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Introduction: Despite state of the art tracheo-esophageal (TE) voice-rehabilitation after laryngectomy, some patients are unable to produce voice of sufficient quality, because of hypotonicity or atonicity of their pharyngo-esophageal (PE) segment. Furthermore, the TE voice is low pitched, which presents a problem especially for female laryngectomized patients. A voice-producing element (VPE) is developed, based on the double-membrane concept, to supply the laryngectomized patients with a better substitute voice. Materials and methods: The VPE is comprised of two elastic membranes inside a circular housing that can be inserted in a shunt valve. Four identical prototypes were manufactured and tested in-vitro under physiological conditions. Prototypes were also tested in 17 female laryngectomised patients. An aerodynamic and acoustical analysis was performed, the maximum phonation time, speech rate and intonation capability determined. Finally the voice was perceptual evaluated. Results: Basic sound, containing multiple harmonics, was successfully produced under physiologic air pressure and airflow conditions. The fundamental frequency and sound pressure level could be controlled by changing the driving pressure, thus enabling sufficient intonation. The obtained frequency range (190 - 350 Hz) is appropriate for producing a female voice. The VPE produced a sound with a low noise-to-harmonics ratio (mean 0.15), the efficiency of sound production (5.5.10(-5)) is comparable to normal vocal folds. The clinical study clearly showed that the pitch and sound intensity were increased without an unacceptable increase in driving lung pressure. The flow rates were lower than normal, leading to significantly longer phonation times. Accumulation of mucus did not interfere with speech production. Conclusion: Functional restoration of the voice after laryngectomy with a VPE, based on the double-membrane concept, appears a feasible concept for female laryngectomized patients or patients with a hypo-or atonic PE segment.

Despite state of the art tracheo-esophageal (TE) voice-rehabilitation after laryn-gectomy, some patients are unable to produce voice of sufficient quality, because of hypotonicity or atonicity of their pharyngo-esophageal (PE) segment. Furthermore, the TE voice is low pitched, which presents a problem especially for female laryngectomized patients. A voice-producing element (VPE) is developed, based on the double-membrane concept, to supply the laryngectomized patients with a better substitute voice. The VPE is comprised of two elastic membranes inside a circular housing that can be inserted in a shunt valve. Four identical prototypes were manufactured and tested in-vitro under physiological conditions. Prototypes were also tested in 17 female laryngectomised patients. An aerodynamic and acoustical analysis was performed, the maximum phonation time, speech rate and intonation capability determined. Finally the voice was perceptual evaluated. Basic sound, containing multiple harmonics, was successfully produced under physiologic air pressure and airflow conditions. The fundamental frequency and sound pressure level could be controlled by changing the driving pressure, thus enabling sufficient intonation. The obtained frequency range (190 - 350 Hz) is appropriate for producing a female voice. The VPE produced a sound with a low noise-to-harmonics ratio (mean 0.15), the efficiency of sound production (5.5-10(-5)) is comparable to normal vocal folds. The clinical study clearly showed that the pitch and sound intensity were increased without an unacceptable increase in driving lung pressure. The flow rates were lower than normal, leading to significantly longer phonation times. Accumulation of mucus did not interfere with speech production. In conclusion, functional restoration of the voice after laryngectomy with a VPE, based on the double-membrane concept, appears a feasible concept for female laryngectomized patients or patients with a hypo- or atonic PE segment.

Despite state of the art tracheo-esophageal (TE) voice-rehabilitation after laryn-gectomy, some patients are unable to produce voice of sufficient quality, because of hypotonicity or atonicity of their pharyngo-esophageal (PE) segment. Furthermore, the TE voice is low pitched, which presents a problem especially for female laryngectomized patients. A voice-producing element (VPE) is developed, based on the double-membrane concept, to supply the laryngectomized patients with a better substitute voice. The VPE is comprised of two elastic membranes inside a circular housing that can be inserted in a shunt valve. Four identical prototypes were manufactured and tested in-vitro under physiological conditions. Prototypes were also tested in 17 female laryngectomised patients. An aerodynamic and acoustical analysis was performed, the maximum phonation time, speech rate and intonation capability determined. Finally the voice was perceptual evaluated. Basic sound, containing multiple harmonics, was successfully produced under physiologic air pressure and airflow conditions. The fundamental frequency and sound pressure level could be controlled by changing the driving pressure, thus enabling sufficient intonation. The obtained frequency range (190 - 350 Hz) is appropriate for producing a female voice. The VPE produced a sound with a low noise-to-harmonics ratio (mean 0.15), the efficiency of sound production (5.5-10(-5)) is comparable to normal vocal folds. The clinical study clearly showed that the pitch and sound intensity were increased without an unacceptable increase in driving lung pressure. The flow rates were lower than normal, leading to significantly longer phonation times. Accumulation of mucus did not interfere with speech production. In conclusion, functional restoration of the voice after laryngectomy with a VPE, based on the double-membrane concept, appears a feasible concept for female laryngectomized patients or patients with a hypo- or atonic PE segment.

Introduction: Despite state of the art tracheo-esophageal (TE) voice-rehabilitation after laryngectomy, some patients are unable to produce voice of sufficient quality, because of hypotonicity or atonicity of their pharyngo-esophageal (PE) segment. Furthermore, the TE voice is low pitched, which presents a problem especially for female laryngectomized patients. A voice-producing element (VPE) is developed, based on the double-membrane concept, to supply the laryngectomized patients with a better substitute voice.Materials and methods: The VPE is comprised of two elastic membranes inside a circular housing that can be inserted in a shunt valve. Four identical prototypes were manufactured and tested in-vitro under physiological conditions.Prototypes were also tested in 17 female laryngectomised patients. An aerodynamic and acoustical analysis was performed, the maximum phonation time, speech rate and intonation capability determined. Finally the voice was perceptual evaluated.Results: Basic sound, containing multiple harmonics, was successfully produced under physiologic air pressure and airflow conditions. The fundamental frequency and sound pressure level could be controlled by changing the driving pressure, thus enabling sufficient intonation. The obtained frequency range (190 - 350 Hz) is appropriate for producing a female voice. The VPE produced a sound with a low noise-to-harmonics ratio (mean 0.15), the efficiency of sound production (5.5.10(-5)) is comparable to normal vocal folds.The clinical study clearly showed that the pitch and sound intensity were increased without an unacceptable increase in driving lung pressure. The flow rates were lower than normal, leading to significantly longer phonation times. Accumulation of mucus did not interfere with speech production.Conclusion: Functional restoration of the voice after laryngectomy with a VPE, based on the double-membrane concept, appears a feasible concept for female laryngectomized patients or patients with a hypo-or atonic PE segment.

Despite state of the art tracheo-esophageal (TE) voice-rehabilitation after laryn-gectomy, some patients are unable to produce voice of sufficient quality, because of hypotonicity or atonicity of their pharyngo-esophageal (PE) segment. Furthermore, the TE voice is low pitched, which presents a problem especially for female laryngectomized patients. A voice-producing element (VPE) is developed, based on the double-membrane concept, to supply the laryngectomized patients with a better substitute voice.The VPE is comprised of two elastic membranes inside a circular housing that can be inserted in a shunt valve. Four identical prototypes were manufactured and tested in-vitro under physiological conditions.Prototypes were also tested in 17 female laryngectomised patients. An aerodynamic and acoustical analysis was performed, the maximum phonation time, speech rate and intonation capability determined. Finally the voice was perceptual evaluated.Basic sound, containing multiple harmonics, was successfully produced under physiologic air pressure and airflow conditions. The fundamental frequency and sound pressure level could be controlled by changing the driving pressure, thus enabling sufficient intonation. The obtained frequency range (190 - 350 Hz) is appropriate for producing a female voice. The VPE produced a sound with a low noise-to-harmonics ratio (mean 0.15), the efficiency of sound production (5.5-10(-5)) is comparable to normal vocal folds.The clinical study clearly showed that the pitch and sound intensity were increased without an unacceptable increase in driving lung pressure. The flow rates were lower than normal, leading to significantly longer phonation times. Accumulation of mucus did not interfere with speech production.In conclusion, functional restoration of the voice after laryngectomy with a VPE, based on the double-membrane concept, appears a feasible concept for female laryngectomized patients or patients with a hypo- or atonic PE segment.

Background. A sound generator based on a double-membrane design that fits into a regular tracheoesophageal shunt valve may improve voice quality after total laryngectomy in patients rehabilitated with surgical voice prostheses.Methods. Voice-producing element (VPE) prototypes were manufactured using medical grade biocompatible materials and tested in vitro under physiological conditions.Results. Basic sound, containing multiple harmonics, was successfully produced under physiologic air pressure and airflow conditions. The fundamental frequency and sound pressure level (SPL) is controlled by changing the driving pressure, thus enabling sufficient intonation for day-to-day speech. The obtained frequency range (190-350 Hz) is appropriate for producing a female voice. The low noise-to-harmonics ratio (mean 0.15) and also the efficiency of sound production (5.5 X 10(-5) at 80 dB(A) and 0.15 m microphone distance) is comparable to that of normal vocal folds.Conclusions. Functional restoration of the voice after laryngectomy with a double-membrane VPE appears to be a feasible concept for female laryngectomized patients with a hypetonic, or atonic pharyngoesophageal segment. (c) 2007 Wiley Periodicals, Inc.

For voice rehabilitation after total laryngectomy a shunt valve is usually placed in the tracheo-esophageal (TE) wall, thereby enabling the production of a TE voice. Some patients, however, are unable to produce a voice of sufficient quality. Furthermore, the TE voice is low pitched, which presents a problem especially for female laryngectomized patients. The voice quality after laryngectomy might be improved by introducing a voice-producing element (VPE) into the TE shunt valve. In this study a sound generator was developed that is suitable for application in such a VPE. This sound generator consists of two elastic membranes placed parallel inside a circular housing. A substitute voice source is created when the membranes start to vibrate via a constant flow of air passing between them. To determine the optimal membrane configuration for proper functioning under physiological conditions, up-scaled physical VPE models with different membrane geometries were evaluated using in vitro experimental tests. For certain membrane geometries the tests showed that a basic sound, containing multiple harmonics, could be successfully produced under physiological air pressure and airflow conditions. The fundamental frequency (60-95 Hz) and sound pressure level (57-78 dB, at 15 cm microphone distance) were regulated via changes in the driving pressure, thereby enabling the possibility of intonation in laryngectomized patients' speech. The obtained frequency range is considered appropriate for producing a substitute voice source for female patients. The geometry considerations in this study can be used for the development of a true scale VPE that can be evaluated clinically, to eventually replace the voice after laryngectomy.