An experimental model of the pharyngoesophageal segment in tracheoesophageal phonation.

Tracheoesophageal (TE) speech is an important method of speech rehabilitation for those who undergo a total laryngectomy. Despite the many advantages over other methods, there is still room for improvement in terms of the overall quality of the TE voice as well as its success rate. These points could be greatly assisted by an improved knowledge on the mechanics of TE speech. Here, an experimental model of the pharyngoesophageal segment (PES), based on the idea of a collapsible tube, is proposed. To implement the model, considerable simplifications had to be made, most notably in the use of a thin flexible tube to represent the PES. The model was used to assess the minimum amount of tonicity required for the onset of phonation in terms of the flow rate and longitudinal tension. Additionally, comparisons with a mathematical model [Tourinho, da Silva, dos Santos, Thomaz, and Vieira, J. Acoust. Soc. Am. 149, 1979-1988 (2021)] have been made, yielding similar trends for sufficiently large flow rates. The measurements also suggest that the phonation frequency is most affected by the tonicity of the PES, which highlights the question of which physiological mechanism is responsible for the control of the fundamental frequency of phonation.

Voice Restoration and Quality of Life in Larynx Cancer.

Voice restoration following laryngectomy has a significant influence on quality of life (QOL). Three main techniques exist to provide voice: esophageal speech (ES), artificial larynx (electrolarynx [EL]), and tracheoesophageal puncture (TEP). Although the EL was historically the most used technique, TEP has quickly become the gold standard. ES remains the least frequently used technique in developed countries. Technique selection must be made on an individual basis, considering the patient's cancer history and comorbidities. Ultimately, the choice in voice-restoration technique requires joint decision making with the surgeon, speech pathologist, and patient.

Factors contributing to clinician training and development in the clinical area of laryngectomy and tracheoesophageal voice.

BACKGROUND: It has long been recognized that tracheoesophageal speech (TES) rehabilitation after laryngectomy is a specialized area of practice for speech and language therapist (SLTs) due to the complex nature of patient presentation and the invasive components of the SLT's role in this area. Therefore, postgraduate experience and training is required to work competently and safely in this clinical area. However, it is generally acknowledged that the steps and processes followed by individual clinicians to achieve this training and clinical skill development are inconsistent and vary widely across services. There is a need to identify critical elements deemed most beneficial to clinical skill development in order to inform future training models. AIMS: To explore clinicians' perceptions of factors that contribute to training and clinical skills development in the area of TES rehabilitation post-laryngectomy. METHODS & PROCEDURES: All participants were SLTs working in an Australian clinical service, with a current or recent clinical caseload that included patients using TES. A total of 36 SLTs were recruited and then grouped by level of experience (novice n = 15, intermediate n = 7, experienced n = 14). Each participant took part in one small focus group with other participants of similar experience level. Ten focus groups were conducted, each of approximately 60 min in duration. A semi-structured interview guide was used to facilitate the discussion of issues relating to training in this area. Thematic analysis was used to analyse transcripts and identify themes. OUTCOMES & RESULTS: Interviews identified six key themes, including: Learning with and from others; Formal programmes; Hands-on learning; Processes that influence training; and Individual influences. SLTs reported both positive issues and elements that were challenging across all five themes. The final (sixth) theme was identified regarding clinician perceptions of how this area differed to specialized training in other areas of the profession. The majority of themes were discussed equally by clinicians across all three experience levels. CONCLUSIONS & IMPLICATIONS: Participants across all experience levels identified that multiple factors contributed to clinicians successfully gaining skills, understanding and competency when working in TES rehabilitation post-laryngectomy. These factors, when fully considered and incorporated into future SLTs training pathways and opportunities, have the potential to optimize competency, skill acquisition and maintenance in this area. What this paper adds What is already known on this subject While studies have considered the training, preparation and knowledge base of SLTs working in the clinical area of TES, the focus has predominantly been at the immediate postgraduate level or assessment of university course work. No studies have used a qualitative methodology to consider the reflections and perceptions of clinicians' training pathways and training needs across all levels of experience for this clinical area. What this paper adds to existing knowledge The results of this study build upon the existing body of literature regarding education and training in this area, determining factors SLTs feel are required to successfully gain skills, understanding and competency when working in TES rehabilitation. The findings highlight that training pathways and methods in this clinical area are an ongoing consideration for SLTs regardless of experience level and have the ability to impact on future competency programmes, training opportunities and delivery methods in this area. What are the potential or actual clinical implications of this work? Effective and ongoing postgraduate training programmes and professional development opportunities have the potential to positively impact on professional competence and confidence, patient safety and overall service delivery. Hence, the themes generated from this research highlight essential factors to include within training and professional development programmes for SLTs in TES rehabilitation. This information can be used to help optimize current training pathways for all experience levels.

Influence of Collective Esophageal Speech Training on Self-efficacy in Chinese Laryngectomees: A Pretest-posttest Group Study.

Total laryngectomy affects the speaking functions of many patients. Speech deprivation has great impacts on the quality of life of patients, especially on self-efficacy. Learning esophageal speech represents a way to help laryngectomees speak again. The purpose of this study was to determine the influence of collective esophageal speech training on self-efficacy of laryngectomees. In this study, 28 patients and 30 family members were included. The participants received information about training via telephone or a WeChat group. Collective esophageal speech training was used to educate laryngectomees on esophageal speech. Before and after collective esophageal speech training, all participants completed the General Self-Efficacy Scale (GSES) to assess their perceptions on self-efficacy. Through the training, laryngectomees recovered their speech. After the training, the self-efficacy scores of laryngectomees were higher than those before the training, with significant differences noted (T<0.05). However, family members' scores did not change significantly. In conclusion, collective esophageal speech training is not only convenient and economical, but also improves self-efficacy and confidence of laryngectomees. Greater self-efficacy is helpful for laryngectomees to master esophageal speech and improve their quality of life. In addition, more attention should be focused on improving the self-efficacy of family members and making them give full play to their talent and potential on laryngectomees' voice rehabilitation.

Integrated rehabilitation after total laryngectomy: a pilot trial study.

BACKGROUND: Acquisition and acceptance of the alaryngeal voice, psychological state, and Quality of Life (QoL) of laryngectomized patients. METHODS: Thirty-two patients who underwent total laryngectomy were included in the study; 17 of them were treated by a psychologist and a speech therapist (experimental group); 15 performed only speech therapy (control group). RESULTS: The experimental group showed a significant improvement in all parameters of the INFVo scale, in the score of the Environment subscale and in the total score of the I-SECEL (Self-Evaluation of Communication Experiences after Laryngeal Cancer); in the Depression, Obsession-Compulsion and Paranoia areas of the SCL-90-R (Symptom Check List-90-Revised); and in the Social area (REL) of the WHOQOL-B (World Health Organization Quality of Life Scale-Brief). CONCLUSIONS: An integrated rehabilitative approach to laryngectomized patients improves emotional state and psychosocial aspects and promotes acceptance and use of the new voice and recovery of a better quality of life.

Laringe eletrônica para reabilitação vocal de pacientes submetidos à laringectomia total / Electronic larynx for vocal rehabilitation of patients submitted to total laryngectomy

CONTEXTO: Este PTC tem por objetivo avaliar as evidências científicas atualmente disponíveis acerca da eficácia e segurança da laringe eletrônica na reabilitação da fala em pacientes laringectomizados. O câncer de laringe faz parte do conjunto de neoplasias malignas de diferentes localizações que compõem o carcinoma epidermóide de cabeça e pescoço (CECP), representando 25% destes tumores. Ocorre predominantemente em homens, sendo esperados 6.360 novos casos neste grupo, e 990 casos em mulheres, segundo estimativas do INCA para 2016. Nos tumores avançados de laringe, a cirurgia de retirada total do órgão é necessária, a denominada laringectomia total. Como consequência, o indivíduo perde a capacidade de fala, causando prejuízo para a qualidade de vida do paciente. A reabilitação fonatória integral é fundamental para que estes indivíduos possam retornar ao convívio social e profissional de forma satisfatória. A laringe eletrônica (eletrolaringe) é um equipamento eletrônico movido a bateria recarregável tipo bastão vibrador, portátil, leve e de fácil utilização e aprendizagem. O paciente pressiona o equipamento na região submandibular ou na porção mediana do pescoço (papada) e aciona o botão para emissão do som. Ele emite uma vibração sonora contínua, que é transmitida ao ressonador buconasofaríngeo, e pelos órgãos articuladores, como lábios, língua e dentes, é transformada em palavra falada. Uma das desvantagens do seu uso, em relação às demais opções terapêuticas seria o fato do equipamento produzir um som contínuo, monótono, com tonalidade robótica e sem inflexões de sentimento. Seu uso também requer o uso de uma das mãos, de forma alternada para não cansar muito os braços. Por outro lado, suas vantagens incluiriam maior facilidade de aprendizado pelos pacientes e não requerer cirurgia para sua colocação inicial ou substituição frequente (como a prótese traqueoesofágica). TECNOLOGIA E INDICAÇÃO: Laringe eletrônica - Neoplasia maligna da laringe (CID-10 C32). PERGUNTA: O uso da laringe eletrônica é eficaz, seguro e custo-efetivo em pacientes com câncer de laringe submetidos à laringectomia total, quando comparado às demais técnicas de reabilitação da voz (prótese traqueoesofágica ou voz esofágica)? EVIDÊNCIAS CIENTÍFICAS: Foi realizada pelos pareceristas uma busca nas bases de dados Medline e Embase por estudos que avaliassem desfechos como qualidade de vida e auditivos-perceptivos. As evidências e recomendações foram classificadas seguindo a recomendação GRADE. Foram selecionados para análise 15 estudos para extração dos resultados, os quais aplicaram metodologias e desfechos muito diversos. Desta forma, destes foram selecionados apenas os desfechos principais relacionados à qualidade de vida (V-RQOL, VHI, QLQ-C30) e perceptivos (inteligibilidade e aceitabilidade da fala). Os resultados, de uma maneira geral, não apontaram para melhor qualidade de vida percebida pelo grupo de pacientes com laringe eletrônica, em relação aos demais grupos. Também não foi observado melhor desempenho da tecnologia em termos perceptivos. A quase totalidade dos estudos são do tipo transversal, e possuem tamanho de amostra muito pequeno para que se possa inferir conclusões decisiva em relação à melhor performance de alguma das tecnologias em detrimento das demais. QUALIDADE DAS EVIDÊNCIAS: a qualidade das evidências foi classificada como de muito baixa qualidade. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO INCREMENTAL: o impacto orçamentário incremental estimado para cinco anos (2018 a 2022) aponta para um incremento nos custos com a incorporação da laringe eletrônica da ordem de R$ 10,3 milhões a R$ 31,7 milhões em 5 anos, dependendo da oferta da tecnologia (oferta limitada aos pacientes em casos de falha nas outras duas técnicas ou oferta a todos os pacientes, respectivamente), ou de economia de recursos da ordem de R$ 3,5 milhões no caso da oferta como opção à prótese traqueoesofágica após falha na reabilitação por voz esofágica. CONSIDERAÇÕES FINAIS: O balanço entre a qualidade das evidências disponíveis e os benefícios demonstrados é fraca a favor da incorporação do equipamento laringe eletrônica, frente à qualidade das evidências disponíveis, sem evidências suficientes em relação ao melhor desempenho da tecnologia quando comparada à prótese traqueoesofágica ou voz esofágica, seja em termos de qualidade de vida e desempenho ou de inteligibilidade e aceitabilidade da voz. Considerando um cenário de alto índice de falhas da voz esofágica, onde menos da metade dos pacientes têm sucesso com a técnica, que prepondera no cenário nacional, e considerável proporção de falha da prótese traqueoesofágica, prover aos pacientes uma alternativa de fácil uso à completa afonia, parece ser factível e importante para esses pacientes, frente ao impacto estimado para esta alternativa. RECOMENDAÇÃO: FRACA a favor da incorporação, para a reabilitação dos pacientes laringectomizados RECOMENDAÇÃO INICIAL DA CONITEC: Os membros do plenário presentes na 65ª Reunião da CONITEC em 05 de abril de 2018 recomendaram por unanimidade que a matéria fosse submetida à consulta pública com recomendação favorável à incorporação, mediante elaboração de fluxo de utilização em relação às demais opções de tratamento. CONSULTA PÚBLICA: A consulta pública nº 22, de 23 de maio de 2018, foi realizada no período de 25 de maio a 13 de junho de 2018. Foram recebidas 562 contribuições, sendo 444 do formulário "experiência ou opinião" e 118 do formulário "técnico-científico". Após a apreciação das contribuições encaminhadas pela consulta pública, o plenário da CONITEC entendeu que não houve argumentação suficiente para alterar sua recomendação inicial, mantendo-se a recomendação favorável à incorporação da laringe eletrônica para a reabilitação vocal após laringectomia total, mediante elaboração de fluxo de utilização em relação às demais opções de tratamento. RECOMENDAÇÃO FINAL DA CONITEC: Os membros da CONITEC presentes na 68a reunião ordinária, no dia 04 de julho de 2018, deliberaram, por unanimidade, recomendar a incorporação ao SUS da laringe eletrônica para neoplasia maligna da laringe. Foi assinado em 04/07 o registro de deliberação n° 354/2018 pela incorporação da tecnologia ao SUS. DECISÃO: Incorporar a laringe eletrônica para neoplasia maligna da laringe no âmbito do Sistema Único de Saúde ­ SUS, dada pela Portaria nº 39 de 11 de setembro de 2018, publicada no DOU 12/09/2018.

Electrophysiological activity of the pharyngoesophageal transition of total laryngectomees.

OBJECTIVES/HYPOTHESIS: To determine the association of the electrophysiological activity of the pharyngoesophageal transition with tracheoesophageal speech proficiency in total laryngectomees. STUDY DESIGN: An observational (nonexperimental) study of the correlation type with a descriptive approach. METHODS: Thirty-four individuals (26 males), average age 62.5 years, total laryngectomees rehabilitated with the use of a tracheoesophageal prosthesis, were assessed for tracheoesophageal speech proficiency using an adapted protocol and classified as good, moderate, or poor speakers. Next they were submitted to electromyography of the muscles of the pharyngoesophageal transition with a needle electrode. The area to be examined was located by videofluoroscopy. Electromyographic analysis was characterized as normal, neurogenic injury (moderate to severe, severe, severe to total), myopathic injury, or inconclusive. The Fisher exact test was used to determine the association between the speech proficiency variables and electromyography. RESULTS: in the final rating of tracheoesophageal speech proficiency, most laryngectomees were categorized as moderate (n = 24) and a few as good (n = 3). Electromyography revealed neurogenic injury in all laryngectomees, which was severe in most cases (n = 20), followed by severe to total (n = 10), and moderate to severe injury (n = 4). There was no significant association between he electromyographic analyses of neurogenic injuries and tracheoesophageal speech proficiency. CONCLUSIONS: Whether or not the musculature of the pharyngoesophageal transition of tracheoesophageal speakers had a preserved motor unit, did not prevent voice acquisition and was not associated with tracheoesophageal speech proficiency. However, further studies are needed in this area. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:1369-1375, 2017.

Enhancement of Spanish Oesophageal Speech vowels using coherent subband modulator Kalman filtering.

This paper proposes an Oesophageal Speech (OES) enhancement method, based on Kalman filtering. The Kalman filter is applied to modulators of OES frequency subbands instead of the fullband signal. The OES frequency subbands are decomposed into modulators and carriers components using coherent demodulation. In comparison with fullband Kalman filtering and pole stabilization, the proposed technique shows better results. The system performance is evaluated objectively and subjectively using the Harmonic to Noise Ratio (HNR) and Mean Opinion Score (MOS) respectively. Results have shown that Kalman filter in subband modulators processing is robust and efficient, improving the HNR by 4 to 5 dB for all Spanish vowels.

Novel esophageal speech therapy method in total laryngectomized patients: biofeedback by intraesophageal impedance.

The loss of the best communication port after total laryngectomy surgery makes speech rehabilitation an important goal. Our aim was to improve the quality of esophageal speech (ES) using online esophageal multichannel intra-luminal impedance (MII) as a new biofeedback method. Twenty-six total laryngectomized patients were included. Before ES therapy, an esophageal motility test was carried out. MII catheters were placed in all subjects who were then randomized into two groups. Group 1 included 13 cases, who were retrained according to the classical method. Group 2 included 13 cases, who were retrained according to the simplified animation of air movements within the esophagus and upper stomach resulting from the modifications of intra-esophageal air kinetics gained by MII. The level of speech proficiency was evaluated relative to pretraining levels using perceptual scales in the third and sixth months. Acoustic voice was analyzed. The number of syllables read per minute and the intelligibility of monosyllabic and dissyllabic words were calculated. In this study, MII was used for the first time in alaryngeal speech rehabilitation as a biofeedback method; an overall sufficient speech level was achieved by 68.4% at the end of therapy, whereas attendance was 90%. A statistically significant improvement was found in both groups in terms of ES level compared with the pretraining period although there was no significant difference between groups. Although we did not observe the expected difference between groups suggested by our hypothesis, MII may be used as an objective tool to show patients how to swallow and regurgitate air during training, and may thus expedite ES therapy both for the speech therapist and the patient in the future.

Voice Restoration After Total Laryngectomy.

The ability to speak and communicate vocally is a unique human characteristic that is often taken for granted but is fundamental to many activities of daily living. Loss of voice after total laryngectomy can lead to a serious decrease in quality of life and can precipitate significant frustration over the inability to communicate effectively. There are 3 main methods of voice restoration: esophageal speech, usage of the electrolarynx, and tracheal-esophageal puncture for tracheal-esophageal speech, which can be performed primarily or secondarily. Although all 3 methods have potential benefits, the gold standard is tracheal-esophageal speech.

Harmonic to noise ratio improvement in oesophageal speech.

BACKGROUND: This manuscript presents oesophageal speech enhancement. Patients who have undergone a laryngectomy as a result of larynx cancer, that is, laryngectomees, have communication problems. Due to removal of the larynx, oesophageal speech has extremely low intelligibility. OBJECTIVE: Thus, it is necessary to process acoustical parameters, such as Harmonic to Noise Ratio (HNR) in order to increase intelligibility. METHODS: The research focused on oesophageal Spanish /a/ phoneme improvement. In order to enhance oesophageal speech two techniques were applied: Kalman filtering and an algorithm which stabilizes the vocal tract poles. Speech enhancement was measured using the MDVP tool. The oesophageal voice database was compiled with the help of the local association of laryngectomees. RESULTS: The results show an average improvement of 4.2 dB in the HNR. Statistically, differences on average between the original and processed voices, (p < 0.001) for HNR parameter were proven to be significant and we therefore conclude that voice quality was improved due to evidence of a higher HNR on average. CONCLUSIONS: As a conclusion, the study confirms oesophageal voice enhancement since speech parameters are closer to the normal average range. Subjectively, the oesophageal breathing noise is reduced substantially, as is reflected in the MOS test.

Investigation of intra-esophageal air kinetics and esophageal sphincters in patients with total laryngectomy during esophageal speech.

The purpose of this study was to evaluate the air kinetics of well- and poor-speaking patients and their upper (UES) and lower (LES) esophageal sphincter pressures . The esophageal speech capability of 23 total laryngectomy patients was assessed with the Wepman scale. LES and UES points and pressures were measured, and air kinetics were compared. All patients were male, with an average age of 58 years. Both the LES and UES pressures were not statistically different between good-speaking and poor-speaking patients (p > 0.05). The ability to speak was estimated only by looking at tracings. Good speakers are able to retain air successfully and on a long-term basis between the upper and lower esophageal sphincters. During short and/or rapid speech, these patients are able to rapidly suck and then expel the air from their upper esophagus. During long speeches, after sucking the air into their distal esophagus, they used the air in the upper part of the esophagus during the speech, only later seeming to fill the lower esophagus with the air as a possible reserve in the stomach. It has been shown that the basic requirement for speaking is the capacity to suck and store the air within the esophagus. For successful speech, the air should be stored inside the esophagus. MII technology contributes to our understanding of speech kinetics and occupies an important place in patient training as a biofeedback technique.

Predictive value of esophageal motility test in the proficiency of esophageal speech.

One method of speech rehabilitation following total laryngectomy surgery is esophageal speech therapy (EST). In this method, which has witnessed relatively low success rates at the end of therapy, identification of patients who can benefit from EST beforehand will be important for determining the appropriate method for alaryngeal speech rehabilitation and might be cost-effective, saving time and labor. To this end, this study conducted research on the feasibility of manometric data measured prior to therapy using an esophageal motility test (EMT) in order to determine the candidates most suitable for esophageal speech (ES) beforehand. A total of 51 total laryngectomy male patients who had never been subject to any kind of speech rehabilitation and had always been articulate were included in the study. Data were collected from 44 patients who completed EST, lasting for 6 months in total and consisting of 11 sessions. Manometric measures were obtained through EMT using a water-perfusion system with a Dent sleeve catheter on the patients prior to the therapy. Wepman's scale was used in order to evaluate ES proficiency. Following the therapy, in accordance with this scale, while patients whose scores was 1, 2, or 3 were considered as adequate, those whose scores were 4, 5, 6, or 7 were considered inadequate and were divided into two groups. Manometric correlations were analyzed between 17 patients (group I) who were able to perform ES at an adequate level and 27 patients (group II) who could not. No statistically significant difference between the groups could be observed in terms of average pressure generated within the upper and lower esophageal sphincters obtained through EMT, peak amplitude of esophageal body contraction pressure, contraction duration time, onset velocity, or peak velocity values. EMT conducted prior to application of EST to total laryngectomized patients did not have any value in determining the level of ES that a patient could reach. Our results also suggest that sphincter pressures or esophageal motility patterns do not have any predictive value and should not be performed.

Optimal subband Kalman filter for normal and oesophageal speech enhancement.

This paper presents the single channel speech enhancement system using subband Kalman filtering by estimating optimal Autoregressive (AR) coefficients and variance for speech and noise, using Weighted Linear Prediction (WLP) and Noise Weighting Function (NWF). The system is applied for normal and Oesophageal speech signals. The method is evaluated by Perceptual Evaluation of Speech Quality (PESQ) score and Signal to Noise Ratio (SNR) improvement for normal speech and Harmonic to Noise Ratio (HNR) for Oesophageal Speech (OES). Compared with previous systems, the normal speech indicates 30% increase in PESQ score, 4 dB SNR improvement and OES shows 3 dB HNR improvement.

The Amatsu's tracheoesophageal shunt: analysis of 84 cases.

INTRODUCTION: Amatsu's tracheoesophageal shunt can be indicated for vocal rehabilitation in candidates to total laryngectomy. It is performed in the period of the procedure of total laryngectomy and has been indicated due to its technical facility, exemption from the use of voice prosthesis, and lack of additional costs for its maintenance. OBJECTIVE: To evaluate the results obtained with the Amatsu's tracheoesophageal shunt, along 14 years of experience, in two Brazilian hospitals. STUDY DESIGN: Clinical retrospective. MATERIAL AND METHOD: From 1991 to 2005, eighty-four patients were submitted to the Amatsu's tracheoesophageal shunt. Seventy-seven (91.7%) were male and seven (8.3%) female, aged between 30 and 82 years, mean age of 57.5 years, and an average age of 52 years. All patients had squamous cell carcinoma of larynx and/or hypopharynx. Sixty-eight (81.0%) were stage III or IV. They were submitted to total laryngectomy and the Amatsu's tracheoesophageal shunt was performed during the tumor removal surgery. The following variables were analyzed: acquisition of intelligible speech, vocal recovery time after surgery, and the occurrence of specific surgical complications of the shunt (pulmonary aspiration). RESULTS: Seventy-six patients were evaluated with respect to the effectiveness of the technique. Fifty-three patients (70.0%) presented vocalization by the shunt; in 46 patients (60.5%), the speech was fully intelligible. The time required for restoration of speech was 12-87 postoperative days. Of the 83 patients evaluated in relation to the development of complications, 25 (30.1%) presented aspiration by the shunt during oral ingestion. In 23 patients (27.7%), the aspiration was managed conservatively without complications. Two patients (2.4%) required surgical closure of the shunt due to intractable aspiration. CONCLUSION: Vocal rehabilitation with the Amatsu's tracheoesophageal shunt is effective in most patients who underwent total laryngectomy. It can be evidenced by the acquisition of intelligible speech in most patients. The aspiration, although often, is not shown to be a limiting complication.

Complications of tracheoesophageal puncture and speech valves: retrospective analysis of 47 patients.

OBJECTIVES: This study aims to evaluate the complications of tracheoesophageal puncture (TEP) for voice restoration and speech valves in patients undergoing total laryngectomy. PATIENTS AND METHODS: Between January 2006 and June 2011, 47 male patients (mean age 62.8±1.2 years; range 41 to 80 years) who underwent TEP and speech valve for voice restoration after total laryngectomy were retrospectively analyzed. Secondary TEP was performed and Provox indwelling voice prosthesis were inserted in all patients. Demographic, disease and treatment characteristics of patients were recorded. Complications related to TEP and speech valves, the management of complications and clinical conditions of complete closure of TEP were also recorded. RESULTS: Tracheoesophageal puncture and speech valve related complications were observed in 20 patients. The majority of complications were minor complications including granulation tissue formation (n=2, 4.2%), deglutition of prosthesis (n=6, 12.7%) and TEP enlargement/leakage around prosthesis (n=9, 19.1%). Major complications were observed in three patients. Two of them were life-threatening complications; a mediastinitis (n=1, 3.1%) and paraesophageal abscess (n=1, 3.1%), and both appeared in the first month of the postoperative period. The overall complication rate was 42.6% during mean follow-up of 15.3 months. Tracheoesophageal fistula enlargement (n=9, 19.1%) was the most common minor complication and the most common cause of complete closure of TEP in this study. CONCLUSION: Tracheoesophageal puncture for voice restoration is not an entirely innocent procedure without any complications. Patients should be monitored for TEP-related complications in the early and late postoperative period.

Speech rehabilitation during the first year after total laryngectomy.

BACKGROUND: Gaining a new voice is one of the major aims after total laryngectomy. The objective of this study was to describe the process and results of speech rehabilitation during the first year after surgery. METHODS: Speech intelligibility was measured 6 months (n = 273) and 1 year (n = 225) after total laryngectomy. RESULTS: Objective (23.4 to 47.5 points, p < .0001) and subjective (51.6 to 64.7 points, p < .0001) speech intelligibility improved between 6 months and 1 year after total laryngectomy. Patients who used tracheoesophageal puncture (TEP) had the best results in speech intelligibility 6 months and 1 year after total laryngectomy. In all, 12% of the patients who used TEP initially no longer used it 1 year later. Patients who had received rehabilitation had better objective speech intelligibility than those who did not. CONCLUSIONS: Speech improves considerably between 6 months and 1 year after total laryngectomy. Nonattendance of rehabilitation is associated with a worse functional outcome in speech rehabilitation.