patients' quality of life. The objective of this study was to evaluate the evolution of the quality of life of patients with laryngeal cancer submitted to total laryngectomy and using electrolarynx. This is an observational study with a cross-sectional design and a quantitative approach. It was conducted between April 2022 and January 2023 in a Brazilian cancer hospital. For data collection, a quality of life questionnaire, validated for patients with head and neck cancer at the University of Washington, was applied in two phases: from 7 days after total laryngectomy and, subsequently, from 70 days after surgery using electronic larynx for at least 60 days. The inclusion criteria were patients undergoing total laryngectomy included on the Aldenora Bello Cancer Hospital's election list to receive the electronic larynx. Patients who did not sign the informed consent form were not included. The sample consisted of 31 patients, of which approximately 84% were men and approximately 93% at the age of 50 years or older. When comparing the phases, it is possible to observe that the item speech had the greatest progress, while chewing had the least. Only the item recreation, swallowing, taste, and saliva did not show any statistical significance. The score for the general quality of life questions increased. Electronic larynx is a viable and useful method of voice rehabilitation. Our data suggest that the use of the electrolarynx as a postlaryngectomy method of verbal communication is responsible for positive effects on patients' quality of life.

Treatment of an Enlarged Periprosthetic Leakage Using Filler Injection in Patients With Provox Prosthesis: A Case Report

Recently, the most commonly used method for voice rehabilitation in total laryngectomy patients is to maintain tracheoesophageal shunt speech after inserting a voice prosthesis. One of the most common side effects, besides valve deterioration, is periprosthetic leakage due to dilatation of the tracheoesophageal shunt. Tissue implantation may be considered as one of the conservative treatments before attempting surgical treatment. When tissue implantation is attempted more than once, the treatment success rate is close to 90%. The authors experienced a case in which an 86-year-old patient developed aspiration pneumonia due to periprosthetic leakage. The patient refused surgical treatment. He was treated successfully for injecting hyaluronic acid filler 3 times and has been without a leakage for 9 months. This procedure can be considered as an alternative method to treat periprosthetic leakage.

Speech rehabilitation after total laryngectomy with voice prostheses: phonatory results

The approaches for voice rehabilitation after laryngectomy vary significantly, as they can be classified into natural and device-aided (external and surgical). The techniques differ in degree of accessibility, success and vocal results. Until the introduction of surgical methods, esophageal speech was the mainstay of rehabilitation. It is associated with long training period with questionable success. The electrolarynx, which in our country is still traditionally accepted as the main method of voice rehabilitation after laryngectomy, generates speech with a low degree of intelligibility and mechanical sound. The implantation of a voice prosthesis in a surgically shaped tracheoesophageal fistula is currently accepted as the gold standard. The aim of the study was phoniatric analysis of voice production in alaryngeal speech after tracheo-oesophageal puncture and implantation of a voice prosthesis. The characteristics of tracheoesophageal and oesophageal speech are compared. The obtained results show that the voice production after implantation of a voice prosthesis significantly exceeds the oesophageal voice in terms of average duration of phonation with one air bolus, number of words uttered with one bolus, and the pace and expressiveness of speech.

A study on tracheoesophageal phonation based on a collapsible channel model.

Laryngeal cancer afflicts a large number of people worldwide, and some will need surgery to contain the disease. Currently, tracheoesophageal (TE) speech is a common method of voice rehabilitation for patients who have had their larynges excised. However, despite the relatively high success rate, not everyone is capable of producing the TE voice, usually due to the tonicity of the pharyngoesophageal segment (PES). The present work studies how the tonicity of the muscles of the PES affects TE phonation, focusing mainly on hypotonicity. A simplified collapsible channel model is used. Steady-state solutions are obtained and a linear stability analysis is performed. It is then shown that the steady-state solutions of the model are similar to the wide variety of possible PES configurations that are reported in the literature. The linear stability analysis results provide a simple expression for the estimation of the minimum tonicity required for self-sustained oscillations of the PES.

Tracheo Esophageal Prosthesis Insertion Under Endoscopic Guidance and Local Anaesthesia- Feasibility and Outcome.

Voice rehabilitation after laryngectomy is by tracheo esophageal puncture (TEP) and prosthesis insertion. Secondary TEP is very difficult due to neck fibrosis. Puncture under local anaesthesia with endoscopy guidance is a feasible option. Retrospective review of all laryngectomy patients from March 2009 till March 2019 was done and the methods of voice rehabilitation were assessed. The patients undergoing the procedure were classified according to the timing of insertion and type as primary insertion under general anaesthesia (Group P), secondary insertion under local anaesthesia (Group L), secondary insertion under general anaesthesia (Group G). The speech outcome and the procedure outcome were compared. There were 148 patients who underwent laryngectomy, of which groups P, G, L were 12, 12 and 11. The rate of successful insertion was 100% in primary, 91.6% in secondary in general anaesthesia and 91% in secondary under local anaesthesia. All secondary TEP were done after surgery and radiotherapy. Complications related to the insertion techniques were minimal. Speech outcome were similar on intelligibility rating scale and longevity was not affected by the method. TEP in local anaesthesia is feasible and has comparable outcome with TEP in general anaesthesia. Financial burden was very much less in group L compared to the other two groups.

An evaluation of Short-term Treatment Outcomes of Cricothyroid Visor Maneuver: A Proof-of-Concept Pilot Study

Muscle tension dysphonia (MTD) is used as a clinical and diagnostic descriptive label for a diverse range of vocal fold behaviors caused by increased tension of the (para) laryngeal musculature. These increased tension can occur in the cricothyroid muscle and in the ''visor'' mechanism, contributing to voice problems. The main goal of this study is to determine whether a new method, the cricothyroid visor maneuver (CVM), is an effective method for improving quality and other aspects of the MTD patients' voices. Eighty-eight adult female patients participated in this quasiexperimental study. One group consisted of 30 MTD patients (mean age 28.7 ± 4.95 years) for whom manual circumlaryngeal therapy (MCT) was provided. The other group consisted of 30 MTD patients (mean age 28.9 ± 5.1 years) who received CVM. Also, 28 adult females with MTD (mean age 28.60 ± 4.56 years), who were on the clinic's waiting list, served as a control group and did not receive any treatment. Treatment was provided in a single 30-minute session. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the short-term effects of the two treatment programs. Also, perceptions of patients' about their voice quality before and after therapy were assessed by visual analogue scale. Perceptually, Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) ratings improved in all patients with both treatment methods. Acoustically, with CVM, harmonic-to-noise ratio and Cepstral Peak Prominence increased and perturbation (jitter and shimmer) measures decreased and there was not significant change in MCT and control groups. Visual analogue scale showed that feelings of patients improved after therapy in both treatment methods, with higher scores for patients receiving CVM in comparison to the MCT method. These results suggest that CVM can be an effective method for voice rehabilitation in patients with MTD and manipulation of Cricothyroid muscle and ''visor'' mechanism can lead to marked voice improvement.

<p>Verbal performance of total laryngectomized patients rehabilitated with esophageal speech and tracheoesophageal speech: impacts on patient quality of life</p>

IntroductionTotal laryngectomy has important psychophysical and social consequences for patients’ quality of life because of the functional changes resulting from the removal of the larynx. Voice deprivation is perhaps the most relevant limiting factor in social relationships, increasing feelings of solitude and tending to drive individuals into social isolation. Multiple voice rehabilitation methods after total laryngectomy are available. This study aimed to determine the acoustic quality of the rehabilitated voice achieved with esophageal speech (ES) and tracheoesophageal speech (TES), and acoustic quality impacts on patients’ perceptions of their quality of life.Materials and methodsThe patient inclusion criterion was the completion of a speech rehabilitation course with ES or TES at least 6 months after total laryngectomy. The voice acoustic analysis was carried out automatically by using the Multidimensional Voice Program. The following parameters were extracted: fundamental frequency (F0), Jitter% (Jitt), Shimmer% (Shim), and noise-to-harmonic ratio (NHR). Subjective voice evaluation was performed by using the following questionnaires: Voice Handicap Index (VHI), Voice-related Quality of Life (V-RQOL), and Voice Performance Questionnaire (VPQ).ResultsThe acoustic analysis showed a difference between ES and TES patients on all acoustic parameters; this difference was significant for F0 (133.09±2.4 and 119±3.3, respectively; p<0.001), NHR (0.43±0.21 and 0.31±0.14, respectively; p=0.02), and maximum phonation time (2.02±038 s and 10.64±0.28 s, respectively; p=0.01. Regarding patient-related outcomes, TES correlated with better total scores compared with ES; however, the differences in the total scores on the VHI (p=0.09), V-RQOL (p=0.39), and VPQ (p=0.52) were not statistically significant.ConclusionThe rehabilitation of laryngectomized patients must be addressed by a multidisciplinary team that considers the personalities, personal needs, and relational conditions of individual patients in order to determine and apply the phonatory rehabilitation method most suitable for achieving a better quality of life.

Positive Effects of Manual Circumlaryngeal Therapy in the Treatment of Muscle Tension Dysphonia (MTD): Long Term Treatment Outcomes

IntroductionManual circumlaryngeal therapy (MCT) aims to correct laryngeal position and relax (para) laryngeal and cervical muscles resulting in improved voice quality. The goal of the current study was to further verify long-term effects of MCT in the treatment of Muscle Tension Dysphonia (MTD) patients based on acoustic findings and perceptual judgments. MethodTwenty-eight adult female patients who had been referred to the speech therapy clinic of Khatam Hospital, Zahedan city, participated in this study. Manual circumlaryngeal therapy was undertaken. There were 15 therapy sessions, three sessions per week, each with duration of 30 minutes. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the long-term (6-months) effects of the 15 treatment program. ResultsAcoustically, Harmonic to Noise Ratio (HNR) increased and perturbation (Jitter and Shimmer) measures decreased, and perceptually, the subjective CAPE-V ratings improved in all patients. ConclusionThese results suggest that MCT can be an effective method for voice rehabilitation in patients with MTD and the changes due to the therapy were persistent over a 6-month duration following the termination of treatment sessions.

VOICE REHABILITATION OF PATIENTS AFTER LARYNGECTOMY BY MEANS OF TRACHEOESOPHAGEAL SHUNTING AND VOICE PROSTHETICS

Aim - to evaluate the effectiveness of voice rehabilitation with the use of voice prosthesis, and to review the existing methods of voice rehabilitation with their advantages and disadvantages in order to define the most effective one. Materials and methods. 26 clinical cases include patients aged 54-70 years who underwent laryngectomy as a part of the throat cancer treatment. Voice prostheses were used for their rehabilitation. Results. Tracheoesophageal shunting with voice prosthesis has remarkable advantages over the other methods of restoring the normal voice function.

The impact of vocal rehabilitation on quality of life and voice handicap in patients with total laryngectomy.

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.

ABCLOVE: Voice therapy outcomes for patients with head and neck cancer.

Dysphonia related to head and neck cancer is unique, and demands treatment tailored to its unique pathology. Activate exercises, breathing, counseling, laryngeal manipulation, oral resonance, vocal exercises, and elimination of habits (ABCLOVE) is an 8-week multimodality voice therapy program addressing vocal rehabilitation specifically for patients with head and neck cancer. Twenty-nine patients with a history of head and neck cancer were enrolled in the ABCLOVE program and outcomes were retrospectively reviewed. Relative average pertubation, maximum phonation time (MPT), pitch range, Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), and Voice Handicap Index (VHI) were assessed. The pretreatment and posttreatment improvements in the relative average pertubation (1.86 vs 0.92), MPT (10.53 seconds vs 15.17 seconds), VHI (51.7 vs 29.9), and pitch range (168 Hz vs 244 Hz) were statistically significant (p < .0001). The subjective CAPE-V ratings improved in all but 2 patients. The ABCLOVE voice program provides clinicians with an effective and reproducible method for voice rehabilitation in patients with head and neck cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1810-E1813, 2016.

Candida biofilm formation on voice prostheses.

Laryngopharyngeal malignancy is treated with radiotherapy and/or surgery. When total laryngectomy is required, major laryngeal functions (phonation, airway control, swallowing and coughing) are affected. The insertion of a silicone rubber voice prosthesis in a surgically created tracheoesophageal puncture is the most effective method for voice rehabilitation. Silicone, as is the case with other synthetic materials such as polymethylmethacrylate, polyurethane, polyvinyl chloride, polypropylene and polystyrene, has the propensity to become rapidly colonized by micro-organisms (mainly Candida albicans) forming a biofilm, which leads to the failure of the devices. Silicone is used within voice prosthetic devices because of its flexible properties, which are essential for valve function. Valve failure, as well as compromising speech, may result in aspiration pneumonia, and repeated valve replacement may lead to either tract stenosis or insufficiency. Prevention and control of biofilm formation are therefore crucial for the lifespan of the prosthesis and promotion of tracheoesophageal tissue and lung health. To date, the mechanisms of biofilm formation on voice prostheses are not fully understood. Further studies are therefore required to identify factors influencing Candida biofilm formation. This review describes the factors known to influence biofilm formation on voice prostheses and current strategies employed to prolong their life by interfering with microbial colonization.

Office-based tracheoesophageal puncture: Updates in techniques and outcomes

PurposeTracheoesophageal puncture (TEP) is an effective rehabilitation method for postlaryngectomy speech and has already been described as a procedure that is safely performed in the office. We review our long-term experience with office-based TEP over the past 7years in the largest cohort published to date. Materials and MethodsA retrospective chart review was performed of all patients who underwent TEP by a single surgeon from 2005 through 2012, including office-based and operating room procedures. Indications for the chosen technique (office versus operating room) and surgical outcomes were evaluated. ResultsFifty-nine patients underwent 72 TEP procedures, with 55 performed in the outpatient setting and 17 performed in the operating room, all without complication. The indications for performing TEPs in the operating room included 2 primary TEPs, 14 due to concomitant procedures requiring general anesthesia, and 1 due to failed attempt at office-based TEP. Nineteen patients with prior rotational or free flap reconstruction successfully underwent office-based TEP. ConclusionsTEP in an office-based setting with immediate voice prosthesis placement continues to be a safe method of voice rehabilitation for postlaryngectomy patients, including those who have previously undergone free flap or rotational flap reconstruction. Office-based TEP is now our primary approach for postlaryngectomy voice rehabilitation.

Stimmrehabilitation nach Laryngektomie

Laryngeal and hypopharyngeal carcinomas are among the most common malignant tumours of the head and neck region, accounting for about 3,000 new cases per year. Despite enormous advances in organ preservation surgery and chemoradiotherapy, total laryngectomy is still necessary in approximately one quarter of affected patients. The removal of the larynx results in the loss of 3 important functions, i. e., voice production, the air conditioning mechanism of the nose, and the ability to smell. Whereas voice rehabilitation has been a mainstay of treatment from the very beginning of laryngeal surgery, pulmonary and olfactory rehabilitation has received increasing attention only in the past 2 decades. Today every head and neck surgical oncologist should be familiar with the various methods of voice rehabilitation and the use of heat and moisture exchangers for air conditioning. The objective of this article is to provide an overview of current methods of rehabilitation after total laryngectomy and to introduce young surgeons with an interest in voice rehabilitation to available techniques.

Tracheoesophageal Voice Prosthesis Outcomes: Success or Insucess?

Introduction: Total laryngectomy/pharingo-laryngectomy is a potentially aggressive surgery for advanced laryngeal/hypopharyngeal carcinomas, which results in important physical and functional changes that compromise some of the most vital functions, including speech communication. For these patients, tracheoesophageal speech is considered to be the gold standard for voice rehabilitation. Objectives: The purpose of the present study was to determinate the success rate of voice prosthesis rehabilitation, voice prosthesis lifetime and the rate of complications, and its related clinicopathologic factors. Material and Methods: Retrospective review of 92 patients who undergone tracheoesophageal puncture (TEP) performed between January 2007 and December 2012 at the Francisco Gentil Portuguese Institute of Oncology of Oporto. Age, primary disease, staging, the extent of surgical resection, radiotherapy treatment, timing of TEP, surgical and prosthesis-related complications were noted. The impact of these clinicpathological factors on functional outcome, complications of TEP and lifetime of prosthetic valves was assessed in univariate analysis. Vocal rehabilitation efficacy with voice prosthesis was assessed with the multidimensional Harrison-Robillard Shultz (HRS) Rating Scale. Lifetime of voice prosthesis and early and late complications were recorded. Results: A total of 83 patients met the study criteria, predominantly males (94%) with a mean age of 63.7 years. 77% of the patients underwent primary and 23% secondary TEP. 68.7% of patients achieved functional tracheoesophageal speech (HRS score ≥ 10), 67.2% had performed primary TEP and 73.7% had performed secondary TEP. The mean device lifetime was 9.8 months for voice prosthesis. Prosthesis-related complications occurred in 81% of the patients and the most common issues were prosthesis leakage (76%) and displacement (22%). The most common surgical-related problem was a large and deep tracheostoma. Conclusions: Our success rate of voice rehabilitation was comparable to that reported in published literature with a satisfactory median device lifetime. Because of its safety and simplicity, tracheoesophageal puncture is considered to be an effective method for voice rehabilitation after total laryngectomy.

Practice of laryngectomy rehabilitation interventions

To provide a perspective of contemporary practice in rehabilitation of speech and swallowing in patients undergoing total laryngectomy in Australia. In Australia, the preferred method of voice rehabilitation is by the use of tracheo-oesophageal voice prosthesis. Dysphagia is an ongoing problem and the use of adjuvant radiation and chemotherapy compounds this problem. There are difficulties associated with surgery because of the variation in disease involvement of pharyngeal mucosa and musculature, as well as difficulties associated with healing in previously chemoradiated surgical fields. This article demonstrates the need for careful consideration of surgical technique, particularly in closure of the neopharynx in the chemoradiated patient. It encourages further research into the problems of speech and particularly swallowing in this patient population, as these problems impact significantly on the quality of life.

Przyczyny i czas pomiędzy kolejnymi wymianami protez głosowych u chorych po laryngektomii – analiza 184 wymian u 42 chorych

IntroductionImplantation of the indwelling voice prosthesis has become the preferred method of voice rehabilitation after total laryngectomy. Frequent prosthesis dysfunction remains the major problem. AimAnalysis of the indwelling time and indications for multiple voice prosthesis replacements. MethodsForty two patients after total laryngectomy due to laryngeal cancer (6 women and 36 men, mean age 62.1±6.7 years) were included. 184 voice prosthesis replacements were analyzed (1271 patient-months). ResultsMean time between replacements was 260±150 days. The indwelling time decreased from 267 days to the first replacement to 100–160 days at eighth and subsequent exchanges (p<0.01). Most frequent indications for replacement were leakage of fluids through the prosthesis, phonation problems caused by mucosal overgrowth around the prosthesis, inaccurate sizing, deformation, and spontaneous extrusion. The lifetime of voice prostheses was positively correlated with patients’ age. Mycological culture of the smear taken from tracheoesophageal fistula at first replacement was positive in 34/41 cases, at the second in 29/31 cases, the third in 29/31, and at the fourth and subsequent replacements in all specimens. Most patients indicated the following factors as possible causes of a shortened lifetime of the prosthesis: use of alcohol and coffee (34% of responders), inappropriate dietary habits (sweets and tough foodstuff – 17%), cleaning of voice prosthesis discordant with the recommendations of the manufacturer (14%). ConclusionsAlthough our results confirm common indications for voice prosthesis replacement we also showed that the time between exchanges is gradually getting shorter. This observation could have implications for the current reimbursement practices.

Voice‐related quality of life (V‐RQOL) outcomes in laryngectomees

Laryngeal cancer has a significant impact on patients. This study compared the Voice-Related Quality of Life (V-RQOL) outcomes specific to 3 different postlaryngectomy voice rehabilitation methods. We conducted a retrospective review of 75 patients with laryngectomy from our V-RQOL questionnaire database. The database included 18 electrolaryngeal speech (ELS), 15 esophageal speech (ES), and 42 tracheoesophageal speech (TES) patients. Pairwise comparisons of V-RQOL outcomes showed that TES was perceived to be better than ELS (p < .001). ES was perceived as better than ELS, but this was driven by a difference in the total and social-emotional V-RQOL scores (p < .05). There was no difference between TES and ES groups. Only ELS showed a positive correlation with time after surgery and older age. Patients using TES had similar V-RQOL outcomes compared to ES and both performed significantly better than ELS. For ELS, the total V-RQOL score was better with longer time after surgery and older age.

Analysis of Pepsin in Tracheoesophageal Puncture Sites

Tracheoesophageal puncture (TEP) and prosthesis insertion is a well-established method of voice rehabilitation after laryngectomy. Maintenance of the prosthesis and tract can be challenging, and reflux to the TEP site has been proposed as a cause. The sites of TEP were evaluated for the presence of pepsin in tissue biopsy specimens and tract secretions to explore this association. Patients with TEP were interviewed for a history of symptoms related to reflux, medication use history, TEP voice quality, and incidence of TEP complications. Tissue biopsy specimens and tract secretions were obtained from TEP sites and analyzed for the presence of pepsin via sodium dodecyl sulfate-polyacrylamide gel electrophoresis Western blot analysis. Twelve of 17 patients (47%) had some history of preoperative or postoperative symptoms of gastroesophageal reflux disease or laryngopharyngeal reflux. Pepsin was present within the TEP site in a total of 10 of 17 patients (58%; 7 of 17 tissue biopsy specimens and 6 of 7 secretion samples). There were no statistically significant associations between the presence of pepsin and sex, reflux history, use of acid suppressive medicine, or time since laryngectomy. Reflux with subsequent pepsin deposition into the TEP tract occurs in a majority of laryngectomy patients. Further studies on the effect of reflux on the health and function of the TEP tract are warranted.

Primary tracheoesophageal puncture using carbon dioxide laser

Primary tracheoesophageal puncture (TEP) is now considered to be the preferred method for voice rehabilitation after laryngectomy . The traditional method of creating a puncture with a no. 11 stab knife often leads to an eccentric puncture with irregular ragged margin, leading to scarring in the future. In this report we describe the innovative way of creating a TEP using a carbon dioxide (CO(2)) laser. This novel method of using a laser for the creation of a precise TEP could, perhaps, influence peri-prosthetic leakage and lead to better voice rehabilitation for patients that have undergone laryngectomy.