4.5 Alaryngeal Speech Options

Question 1

What are the 4 major systems of speech?

Answer 1

• Power system –> lungs
• Phonatory system –> sound source (vocal folds)
• Shaping system –> resonance (pharyngeal, oral, and nasal cavities)
• Refinement system –> articulation

Question 2

What changes occur in a laryngectomee patient? (2)

Answer 2

• Vibratory source (vocal folds) have been removed

- Power source (lungs) is disconnected from vibratory source

Question 3

What is a pneumatic device?

Answer 3

add picture

Question 4

What are the advantages of a pneumatic devices? (7)

Answer 4

• Simple in design –> limited number of parts
• Durable
• Requires no batteries
• Hoarse voice rather than a mechanical sounding voice (buzzing) of electric devices
• Uses patient’s own air supply
• Inexpensive cost ($50.00 - 160.00)
• Models

Question 5

How do pneumatic devices use patient’s own air supply? (2)

Answer 5

• Phonation is easily coordinated with respiration

- Normal phrasing and flow of speech are easy

Question 6

What are the different models of Pneumatic devices? (3)

Answer 6

• Tone Airc II
• Tokyo Artificial Larynx
• Dutch Speech

Question 7

What are the disadvantages of pneumatic devices? (6)

Answer 7

• Requires access to stoma
• Highly conspicuous –> visually distracting to the listener
• Requires one or two hands –> difficult to use if have a motor disorder
• Saliva will frequently clog the air tube
• No pitch control
• Very low fundamental frequency

Question 8

What do we need to know about artificial larynx? (3)

Answer 8

• Source + Filter
• Placement varies
• Pros + Cons

Question 9

What do we need to know about Intra oral devices? (4)

Answer 9

• All neck models can be fitted with an adapter that turns them into an oral device
• Embedded in denture/retainer
• Intra-Oral Adapter
• Hand held controller for on/off

Question 10

What are the criteria that we use to choose an artificial larynx? (7)

Answer 10

• Preference
• Neck integrity
• Pulmonary status
• Manual dexterity
• Salivary situation
• Hearing aid
• Regularity of stoma

Question 11

When should you conduct therapy with an artificial larynx?

Answer 11

as soon as possible; may preop introduce

Question 12

How do you conduct therapy with clients who use an artificial larynx (AL)?

Answer 12

Group + individual (if possible) - 60-90 min sessions

Question 13

What does therapy with an artificial larynx (AL) include? (5)

Answer 13

• Choose AL
• Work on placement and pressure
• Voicing
• Timing/phrasing
• Articulation

Question 14

What are the steps of AL therapy?

5+4

Answer 14

• Demonstrate use & educate
• Palpate neck to find site
• Practice simple task while you push buttons (counting)
• Instruct patient to shape sounds with mouth + practice variations in sound. Make sure they don’t forcefully exhale
• When ready, patient starts to use device themselves + work on:
• —–Coordination with speech & button
• —–Natural pauses
• —–Reduced speech rate
• —–Increase articulation

Question 15

What is the process of esophageal speech? (5)

Answer 15

A. Tongue press to inject air into esophagus
B. Air enters esophagus
C. Air released from esophagus to produce sound
D. Sound shaped into speech
E. Location of tissue vibration for sound

Question 16

A normal air reservoir within the lungs of is approx. ____-____ ml of air. Approximately ____-____ ml of air are used in a typical phonation.

Answer 16

3500-4000

1500-2000

Question 17

Esophagus can hold __-__ ml of air when fully inflated. However, it doesn’t fully inflate with injection of air. Only the top __ or __ inflates for voice production for speakers judged as ‘good’ and ‘superior’ esophageal speakers.

Answer 17

60-80

1/3 or 1/2

Question 18

1. PE segment may be damaged due to the what?

2. What must you have functioning?

Answer 18

• Original surgery

- PE segment

Question 19

Pt’s with structural or nerve damage may not be able to use What?

Answer 19

Esophageal Speech

Question 20

What are the therapy steps for esophageal speech? (5)

Answer 20

• Demonstrate the method & educate
• Help them feel comfortable with situation
• Try air injection (elicit burp), plosives (ta ta ta), last resort try swallowing
• Start with sound production-syllables-words-speech
• Slowing the rate of speech
• encouragement + education are huge with this approach!

Question 21

What are the advantages of esophageal speech? (2)

Answer 21

• Don’t need anything

- Free

Question 22

What are the disadvantages of esophageal speech? (2)

Answer 22

• Negative connotation

- Takes longer to learn

Question 23

What are the different components of laryngeal speech in comparison to esophageal speech? (4)

Answer 23

• Power comes from moving air from the lungs
• Vibration source=vocal folds
• Resonator = vocal tract
• Articulators = tongue, teeth, lips, hard + soft palate

Question 24

What are the different components of esophageal speech in comparison to laryngeal speech?(4)

Answer 24

• Power comes from injecting air into the esophagus + then moving air from the esophagus to the pharyngo-esophageal segment
• Vibration source=P-E segment
• Resonator = same
• Articulators = same

Question 25

Where is the puncture for a tracheal esophageal puncture (TEP)?

Answer 25

• Puncture through pharyngoesophageal segment

Question 26

How do you choose a candidate for TEP? (5)

Answer 26

• Good healing
• Free of disease, cognitive issues, + should be medically stable (eyesight, dexterity, good hygiene, etc.)
• Good stoma
• Emotionally stable
• Pass the insufflation testing

Question 27

What are the advantages of TEP?

Answer 27

Quick restoration of voice, uses pulmonary air to drive speech, high success rate (85-95%)

Question 28

What are the disadvantages of TEP? (2)

Answer 28

• Complications from surgery, stenosis, slight risk of aspiration, not all are candidates for this (very strict selection criteria used)
• TEP can be dislodged, defective, or person can develop a fistula. Usually see signs of discomfort such as coughing