Special populations Flashcards
What are common treatments for laryngeal cancers?
- radiation therapy
- chemotherapy
- surgery
What are some of the first symptoms of laryngeal cancer?
chronic hoarseness, dyspnea, stridor, dysphagia, pain, swelling, odynophagia
What are the different types of laryngectomies?
- total laryngectomy
- hemilaryngectomy
- supraglottic laryngectomy
What is a total laryngectomy?
all of the laryngeal structures are removed
-the trachea is pulled up and sutured to the tracheostoma
What is a hemi-laryngectomy?
half of the larynx is removed (right or left side)
When is a hemi-laryngectomy a viable option?
if the tumor is confined to one VF and the doctors are sure they will remove the whole tumor with just the removal of the one VF
What is the biggest risk of a hemi-laryngectomy?
dysphagia
What is a supraglottic laryngectomy?
when everything above the larynx is removed
What do surgeons do to the larynx during a supraglottic laryngectomy?
pull it up so it is closer to the tongue (the tongue can then help protect the airway)
What two types of laryngectomy can preserve the voice?
hemi-laryngectomy and supraglottic laryngectomy
Where does a person’s air come from if they have a total laryngectomy?
their tracheostoma
What is the problem with air that comes through the stoma?
it isn’t warmed, moistened, or filtered
What are separated during a total laryngectomy?
the eating and air pathway
What is an electrolarynx?
a device that that looks like a microphone with a button on the end
- the head of the device is put flush against the skin
- the device vibrates the air in the cavities and the articulators shape the air
What are some advantages of an electrolarynx?
easily portable, fast way to start communicating, can possibly have pitch variations
What are some disadvantages of the electrolarynx?
- can’t use both hands when speaking
- can sound very mechanical
- may feel socially awkward
What sound education for using the device include?
- when to phrase
- when to press the button
- proper seal
- over articulation of words
What is esophageal speech?
when the client learns to inject air just underneath the upper esophageal sphincter and then pushes it back out
What does the tongue do during esophageal speech?
acts as a piston; pushes the air back to the pharynx and esophagus
How much air can someone use while using esophageal speech?
about 100 CCs
How much air does a person use when they speak normally?
5 liters
What is the power source for esophageal speech?
injected air
What is the medium used during esophageal speech?
injected air
that is the vibratory source for esophageal speech?
upper esophageal sphincter
What is the power source of speech while using the electrolarynx?
the battery
what is the medium for electrolarynx speech?
air
what is the vibratory source for electrolarynx speech?
the head of the device
What are some advantages for esophageal speech?
- hands free
- no external device needed
- sounds more natural than the buzzing of the electrolarynx
What are some disadvantages of esophageal speech?
- harder to learn
- articulators must be in good shape
- can cause stomach pain if not done properly
What is a tracheoesophageal prothesis/puncture?
When a small slit is placed in between the trachea and the esophagus and a prosthesis is inserted into the slit
What kind of valve is the prosthesis?
a one way valve
What kind of punctures are there for TEP?
primary (done during laryngectomy)
secondary (done after the laryngectomy)
Where does a TEP deliver air?
right under neath the upper esophageal sphincter
What kind of prosthesis do most people get for a TEP?
an indwelling prosthesis
How often does an indwelling prosthesis need to be replaced?
every 4-6 months
What is the power source for TEP?
exhaled air
What is the medium for TEP?
air
What is the vibratory source for TEP?
the upper esophageal sphincter
What is stoma blast?
when a rush of air comes out of the stoma if it is not properly occluded
What do people use to occlude their stomas?
fingers, thumb, buttons and HMEs
What do HMEs do?
warm and filter the air that comes into the stoma
What is the most natural sounding method of alternative speech?
use of the TEP
What should the SLP become familiar with preoperatively for a laryngectomy?
- type/extent of lesion
- physician prognosis
- likely surgical procedures
SLPs should make sure patients understand what before laryngectomy?
- terminology about disease and procedure
- communication will be restored
- what things will not be affected
What should SLPs help educate about postoperatively?
- filtering of air that goes into the stoma
- moistening of air and stoma
- cleaning and maintenance (nystatin and vaseline)
- breathing (all air comes through the stoma now)
- oral care (nystatin to prevent thrush)
What do professional voice users often need education about?
vocal hygiene and how to properly use the voice
What do professional voice users often benefit from?
looping
What are professional voice users prone to?
muscle tension dysphonias
What profession is at the largest risk for voice problems out of all the professions?
Teachers
What are some female vocal characteristics?
- use more adjectives
- more emotional words
- more descriptive vocabulary
- more breathy
- more facial expressions
- more intonation and pitch variability
What are some male vocal qualities?
- more direct statements
- faster rate
- speak louder
What is paradoxical vocal fold movement?
When the true and/or false VF inexplicably close on inhalation, exhalation, or both
What is VCD often confused with?
asthma
What is VCD caused by? (etiologies)
- psychogenic
- reflux
- sensitivity to smell
- neurological
- exercise
- allergens
How can we assess VCD?
- try and induce an attack
- interview
How can you induce a VCD attack?
have the person run on a tredmill or blow through a straw
How can you treat VCD?
- feedback
- have client visualize open VFs
- coach on self monitoring skills
- yawn-sigh
- inhale through the nose and exhale on the /s/ phoneme
What is another name for aging voice?
presbyphonia
What is presbyphonia?
clinical condistion of elderly patients presenting to the otolaryngologist with gradual weakening of the voice
What are symptoms of presbyphonia?
- chronic hoarseness
- pain
- tremor
- decreased amplitude
- voice breaks
What caused presbyphonia?
- VF atrophy
- benign/malignant lesion
- laryngitis
- MTD
- tremors
What are the three treatments for aging voice?
- laryngoplasty
- thyroplasty
- voice therapy
What causes pediatric voice problems?
often times misuse/abuse
What are some reminders you should give a child to help eliminate abuses?
- have quiet times during the say
- walk over to a friend to talk to them
- drink a lot of water
- find a voice buddy
When can voice therapy begin for a child?
when they are old enough to understand the importance of using the voice properly
What are some vocal characteristics of the deaf and hard of hearing?
- difficulty with articulatory placement
- prolonged vowel durations
- reduced speaking rate
- nasality
- “cul-de-sac resonance”
What is asthma?
the narrowing of airway tubes in the bronchi and bronchioles
What are some treatments for asthma?
reducing the number of syllables the patient says in one breath
What is emphysema?
a type of chronic obstructive pulmonary disease
-damage to the alveoli in the lungs
What does emphysema cause problems with?
breathing
-voice concerns are secondary
