Alaryngeal Speech

Question 1

Laryngectomy

Answer 1

Surgical removal of the larynx

• Disease
• Trauma

Question 2

Alaryngeal Speech

Answer 2

Oral communication without a larynx

-Role of speech-language pathologist

Question 3

Laryngeal Cancer

Answer 3

Supraglottic malignant tumors
Subglottic malignant tumors
Glottic malignant tumors

Causes:
Smoking
Smoking and drinking

Question 4

Cancer

Answer 4

Immortal cells

• Benign – not cancerous and don’t spread to other parts of the body
• Malignant – cancerous and can spread to other parts of the body
• Metastasis – spread of malignant cells to other parts of the body
  - Well-differentiated
  - Less differentiated

Question 5

Laryngeal Cancer Diagnosis

Answer 5

Auditory perceptual changes

Imaging:

• Indirect laryngoscopy
  - Visible lesions
• Direct laryngoscopy
  - Vocal fold vibration
  
  • Tumor size, location, and type
• MRI or CT
  
  • Tumor size and location

Question 6

Laryngeal Cancer Treatment

Answer 6

Early identification

Radiation – targets cancerous cells

Question 7

Near Total Laryngectomy

Answer 7

Entire larynx is removed except a strip of tissue on the contralateral/opposite side of the tumor

• Tracheostomy
• Strip of tissue is reconstructed into a shunt

Question 8

Total Laryngectomy

Answer 8

Removal of the larynx
Permanent tracheostomy
Neck breathing

Question 9

Cordectomy

Answer 9

Diseased vocal fold is removed

Postsurgical voice is breathy, weak, and hoarse

Question 10

Partial Laryngectomy

Answer 10

Half of the thyroid cartilage, arytenoid cartilage, membranous tissues, and vocal fold on the affected side are removed

Voice is hoarse and breathy
Dysphagia – typically resolves with therapy

Question 11

Supraglottal Laryngectomy

Answer 11

Partial removal of the hyoid bone & thyroid cartilage, removal of the ventricular folds and the epiglottis

Question 12

Laryngeal Cancer Rehabilitation

Answer 12

Interdisciplinary Team:
Otolaryngologist (ENT)
Oncologist
Physician
Nurse
Social worker

Role of SLP:

• Improve pharyngeal function for eating and voice
• Collaborate with other healthcare professionals, patient, and family
• Counseling
• Adjustment and acceptance of new voice

Question 13

Post-Laryngectomy Changes

Answer 13

Increased production of mucous
-Phlegm is removed from the stoma/blowing nose is difficult

Cover stoma with clothing

Reduced sense of taste and smell

No heavy lifting

No swimming/bathing precautions

Loss of laugh, cry, and other emotional vocalizations

Support groups

Question 14

Preoperative Consultation

Answer 14

Counseling and preparing patient/family
Review medical information
Assess patient and needs

Question 15

Postoperative Consultation

Answer 15

Counseling
Alaryngeal speech techniques reviewed/demonstrated
Educate patient and family

Question 16

Electrolarynx

Answer 16

Vibration passes through muscles and tissue of neck creating sound

Patient moves articulators to produce speech

Used early after surgery

Gives patient an acceptable source of speech

Con- sounds artificial
Con- one hand has to be free to use the device

Question 17

Esophageal Speech

Answer 17

Pharyngoesophageal (P-E) sphincter is constructed during surgery
-P-E sphincter functions like “new” vocal folds

Air is forced down and then back up through the P-E sphincter

Each person’s “voice” is different, but typically present with:
Lower fundamental frequency
Lower intensity/loudness
Slower rate of speech
3-5 words compared to 12 on a single breath of air

Cons:
It can be difficult to produce
Small air reserve
Stoma blast
Voice sounds different

Pros:
Produces a more natural sounding voice
No devises or instruments are needed – just air

Question 18

Tracheo-Esophageal Speech

Answer 18

One-way prosthetic valve placed between the trachea and esophagus (air goes from trachea to esophagus, but nothing from the esophagus can enter the trachea)

Stoma is occluded to divert air into the esophagus below the P-E sphincter

Esophageal speech is produced

Acoustics:
Low pitch
Louder than esophageal speech
More natural rate of speech

Question 19

One-Way Valve:

Answer 19

A prosthetic that is inserted into the trachea and esophagus postoperatively

Esophageal edge has a flange to secure the placement

Prosthetic vary and should be selected based on the patient’s needs

Easy flow of air into the esophagus and doesn’t take up too much room in the tracheostomy

Patient is taught how to insert, remove, and clean the prosthetic

Air pressure valve can be added to allow a person to speak without covering the stoma

Pro: most natural-sounding voice, especially for males
Con: Maintenance and may require second surgery for fistula