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The surgery voice rehabilitation after total laryngectomy with the Provox system

100%

Bilewicz R., Burduk P. K., Kopczyński A., Wierzchowska M.

The aim of study. Comparison the voice quality of patients after total laryngectomy using the Provox 2 voice prosthesis and patients with esophageal speech and to discuss difficulties and complications related with its implantation. Material and methods. The study group consists of 39 patients after total laryngectomy and Provox puncture. 36 patients underwent primary puncture, 3 patients – secondary puncture. 32 patients underwent radiotherapy. The time starting of speech learning was approx the 9th day after total laryngectomy and 1st-3th day after secondary implantation. The authors subjectively and objectively analyzed voice of 34 patients with fistular speech and it compared with esophageal speech of 10. The spectrograms analysis of the voice was based on Remacle’s scale. The study showed juxtaposition of early and late complications of patients with voice prostheses. Results. 90% of patients (35 patients) learned the fistular speech. The speech was louder and more intelligible than esophageal voice in subjective estimation. The fistular voice had higher of mean volume (61,1 dB vs. 59 dB), mean longer maximum phonation time (9,5 s vs. 2,2 s), mean higher base frequency F0 (108 Hz vs. 87Hz) and smaller variability of F0 based on mean Jitter ratio (3,8% vs. 6,6%), mean Shimmer ratio (23,18% vs. 23,52%) and mean HPQ ratio (127,34 vs. 141,73) than esophageal voice in objective estimation. Mean range of frequency of the speech was smaller but it was in higher frequencies. The most frequent type of spectrogram was 3th type in experimental group and 2nd type in control group. The mean lifetime of prostheses was 295 days. The most common cause of replacement of the prosthesis was leakage associated with mycosis infection (26 cases). Early complications were observed. The most frequent of them was infection around the fistula during supplementary radiotherapy (7 cases after primary puncture). The most frequent of later complications was widening of fistula and leakage around prosthesis (4 cases). Conclusions. Rehabilitation of patients after total laryngectomy is better using Provox system than learning esophageal speech (according to voice quality aspect). Using of voice prostheses in patients after total laryngectomy can combine with appearance of complications.

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

80%

Ratajczak J., Wojdas A., Jurkiewicz D.

Otolaryngologia Polska

2008

vol. 62(6)

727-730

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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2 Otolaryngologia Polska

2 2018

1 Bilewicz R.

1 Burduk P. K.

1 Jurkiewicz D.

1 Kopczyński A.

1 Ratajczak J.

1 Wierzchowska M.

1 Wojdas A.

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The surgery voice rehabilitation after total laryngectomy with the Provox system

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