Total Laryngectomy Flashcards
Early symptoms of laryngeal cancer are similar to the common cold they include:
- lump in the throat feeling
- persistent throat clearing
- persistent coughing
- sense of discomfort in the throat
- persistent sore throat
- difficulty breathing
- burning sensation when swallowing
- difficulty or pain in swallowing
- referred pain in ear
- unexplained weight loss
Describe a total laryngectomy:
The larynx is removed including the hyoid bone and first tracheal rings. Usually to get a lymph nodes. The neck tissue is brought to the midline to seal the oral cavity from the trachea. The trachea is bent forward.
T or F: You can aspirate with a total laryngectomy.
False
T or F: If someone has a total laryngectomy, you should breath into their mouth during CPR
False - that would just put air in the stomach
T or F: People with a total laryngectomy have no problem swallowing.
False- no aspiration but still can have difficulty especially with bolus entering UES b/c nothing to raise and open it.
What is an issue with breathing through a stoma? How is it resolved?
No oral cavity for moisture. Lungs lose heat and moisture. Can use a heat and moisture exchanger or a sponge to protect them.
Describe the pneumatic artificial larynx (tokyo larynx) and who uses it:
A hose is put on top of the stoma and air causes a flat noise to be transmitted through catheter into oral cavity where articulators can be used. Not common in canada but popular in tonal languages.
Describe the transcervical electrolarynx and who uses it:
Most common in Canada. Batteries are hard to get. Use residual air in the oral cavity to produce sounds.
Describe the Servox transcervical electrolarynx:
Difficult to use when there is lots of scar tissue. Usually produces a low freq. Even if not primary mode, most people have as a backup.
Describe the cooper-rand intraoral electrolarynx:
similar to Tokyo larynx but sound comes from the machine through a tube into the mouth. Tube interferes with articulation more. May use this is scar tissue prevents use of the electrolarynx
List 5 treatment considerations for SLP to use with patients with artificial larynges:
- overarticulation without visible over-exaggerating movements
- identification of best coupling spot
- larynx to skin seal
- develop conversational speech (phrasing, pauses, normal rate, coordination of e-larynx and artic)
- Pragmatic use of the larynx (use it to indicate turn-taking)
List 5 possible goals for a patient with an artificial larynges:
1) Optimal placement
2) Coordination of the “on” control with speaking
3) Articulatory precision
4) Appropriate rate and phrasing
5) Attention to nonverbal behaviours
Describe esophageal speech:
Uses the UES to produce sound. Air is pumped into upper 3rd of the esophagus. Least freq. method in canada but most freq. around the world.
What are the 2 ways of insufflation in esophageal speech:
1) Injection method
2) Inhalation method
* usually pple use both methods
Describe the injection method of insufflating the esophagus:
Sends positive pressure into the esophagus. Plosive consonant injection, glossal compression injection, glossopharyngeal compression injection, “modified swallow”.
Describe the inhalation method of insufflating the esophagus:
Inhale the air and relax the UES a bit and the neg. air pressure will pull the air into the UES.
List Doyle’s 5 steps on the way to esophageal sound production:
1) Train insufflation (injection or inhalation)
2) Voice production on demand following insufflation
3) Repeated production of voice following insufflation
4) Monitor devleopment of detrmimental behaviours
5) Reduce the degree of articulatory contact associated with insufflation and voice production
Describe the stages of esophageal speech development (Snidecor):
- Get air in and out
- Produce plosive consonants, vowels and diphtongs
- Simple useful monosyllabic words
- Voice 2-syllable words with first 2 than 1 insufflation
- Voice phrases
- precise articulation and connected speech
- achieve stress
- Use active conversation
- Conversational speech rate
List 5 advanced goals of esophageal speech (Doyle):
1) prolongation of voicing
2) Increased intelligibility
3) Minimize associated noises or behaviours which have a neg. impact
4) Maintain adequate speech rate
5) Improve prosodic features
List 2 related problems with esophageal speech:
Klunking and Respiratory noise/ stoma blast
Describe Klunking:
Klunking is a squeaky sound during insufflation (audible charging of the esophagus).
Describe respiratory noise/ stoma blast:
The patient needs to learn to uncouple speech and breathing.
Describe Tracheo-esophageal speech:
Esophageal speech driven by airflow from the lungs. A one-way valve attaches trachea and esophagus. Just enough air is needed to push air through when they want to but not all the time.
List some criteria to be a TEP candidate:
- motivation
- understanding of anatomy
- understanding of prosthesis
- adequate manual dexterity
- adequate visual acuity
- ability to care for prosthesis
- No sig. hypophayrngeal stenosis
- Positive air insufflation test
- adequate pulmonary function
- adequate stoma
- mental stability
Describe the Primary TEP timeline:
TEP is inserted at the time of the laryngectomy. Prosthesis is fit after 8-10 days when patient resumes and oral diet. No speaking until 3-4 days later to avoid formation of a fistula.
Describe the secondary TEP timeline:
After the recovery from the laryngectomy. The Prosthesis is inserted on the fourth postoperative day and the patient speaks immediately.
Who manages a TEP:
Insertion and maintenance is a delegated act for SLPs
T or F: The tracheo-esophageal puncture will close if something isn’t inserted into it.
True
List the steps of inserting the Blom-Singer prosthesis:
1) Puncture dilation
2) Puncture Measure
3) Insertion of gel capped prosthesis
4) Cutting or taping of insertion strap
List 5 goals for using TEP speech:
1) Valving (teach when to cover and when not to)
2) Articulation
3) Phrasing
4) Rate
5) Attention to nonverbal behaviours
What is insufflation testing:
Determining if the UES is a good sphincter for voicing. The Blom-Singer insufflation test involves a tube that goes from the stoma through the oral cavity to the esophagus.
What are the four possible outcomes of esophageal insufflation testing:
- Normal tone - good voice production and candidate
- Spasm with complete aphonia (UES is too tight)
- Hypertonicity (reduced voicing) working too hard
- Hypotonicity (reduced voicing) not loud enough
List possible complications of TEP voice rehabilitation:
- leaking TEP valve
- esophageal leaking through TEP fistula into airway
- Opening resistance of the TEP valve (too hard/easy)
- Candida biofilm (due to dry mouth)
- Persistent spasm of the PE segment
- Granuloma, scarring, infection, edema of TEP fisutla
- Disappearance of TEP valve under granuloma tissue
- Swallowing of Prosthesis
- Aspiration of prosthesis
