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Results of rehabilitation of voice and speeches after implantation of valve vocal prosthesis at ill after total removal of larynx

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Ratajczak J., Wojdas A., Jurkiewicz D.
Otolaryngologia Polska
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2008
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vol. 62(6)
727-730
EN
Ill applying with extensive infi ltration of new-growth within of larynx will demand radical therapeutic procedure, which is operation completely removals of organ. Aim of work was estimation of voice and speeches ill with vocal fi stula in comparison with oesophageal voice and speech and with physiological. With research one embraced 81 men in age 42–75 of years. Group I – 32 ill with cancer of larynx, to which executed total laryngectomy and placed the voice prosthesis Provox 2. Group II – 30 ill after operation total removals of larynx, whiches used oesophageal speech. The control group III – 19 persons with physiological voice. Research one began from subjective estimation of replacement voices. Then one executed measurements maximum phonation time of vowel „a”. To objective estimation of voice one used polish programme „IRIS”. One compared: maximum intensities of voices for colloquial speech, F0, Jitter, Shimmer and NHR. In subjective estimation voice of the patients with voice prostheses was greater freedom of production and voice of the patients with voice prostheses appeared to be more loud in relation to oesophageal voice. Greatest statistical essential differences one obtained between maximum phonation times of vowels „a” where clearly is visible, that values obtained for voices of the patients with voice prostheses are to nearer values for physiological voices. Obtained averages values of acoustic analysis: F0, Jitter, Shimmer and NHR did not show statistical of essential differences between voices supplementary, though parameters of voice of the patients with voice prostheses one was to nearer parameters of physiological voice. Characterization perceptive and acoustic speech of the patients with voice prostheses in comparison with oesophageal speech is to nearer characterization of physiological speech. Lack of satisfactory effects of rehabilitation of oesophageal speech, should be effective secondary implantation vocal prosthesis.
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Rehabilitation after total laryngectomy – vision and realization

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Betlejewski S., Ossowski R., Sinkiewicz A.
Otolaryngologia Polska
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2007
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vol. 61(3)
344-348
EN
Universality, early initiation, complexity and continuity – should be the main attributes of rehabilitation in patients after laryngectomy. The authors discuss the problem of universality and accessibility of rehabilitation in Poland. A great role in realization of this attributes played since 20 years the Polish Society of Laryngectomees. Till now the governmental help and the participation of the National Health Fund for the patients after laryngectomy is very limited. The early rehabilitation should be started before the operation and a particular note must be taken to the patient’s changed vital situation after the surgical treatment. The complexity of the rehabilitation must cover the whole spectrum of rehabilitation; it means voice and speech therapy, the improvement of respiratory system function, the problems of respiratory air conditioning and the psychological as well as social psychological aspects. The authors describe a model of such a complex rehabilitation that can be provided in health resorts. In the postoperative period the role of the laryngectomee clubs and associations is very important to assure the continuity of rehabilitation.
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Dysphagia among patients after total laryngectomy: diagnostic and therapeutic procedures

63%
Jamróz B., Chmielewska-Walczak J., Milewska M.
Polski Przegląd Otorynolaryngologiczny
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2020
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vol. 9(4)
23-28
EN
Dysphagia concerns 10–89% patients after total laryngectomy; to a greater extent it regards patients receiving complementary radiotherapy. The disease mechanism is associated with anatomical changes after surgery (typeof surgery) or complications of adjuvant therapy (xerostomia, neuropathy, swelling of tissue, etc.). The above changes lead to: decreased mobility of the lateral walls of the pharynx and tongue retraction, the occurrence of tounge pumping movements, decreased swallowing reflex, weakening of the upper esophageal sphincter opening, contraction of the cricopharyngeal muscle, tissue fibrosis, formation of pharyngeal pseudodiverticulum, etc. As a result: regurgitation of food through the nose and oral cavity, food sticking in middle and lower pharynx, prolongation of bolus transit time. Upon the formation of tracheoesophageal fistula, there may be aspiration of gastric contents. The above changes considerably reduce patients’ quality of life after surgery. The diagnostic protocol includes: medical interview (questionnaires such as EAT 10, SSQ, MDADI, DHI can be helpful), clinical swallowing assessment and instrumental examinations: primarily videofluoroscopy but also endoscopic evaluation of swallowing. Selected cases also require high frequency manometry. The treatment options include: surgical methods (e.g. balloon dilatation of the upper esophageal sphincter, cricopharyngeal myotomy, pharyngeal plexus neurectomy, removal of the pharyngeal pseudodiverticulum), pharmacological treatment or conservative methods (e.g. botulinum toxin injection of the upper esophageal sphincter, speech therapy, nutritional treatment) and supportive methods such as consultation with a psychologist, physiotherapist, clinical dietitian). The selection of a specific treatment method should be preceded by a diagnostic process in which the mechanism of functional disorders related to voice formation and swallowing will be established.
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