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Background: Voice and swallowing problems are often seen in patients with advanced larynx cancer, after total laryngectomy (TL) and chemo/radiotherapy. The aim of this study was to determine the occurrence of voice and swallowing problems in patients who have been laryngectomised and investigate if these symptoms were related to age, time after TL, radiotherapy and TNM-classification. In addition, we studied how often the patients changed their voice prostheses and the need of therapeutic interventions after TL. Methods: Forty-five patients were included in the study and completed the Swedish version of the Sydney Swallow Questionnaire and the Voice Handicap Index-T. Results: Swallowing problems were reported by 89% of the patients and moderate-to-severe voice handicap was reported by 66%. Most of the subjects who had dysphagia also presented voice problems (rs=0.67 p≤.01). Additional therapeutic interventions to manage problems with voice and/or swallowing after TL were required in 62% of the patients. Conclusions: Swallowing and voice problems after TL are common. Thus, the preoperative information and assessment of these functions, as well as the treatment and the post-operative rehabilitation should be evaluated and optimised to provide better functional results after treatment of advanced larynx cancer. [ABSTRACT FROM AUTHOR]

Conclusions: The slit-like trachea-esophagus puncture is a reliable procedure to restore the voice in the patient who has undergone a total laryngectomy. The new voice quality could be similar to normal and could meet the patient's daily needs. Objectives: We report a new method of tracheoneoesophageal (TE) voice rehabilitation. A slit-like trachea-esophagus puncture was made in the tracheoesophageal wall after the total laryngectomy. No voice prosthesis was used. The purpose of this study was to observe its aerodynamic characteristics. Methods: All 60 patients received voice rehabilitation with the slit-like fistula after total laryngectomy. All patients' voices were evaluated as excellent. The aerodynamic characteristics of trachea-esophagus voices were observed. Results: When a patient attempted to phonate, the upper esophagus was closed. Then, the hypopharyngeal cavity expanded. Just before phonating, the upper esophagus was full of air as a ball. The air flow escaped through the segment of the trachea-esophagus slit and entered the pharyngoesophageal segment (PES). The esophageal meatus opened. It was vibrated together with nearby mucus and mucosa to form the voice. The maximum phonation time of the slit-like fistula voice was not significantly different from the Blom-Singer prosthesis voice. Its sound intensity was similar to the normal voice. [ABSTRACT FROM AUTHOR]

This study aimed to relate the results of physiological measurements of the pharyngoesophageal (PE) segment in subjects using tracheoesophageal (TE) or esophageal (E) speech with perceptual assessment of the speakers' voice quality and acoustic measurements of the voice function. It further aimed to investigate possible differences in appearance and placement of the voice source between TE and E speakers. Nine subjects who had undergone a laryngectomy (five TE speakers and four E speakers) participated in the study. They were videoradiographically examined during phonation and silence. Measurements were made of size and placement of the PE segment, the distance between the PE segment and the anterior wall, and the distance between the posterior and anterior esophageal walls beneath the segment. Five trained listeners perceptually assessed the subjects' voice quality, and acoustical analyses of fundamental frequency and sound pressure level were made. The physiological measurements of the nine subjects' individual PE segments varied in terms of appearance and placement during both phonation and silence, but all of the subjects showed a good closure at the PE segment level during phonation. Statistically significant results were found between all of the physiological measurements of the PE segment. Significant results were also found between the acoustical and perceptual assessments of the subjects' voices. No relations were found between the physiological measurements and the acoustic and perceptual results. The conclusion of this study was that there were no specified differences in the PE segment between TE speakers and E speakers, but that there were large individual differences within each speaker group. [ABSTRACT FROM AUTHOR]

Conclusions. Tracheoesophageal phonation appears to participate in early acquisition of esophageal phonation, which remains the preferred method of voice restoration among patients. Further studies into factors predicting and mechanisms underlying acquisition of esophageal phonation among alaryngeal patients may provide information facilitating superior quality of life. Objective. The aim of this study was to examine early acquisition of esophageal phonation following tracheoesophageal phonation, and underlying mechanisms and preferred phonatory methods for alaryngeal patients who master both tracheoesophageal and esophageal phonation. Patients and methods. Subjects comprised 44 alaryngeal patients and were divided into three groups: group A ( n =13), esophageal phonation alone; group B ( n =21), tracheoesophageal phonation alone; and group C ( n =10), patients who acquired esophageal phonation after learning tracheoesophageal phonation. Results. The results indicated that acquisition of tracheoesophageal phonation significantly accelerated acquisition of esophageal phonation to 59.3 days from 184.6 days. Patients in group C stopped tracheoesophageal phonation and predominantly used esophageal phonation. No factors predicting acquisition of esophageal phonation were identified among patients who had mastered tracheoesophageal phonation, including age at time of surgery, irradiation, neck dissection, acquisition time of tracheoesophageal phonation, and maximum phonation time of tracheoesophageal phonation. No evidence of air leakage through the shunt during esophageal phonation was noted in group C. [ABSTRACT FROM AUTHOR]

Objective --To gain insight into the clinical value of using the relatively new evaluation tool digital high-speed endoscopy in addition to the widely used method of videofluoroscopy for imaging of the neoglottis in tracheoesophageal speech after total laryngectomy. Material and Methods --Anatomical and morphologic characteristics of the neoglottis in 37 laryngectomized patients using tracheoesophageal speech were studied by means of visual assessment of digital high-speed endoscopy recordings and visual assessment and quantitative measures of videofluoroscopy recordings, using previously published protocols. Results --Digital high-speed endoscopy provides information complementary to that of videofluoroscopy with respect to the location of the vibration, presence of a mucosal wave, regularity of the vibration and closure of the neoglottis. The information provided by digital high-speed endoscopy overlaps with that provided by videofluoroscopy with respect to the amount of saliva (regurgitation of barium in videofluoroscopy) and the visibility of the origin of the neoglottis (presence of a neoglottic bar in videofluoroscopy). Additionally, relationships were found between the visual assessments of the high-speed recordings and some patient characteristics. Conclusion --Digital high-speed endoscopy provides additional insight into neoglottic characteristics that cannot be studied with videofluoroscopy. The application of both imaging methods enhances the insight into tracheoesophageal voicing. [ABSTRACT FROM AUTHOR]