COMPS: Types of Alaryngeal Speech (O12)

Question 1

What is “insufflation testing”?

Answer 1

A test in which a catheter is placed through the nose into the upper GI tract to determine whether or not a patient WILL BE ABLE TO VOICE WELL WITH A PROSTHESIS after a laryngectomy.

A gasket is placed on the neck and the patient occludes it while they or the SLP blows into the tube.

As air is blown into the tube, it is insufflated as speech if the UES is capable of vibration.

Question 2

________ Communication must involve the
patient in the education of choices for
communication. This does not need to be limited
to just ___ option. The patient should be
educated on the artificial larynx, ___, esophageal
speech as well as ______. (ASHA PowerPoint)

Answer 2

FUNCTIONAL communication
ONE option
TEP
WRITING

Question 3

What are the two passing criteria for insufflation testing?

Answer 3

1. Continuous phonation (about 8 seconds on ‘ah’ or counting from 1-15 on a single breath)
2. Consistent phonation - being able to do the above repeatedly

Question 4

What is an indication that a laryngectomy patient has a hypertonic PE segment?

Answer 4

An intermittant voice/interrupted phonation.

*A hypertonic PE segment will usually pass the insufflation test.

Question 5

What are some pharyngeo-esophageal (PE) segment relaxing procedures and/or surgeries?

(for HYPERtonicity- these procedures help the PE segment relax)

Answer 5

1. Neurectomy (cuts CN X which innervates cricopharyngeus)
2. Myotomy (cuts cricopharyngeus muscle)
3. Botox injections to the PE segment (relaxes the PE segment enough for the pt to voice)

Question 6

T/F: If the patient has bad PE spasms, speech therapy will not help.

Answer 6

True

Question 7

What is an indication that a laryngectomy patient has a HYPOtonic PE segment?

Answer 7

The patient produces a consistent voice/phonation, but displays BREATHY esophageal speech.

*A hypotonic PE segment should NEVER have a relaxing procedure done on it. The patient will not be able to hold down food.

Question 8

What is a PE prosthesis measured in?

Answer 8

French (Fr.)

*Common size for TEP diameter is 16 Fr.

Question 9

Why does the prosthesis need to be tight?

Answer 9

So that the prosthesis doesn’t leak saliva or liquids into the trachea

Question 10

What is a prosthesis?

Answer 10

A tube that connects the trachea to the esophagus via a tracheoesophageal puncture (TEP) to help the patient produce TRACHEOESOPHAGEAL SPEECH.

The pt occludes the stoma and the air enters the esophagus and travels through the UES, causing the sphincter and surrounding tissues to vibrate.

Question 11

What is one common problem with a prosthesis?

Answer 11

Candida/yeast infection- grows on the prosthesis and sticks the valve open, causing leakage.

Should be taken out and soaked in vinegar, hydrogen peoxide, or nystatin to get rid of the yeast buildup.

Question 12

What should you tell the patient regarding dropping the prosthesis down their stoma?

Answer 12

To stay calm, breathe around it, and call 911.

Question 13

What treatment techniques should you teach patients who use an electrolarynx? (for speech)

Answer 13

Teach them to over-exaggerate their speech and use strong tongue movements.

Question 14

What treatment techniques should you teach patients who use a prosthesis? (for speech)

Answer 14

Teach them to PUSH harder. Take a breath and push the air out.

Question 15

What are the 8 hierarchal steps for alaryngeal speech therapy?

Answer 15

1. Work on getting air in and out.
2. CV and CVC syllables w/stops and affricates, then liquids and glides
3. Bisyllabic words
4. Short phrases
5. Articulation practice
6. Longer phrases
7. Pitch and loudness (difficult to achieve much of, but possible and necessary)
8. Conversation!

*TEP speech therapy= same as above but including prosthesis management & occlusion.

Question 16

What is typical words per minute rate for alaryngeal speech? (adequate and excellent)

Answer 16

Adequate: 60-70wpm
Excellent: 100-125

(Normal speech= 150wpm)