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Spring '14-127 (Exam 3) > Lecture 1- alaryngeal speech > Flashcards

Lecture 1- alaryngeal speech Flashcards

0
Q

What should be tried for esophageal speech before surgery?

A

Insufflation testing

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1
Q

What is the most important point about alaryngeal speech?

A

Something has to vibrate

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2
Q

What is insufflation testing?

A

A thin silicone tube, similar to a stomach tube, is inserted through the nose and into the upper esophagus. By closing the tracheostoma (by occlusion) for expiration, air is introduced into the upper esophagus at about the level of a future voice prosthesis.

If the air flows gently upwards and out of the mouth and the patient is able to speak, then it is highly probable that he will also be able to talk with a voice prosthesis.

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3
Q

What happens if you don’t get a good seal between the gasket and the patient’s neck?

A

Then the patient won’t be able to blow air into the esophagus, anytime the housing or gaskets are glued, you have to get a good seal all the way around.

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4
Q

What do we need to ask the patient to do when inserting the silicone tube for the insufflation testing?

A

Pretent to breath through the nose, so they can open the velopharyngeal port because you have to get through the port.

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5
Q

Where does the tube go down?

A

The back f the oral pharynx and they swallow the tube. You have to wiggle the tube through the nose.

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6
Q

Why do you need to do insufflation testing?

A

To see if the UES is capable of vibration.

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7
Q

How far does the hose have to go down?

A

25cm mark

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8
Q

What does it mean if you don’t see the black line on the insufflation hose when you think you have reached the 25 cm mark?

A

The tube could have coiled up near the opening of the esophagus.

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9
Q

How long is every person’s esophagus?

A

30 cm from the cricopharyngeus to the LES.

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10
Q

t/f

we don’t gag off the pharyngeal wall, we gag off the posterior of our tongue and our uvula

A

true

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11
Q

What is the passing criteria for an insufflation test?

A
  1. Continuous phonation of about 8 seconds on /a/ and/or the patient being able to count from 1-15 on one breath.
  2. Consistent- being able to do it repeatedly. Don’t just do it once, do it over a good chunk of time
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12
Q

t/f

Up to half of the people who get a TEP (trachealesophageal puncture) will need some sort of relaxing procedures for the UES

A

true

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13
Q

What techniques can be performed for people with a TEP to help relax the UES so it can vibrate?

A
  1. Botox injections. which will relax the PE segment and allow air to go through. The botox is inserted into the cricopharyngeus. Botox does wear off though but some patients can still voice.
  2. Surgery- The nerve that innervates the criopharyngeus is cut (VAGUS). Neurectomy is done on one side so the nerve is cut (paralyzed) or they slice the muscle on one side (myotemy).
  3. Speech therapy (imagery and relaxation techniques)
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14
Q

Why doesn’t Dr. Blanton like the surgery option?

A

the idea of nicking a muscle (myotemy) that has been irradiated (so it is potentially stiffer) or cut a nerve (Neurectomy). If the esophagus (UES) is somehow damaged in order to allow air to come out, acid and food could also come out.

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15
Q

What is hypertonicity of the PE segment?

A

It’s an effective sphincter (it’s not gonna let go). You will hear an interrupted phonation in the insufflation testing with hypertonicity. It will result in an off again on again voice.

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16
Q

What happens if the PE segment spasms?

A

If the PE segment spasms and it closes then your patient gets nothing in terms of voicing. They will need some sort of procedure (therapy will not fix that). If you get hypertonic voice then therapy can potentially fix it.

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17
Q

What happens to the voice during tonic PE segment?

A

It will yield a passing response. The voice will work

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18
Q

What is Hypotonicity?

A

breathy esophageal speech. That is a problem. It will result in a consistent continuous voice, but it will be breathy and weak. If you put pressure on the esophagus and by mechanical means you are tightening thePE segment (and voicing works), then you know it is hypotonicity.

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19
Q

What can the patient do to help voicing with hypotonicity?

A

You can have your patient wear a choker when they want to talk. You can’t close off the air pipe so they can wear a choker or a really tight collar.

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20
Q

Should hypotonicity have a relaxing surgery done?

A

No, Hypotonic PE segment shouldn’t have a relaxing surgery done to it. Some surgeons make mistakes and do an neurectomy or myotemy on a hypotonic PE segment. This will cause them to lose all their food.

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21
Q

What is the issue with myotemy/neurectomy hypotonic PE segment?

A

there is a high correlation b/w GERD and cancer.

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22
Q

What is the TE prosthesis measured in?

A

Length is measured in mm and diameter is measured in Fr.

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23
Q

How many mm in 1 Fr.?

A

.33 mm in diameter

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24
Q

what is a common size for a prosthetic TEP?

A

16 Fr.

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25
Q

What is important to keep in mind with the collar?

A

It needs to be bigger than the diameter (middle barrel) of the prothesis.

26
Q

Why does the collar need to be a tight fit?

A

Liquid can get in and into the trachea.

27
Q

How do you know how long to make the prothesis?

A

You use the measuring dilator to see where the dilator stops. If it says 12 Fr. then you give the patient a 12 Fr. prothesis and a class of water. If they cough, then go up to a 14 Fr. The Fr./diameter has to fit snug. You must also check the length (mm).

28
Q

What happens if the prothesis is too long?

A

it will piston. The collar in the trachea will piston in the trachea. That isn’t a good fit. If it is too short the collar is going to inflate inside the tissue (between the trachea and the esophagus). This can result in an infection. If you mess up the puncture whole, the odds of it working correctly is really low.

29
Q

What is the name of the movement down the esophagus?

A

peristaltic movement

30
Q

How long are low pressure prothesis designed to last?

A

1-3 days

31
Q

How much are low pressure prothesis?

A

$8

32
Q

What is the problem with having acid reflux or Candida with a prothesis?

A

Acid could be burning off the end of the prothesis.

The yeast that Candida produces will stick to the valve opening. It needs to be cleaned and soaked in vinegar, nystatin, or hydrogen peroxide to extend it’s life.

33
Q

t/f

Creating a TE hole is an inpatient procedure.

A

False. It’s an office procedure. It is not a surgical procedure

34
Q

What is the first thing you must do after creating the TE hole?

A

Put a dilator in it quickly so it doesn’t close up. Always make sure the dilator is in when you remove something so the TEP doesn’t close.

35
Q

t/f

a prosthesis is placed in the TE hole right after the dilator is inserted?

A

False. The hole has to heal before the prothesis is inserted. While it is healing a catheter is inserted through the dilator and outside the stoma as well as hangs down the esophagus otherwise it will pop out.

36
Q

What problem is reported with a catheter?

A

Acid spillage outside the catheter (on clothes).

37
Q

What are a couple of solutions for acid spillage outside the catheter?

A
  • Golf tea

- Tie a knot in it if it is long enough (3ft +)

38
Q

What needs to be removed when the TE hole has healed before the prothesis can be inserted?

A

The Catheter

39
Q

Should the patient be sitting or laying down when removing the catheter?

A

Sitting up because there is going to be saliva and mucous and you don’t want that going back into the trachea

40
Q

After inserting the dilator and before inserting the catheter, why is it important to have the patient occlude the stoma and try to voice?

A

Because you want to see if air will go from the trachea to the esophagus. You must know if the TEP is functional before you put in a prothesis. If it doesn’t work for voicing, you won’t know if it is the puncture or the prothesis that is the issue.

41
Q

What is the process of inserting the prothesis?

A
  • When you put the length sizer in you have to push it in, dissolve the capsule, and be sure the inner collar has seated and then reed it.
  • Load the prosthesis.
  • Insert the prosthesis using the insertion stick
  • Once the prosthesis is inserted, turn the insertion stick to see if it spins easily. You can tell if the prosthesis is seated properly, by inserting the prothesis on that insertion stick, give your patient a cup of warm water so the gel cap dissolves and turn the prothesis. If the prothesis turns then it has seated well. If it doesn’t turn, potentially the collar has inflated inside the puncture. The prothesis will not spin. If it doesn’t turn then the prothesis is stuck against the posterior esophageal wall or the collar has opened inside the puncture. Have the patient voice to see if they can. Always when you place a prosthesis leave the tail sticking out for a few days. Be sure it is seated correctly.
  • Tape the tail in place
  • Removing the prosthesis and the next insertion may be done by the patient Care and feeding of prostheses.
42
Q

Which prothesis does the SLP change, and which one can be changed by the patient?

A

SLP= high pressure prothesis

client= low pressure prothesis

43
Q

Can low pressure prothesis be cleaned in situ?

A

Yes, with a tiny brush and/or flushed with water

44
Q

What can grow on the prothesis if it isn’t cleaned regularly?

A

Candida. Yeast. Cleaning regularly will prevent this.

45
Q

Why is it so common for yeast to grow on the prothesis?

A

Because they no longer have the adequate airflow going through the mouth and nose.

46
Q

What are signs of prosthesis failure?

A
  • Leakage through the prosthesis. This will be the first sign.
  • Air will not pass through as easily. It will be harder and harder for air to go through the valve. They will need to press really heard to speak.
47
Q

If the patient drops the prothesis down their trachea, what should they do?

A

Call 911 and don’t panic. They won’t stop breathing, they will be able to breath around it.

48
Q

t/f

contrast between voice and voiceless phonemes for TEP speakers is quiet diminished

A

true

Voice onset time is the biggest clue for any human to identify any phoneme, and with TEP speakers the contrast isn’t perceived very well.

49
Q

What must we teach electrolarynx patients to do when speaking?

A

Over exaggerate and very strong tongue movements.

50
Q

What do TEP speakers need to do to speak?

A

Push harder. They need to take a breath (inject air) and really push the air out. They have to have some sort of respiratory drive.

51
Q

What are the different types of air injections?

A
  • inhalation
  • consonant injection
  • compression
  • esophageal speech??
52
Q

What is esophageal speech?

A

It is when you inject air and then speak

53
Q

What is compression?

A

Air injection, is essentially swallowing air

54
Q

Compression- what are the 3 pressure systems for the esophageal speaker

A
  • Pressure system 1 – atmospheric pressure in the oral cavity – positive
  • Pressure system 2 – tonic resistance of the PE segment
  • Pressure system 3 – intraesophageal pressure (negative)
55
Q

What is the differece at rest between pressure system 1 and pressure system 3?

A

about 5mm Hg (mercury) in the esophagus

56
Q

What is inhalation?

A

Air injection, putting air into the esophagus. it is difficult to do. They have to inhale air

57
Q

What is consonant injection?

A

Air injection- a lot like the compression system but they are doing it when they are speaking for stops.

58
Q

Which is better, compression or inhalation?

A

Compression is easier to learn but inhalation is probably better

59
Q

What is the process of laryngeal speech therapy (in order)?

A
  • Get air in, get air out. Basic principal, just like voice
  • CV and CVC are the best to begin practicing with. Use stops/affricates first, then liquids and glides. Start with single syllables. If you are TEP speaker then you can use your breath. The stops help your client build up air pressure.
  • Bisyllabic words
  • Phrases
  • Articulation practice
  • Longer phrases
  • Pitch and loudness are minimal but possible and needed all the same for TEP speakers.
  • Conversation
60
Q

What is an adequate rate of speech for alaryngeal speech patients?

A

60-70 wpm is adequate, 100-125 is excellent.

Normal is about 150 wpm

61
Q

What are some things to talk with our patients about?

A
  1. articulation
  2. care and feeding of a prothesis
  3. coach them on how to place one
  4. you need to understand prothesis management
  5. Teach them occlusion
    • Don’t make the stoma any bigger than the patient’s thumb
62
Q

What does TEP speech therapy consist of?

A
  • prosthesis management, occlusion
  • Get air in, get air out. Basic principal, just like voice
  • CV and CVC are the best to begin practicing with. Use stops/affricates first, then liquids and glides. Start with single syllables. If you are TEP speaker then you can use your breath. The stops help your client build up air pressure.
  • Bisyllabic words
  • Phrases
  • Articulation practice
  • Longer phrases
  • Pitch and loudness are minimal but possible and needed all the same for TEP speakers.
  • Conversation

Spring '14-127 (Exam 3) (3 decks)

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