O12 Types of Alaryngeal Speech, Exam 3

Question 1

What is the purpose of insufflation testing?

Answer 1

To determine whether or not a patient will be able to voice well with a prosthesis after undergoing a laryngectomy.

Question 2

How does insufflation testing take place?

Answer 2

A tube is placed down the nose, and then the patient or SLP blows into it to see whether the upper esophageal sphincter vibrates.

Question 3

What are the two passing criteria for a patient to be eligible for a prosthesis?

Answer 3

1. Continuous phonation: about 8 seconds on ‘ah’ and/or the patient being able to count from 1-15 on one breath
2. Consistent phonation: being able to phonate repeatedly

Question 4

What are PE (pharyngo-esophageal) segment relaxing procedures?

Answer 4

botox injections

surgery

Question 5

What is the purpose of PE (pharyngo-esophageal) segment relaxing procedures?

Answer 5

Helps the upper esophageal sphincter relax to be able to vibrate

Question 6

What will hypertonicity in the PE segment result in? Will therapy be helpful?

Answer 6

An intermittent voice/interrupted phonation ; therapy will potentially be helpful.

Question 7

T/F: if you have a tonic PE segment, the voice will work.

Answer 7

True

Question 8

If you have hypotonicity, what will it result in?

Answer 8

Consistent speech, but weak and breathy

Question 9

How can you tell whether the patient is hypotonic?

Answer 9

If voicing works when you press your thumb on the patient’s neck to mechanically tighten the PE segment in the esophagus

Question 10

What is a neurectomy?

Answer 10

Nerve surgery - cuts CN X vagus nerve which innervates cricopharyngeus

Question 11

What is a myotemy?

Answer 11

Surgery to cut cricopharyngeus muscle

Question 12

T/F: Hypotonic PE segment should never have a relaxing procedure done on it!!! No myotemies or neuroectomies! They won’t be able to hold down food.

Answer 12

true

Question 13

What is Blanton’s opinion of myotemies and neuroectomeies?

Answer 13

Not a good plan to cut a muscle that has already been radiated, and cutting a nerve will damage it – this will set up the patient for having acid reflux…

…BUT the other option is the patient may not be able to voice the way they want to, device free – is the price worth it?

Question 14

What will injecting botox into the PE segment accomplish?

Answer 14

Will relax the muscle enough to voice.

Often, even when the botox wears off, the patient will still be able to voice because the patient is used to the sensation and sound of their voices. For some people, this will not happen, however.

Question 15

What will happen if a patient with a hypotonic PE segment gets a relaxing procedure done on their PE segment?

Answer 15

They will not be able to hold down food or liquid anymore

Question 16

What are the three relaxing procedures?

Answer 16

a. neurectomy: cuts CN X
b. myotemy: cuts cricopharyngeus muscle
c. botox the PE segment

Question 17

T/F: If PE spasms are bad, speech therapy won’t help.

Answer 17

TRUE.

Question 18

What is an esophageal stricture?

Answer 18

The esophagus will no longer work the way it should because of…

a. Scarring of the esophagus from repair of the phraynx
b. Tissue changes in the esophagus from radiation
c. Small PE segment

Question 19

What is the length of the tracheal-esophageal (TE) prothesis measured in?

Answer 19

millimeters - mm

Question 20

What is the diameter of the tracheal-esophageal (TE) prothesis measured in?

Answer 20

French - Fr.

Question 21

Why is it important that the TE prosthesis fits tightly?

Answer 21

To prevent leakage from entering the trachea –> aspiration

Test if its tight enough by giving your patient a glass of water.

Question 22

Talk about creating a TE puncture.

Answer 22

• It’s an office procedure
• Punch a hole through the trachea and esophagus, and then quickly insert a catheter to prevent the hole from closing while its healing.

Question 23

What is one tip for taking the catheter out?

Answer 23

Instead of having the patient sit upright, have them lie on their backs to help prevent saliva and boogers from coming up and out with the catheter.

Question 24

What do you need to remember to put in when you take the catheter out?

Answer 24

the dialator

Question 25

Why is it important that the collar on a prosthesis is not too long?

Answer 25

to avoid pistoning in the trachea (move front and back in the trachea)

Question 26

If the collar doesn’t turn, what is this a sign of?

Answer 26

That the prosthesis has inflated inside the puncture between the trachea and esophagus. This is an infection risk.

Question 27

How do you clean a prosthesis?

Answer 27

With a tiny brush or flush with water, or can be taken out and soaked in vinegar, hydrogen peroxide, or nystatin

Question 28

What is often a problem with prostheses?

Answer 28

Candida/yeast

Question 29

If liquid leaks THROUGH the prosthesis, what is this a sign of?

Answer 29

Prosthesis failure

Question 30

If liquid leaks AROUND the prosthesis, what is this a sign of?

Answer 30

Dialation

Question 31

What are some issues with voiced-voiceless consonants with esophageal and TE speakers? What should you teach TEP speakers to do to help this?

Answer 31

Listeners aren’t able to perceive the contrast very well.

Teach to push harder - take a breath and then push the air.

Question 32

What is the biggest cue for the difference between voiced and voiceless consonants?

Answer 32

Voice onset time

Question 33

What are the four types of air injection that can be used for esophageal speech?

Answer 33

1. compression system - swallow air
2. Pressure systems
3. Inhalation - inhale air
4. Consonant injection - inhale air while speaking (best to do on stops)

Question 34

Talk about alaryngeal speech therapy.

Answer 34

a. Get air in, get air out
b. CV and CVC syllables are best to start practicing with, with stops/affricates 1st, then liquids and glides
c. Bisyllabic words
d. Move to Phrases
e. Articulation practice
f. Longer phrases
g. Pitch and loudness are minimal but possible and needed all the same.
h. Eventually, Conversation
i. Maximum rate: 60-70 wpm is adequate, 100-125 is excellent. Normal is about 150 wpm.

Question 35

Talk about TEP speech therapy.

Answer 35

• Prosthesis management and occlusion*
  a. Get air in, get air out
  b. CV and CVC syllables are best to start practicing with, with stops/affricates 1st, then liquids and glides
  c. Bisyllabic words
  d. Move to Phrases
  e. Articulation practice
  f. Longer phrases
  g. Pitch and loudness are minimal but possible and needed all the same.
  h. Eventually, Conversation
  i. Maximum rate: 60-70 wpm is adequate, 100-125 is excellent. Normal is about 150 wpm.