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Total laryngectomy (TL) affects critical functions such as swallowing, coughing and speaking. An artificial, bio-engineered larynx (ABL), operated via myoelectric signals, may improve quality of life for TL patients. To evaluate the efficacy of using surface electromyography (sEMG) as a control signal to predict instances of swallowing, coughing and speaking, sEMG was recorded from submental, intercostal and diaphragm muscles. The cohort included TL and control participants. Swallowing, coughing, speaking and movement actions were recorded, and a range of classifiers were investigated for prediction of these actions. Our algorithm achieved F1-scores of 76.0 ± 4.4 % (swallows), 93.8 ± 2.8 % (coughs) and 70.5 ± 5.4 % (speech) for controls, and 67.7 ± 4.4 % (swallows), 71.0 ± 9.1 % (coughs) and 78.0 ± 3.8 % (speech) for TLs, using a random forest (RF) classifier. 75.1 ± 6.9 % of swallows were detected within 500 ms of onset in the controls, and 63.1 ± 6.1 % in TLs. sEMG can be used to predict critical larynx movements, although a viable ABL requires improvements. Results are particularly encouraging as they encompass a TL cohort. An ABL could alleviate many challenges faced by laryngectomees. This study represents a promising step toward realising such a device.

Patients who have lost vocal cord function due to laryngeal cancer or laryngeal injury are incapable of speech because it is impossible to generate the laryngeal tone from which the voice originates. For such patients, various speech production substitutes have been devised and put into practical use. The electrolarynx is one of these speech production substitutes and it can be used with relative ease. However, the sound is sometimes difficult to hear and its quality is monotonous. Therefore, focusing on the control method to improve the articulation of the electrolarynx, we have proposed an electrolarynx controlled by myoelectric signals of the neck. The sternohyoid muscle, which is located in the superficial layer of the neck, was the source of the myoelectric signals. This muscle is active during speech, and its activity increases mainly at the time of speech in a low voice. We succeeded in detecting the surface myoelectric signals of the sternohyoid muscle and performing on/off control of the electrolarynx by signal processing. This report includes the derivation of a control function for converting into a control signal of the fundamental frequency of the electrolarynx from the relationship between the myoelectric signals and the fundamental frequency of the voice. This report also includes an evaluation of the controllability of the electrolarynx by comparing the obtained control signal with the user’s intention. Regarding the control of the fundamental frequency, we have proposed a method of control in three stages – high, medium, and low – and a method of control in two stages – high and low – and compared their performances. The results of the three-stage control indicated that the use of the logarithm as a control function for converting the myoelectric signals into the fundamental frequency of the electrolarynx succeeded in the control at an accuracy of 90% or more by changing the pitch of the generated sound depending on the subjects. It was also indicated that the error rate was as low as less than 20%, while maintaining a constant sound. This makes it clear that the use of the logarithm as a control function gives the highest controllability. The two-stage control exhibits a very high control success rate exceeding 90%, regardless of the type of control function; in particular, the control function using the logarithm exhibits a control success rate exceeding 95%. These results indicate that the electrolarynx control function obtained using the logarithmic function has excellent controllability.

Summary Objectives The purpose of the present study was to establish the method for an acoustic simulation of a vocal tract created from CT data during phonation of the Japanese vowel /a/ and to verify the validity of the simulation. Material and methods The subjects were 15 healthy adults (8 males, 7 females). The vocal tract model was created from CT data acquired during sustained phonation of the Japanese vowel /a/. After conversion to a mesh model for analysis, a wave acoustic analysis was performed with a boundary element method. The wall and the bottom of the vocal tract model were regarded as a rigid wall and a nonrigid wall, respectively. The acoustic medium was set to 37°C, and a point sound source was set in the place corresponding to the vocal cord as a sound source. The first and second formant frequencies (F1 and F2) were calculated. For 1 of the 15 subjects, the range from the upper end of the frontal sinus to the tracheal bifurcation was scanned, and 2 models were created: model 1 included the range from the frontal sinus to the tracheal bifurcation; and model 2 included the range from the frontal sinus to the glottis and added a virtually extended trachea by 12 cm cylindrically. F1 and F2 calculated from models 1 and 2 were compared. To evaluate the validity of the present simulation, F1 and F2 calculated from the simulation were compared with those of the actual voice and the sound generated using a solid model and a whistle-type artificial larynx. To judge the validity, the vowel formant frequency discrimination threshold reported in the past was used as a criterion. Namely, the relative discrimination thresholds (%), dividing ▵F by F, where F was the formant frequency calculated from the simulation, and ▵F was the difference between F and the formant frequency of the actual voice and the sound generated using the solid model and artificial larynx, were obtained. Results F1 and F2 calculated from models 1 and 2 were similar. Therefore, to reduce the exposure dose, the remaining 14 subjects were scanned from the upper end of the frontal sinus to the glottis, and model 2 with the trachea extended by 12 cm virtually was used for the simulation. The averages of the relative discrimination thresholds against F1 and F2 calculated from the actual voice were 5.9% and 4.6%, respectively. The averages of the relative discrimination thresholds against F1 and F2 calculated from the sound generated by using the solid model and the artificial larynx were 4.1% and 3.7%, respectively. Conclusions The Japanese vowel /a/ could be simulated with high validity for the vocal tract models created from the CT data during phonation of /a/ using the boundary element method.

Aims. Total laryngectomy still plays an essential part in the treatment of laryngeal cancer and loss of voice is the most feared consequence of the surgery. Commonly used rehabilitation methods include esophageal voice, electrolarynx, and implantation of voice prosthesis. In this paper we focus on a new perspective of vocal rehabilitation utilizing alternative and augmentative communication (AAC) methods. Methods and Patients. 61 consecutive patients treated by means of total laryngectomy with or w/o voice prosthesis implantation were included in the study. All were offered voice banking and personalized speech synthesis (PSS). They had to voluntarily express their willingness to participate and to prove the ability to use modern electronic communication devices. Results. Of 30 patients fulfilling the study criteria, only 18 completed voice recording sufficient for voice reconstruction and synthesis. Eventually, only 7 patients started to use this AAC technology during the early postoperative period. The frequency and total usage time of the device gradually decreased. Currently, only 6 patients are active users of the technology. Conclusion. The influence of communication with the surrounding world on the quality of life of patients after total laryngectomy is unquestionable. The possibility of using the spoken word with the patient's personalized voice is an indisputable advantage. Such a form of voice rehabilitation should be offered to all patients who are deemed eligible.

Summary Aim Previous reports have demonstrated good outcomes with the use of the Anterolateral Thigh Flap (ALT) in pharyngeal reconstruction. We report a new modification of free ALT flap pharyngeal reconstruction utilizing vascularised fascial wings or extensions placed in the parastomal gutters to cover the major neck vessels. Patients and methods This was a single-centre retrospective case review. Between November 2017 and January 2019, 8 patients (6 male, 2 female mean age 61, range 35 to 74) underwent near circumferential pharyngeal reconstruction by the modified technique. 3 patients had laryngopharyngectomy for radiorecurrent larynx SCC, 2 for primary, advanced laryngeal SCC, and 3 for primary hypopharyngeal SCC. Results All eight patients regained adequate swallow to maintain nutrition without tube-feeding. Two of the patients have been assessed as appropriate for tracheo-esophageal puncture and are awaiting placement. One patient uses an electrolarynx for speech and 5 patients aphonic only. One patient died 2 months after the procedure from chest infection. There were no flap failures, no fistulas and no strictures at one year. One patient who underwent a salvage laryngopharyngectomy experienced parastomal wound dehiscence, but critically there was no return to theatre for exposed major vessels and the wound healed within 6 weeks requiring dressings only. Conclusion Here we report outcomes of pharyngeal reconstruction with a modified single perforator free ALT flap using fascial extensions to line the parastomal gutters. In the event of parastomal dehiscence, the placement of vascularized tissue parastomally may facilitate spontaneous healing and prevent major vessel exposure.

Purpose: Following a total laryngectomy in which the larynx is completely removed, individuals in the USA have three primary options for alaryngeal verbal communication including tracheoesophageal speech (TES), oesophageal speech (ES) and electrolarynx (EL). Using a large sample of participants from across the USA, this study investigated listener impressions of each primary type of alaryngeal communication. As these are the individuals more likely to be participating in social interactions and in positions of hiring for employment, the general public's impressions of TES, ES and EL may be a vital consideration during the treatment process.Method: A total of 381 individuals rated eight speech samples, including samples from speakers of each alaryngeal communication modality as well samples from age and sex matched laryngeal speakers, with regards to three outcome measures: intelligence, likability and employability.Result: Listener impressions of alaryngeal speech samples were modulated by the type of communication mode. Further, the patterns of results differed by speaker sex, with ES speech rated consistently more favourable for female speakers across all outcome measures and TES rated consistently more favourable for male speakers across all outcome measures.Conclusion: An overall preference for laryngeal speech was noted, particularly with male speakers. The female ES stimuli, interestingly, was the highest rated alaryngeal communication modality. Regardless of speaker sex, all alaryngeal modes greatly affected impressions of employability relative to impressions of likeability and intelligence.

The electrolarynx (EL) is an electromechanical device that enables patients to produce voice following the surgical removal of their larynx. The purpose of this study is to understand the acoustic and perceptual characteristics of Mandarin consonants produced by EL speakers. First, the acoustic characteristics (including speech intensity, consonant duration, spectral peak, and F2 onset) of Mandarin EL consonants are investigated by comparing the EL and normal consonants. Then, a perceptual evaluation of EL consonants is conducted to identify the relationship between acoustical characteristics and perceptual intelligibility. The results suggest three consonant confusion types are mainly responsible for the poor intelligibility of Mandarin EL consonants: (1) the “unaspirated-for-aspirated” confusion caused by the significantly shortened voice onset time of aspirated consonants; (2) the “voiced-for-voiceless” confusion caused by the continuous pulsing of the EL device and low consonant intensity; and (3) the “perceptual omission” caused by low intensity of consonants and / or consonant omission. The results obtained are promising and potential for further improvements in Mandarin EL speech intelligibility.

OBJECTIVE Traditionally, after total laryngopharyngectomy (TLP), patients cannot speak without a prosthesis or an artificial larynx. In Taiwan, most patients use a commercialized pneumatic laryngeal device (PLD). Phonatory tube reconstruction with the anterolateral thigh (ALT) flap is a novel, modified version of synchronous digestive and phonatory reconstruction involving a free muscular cutaneous flap. This study reviewed and compared speech performance between patients who underwent novel flap reconstruction and conventional PLD users. METHOD We retrospectively reviewed patients with laryngeal or hypopharyngeal cancer who underwent TLP from August 2017 to September 2019. The voice handicap index (VHI), speech intelligibility, acoustic and aerodynamic analysis results, and speech range profile (SRP) were compared between patients who underwent ALT phonatory tube reconstruction (ALT group) and those using PLDs (PLD group). RESULTS Twenty patients were included; 13 patients were included in the ALT group, and 7 patients were included in the PLD group. Compared to the PLD group, the ALT group had a better fundamental frequency range (P

Purpose The aim of this study is to use functional magnetic resonance (fMRI) to analyse the cortical presentation of selected language functions in patients after a total laryngectomy. Methods Eighteen patients after total laryngectomy treated with electrolarynx speech and 18 volunteers were included. The mean number of patients’ post-operative speech rehabilitation sessions was five (range of 3–8 sessions). Four paradigms were used, including noun generation, pseudoword reading, reading phrases with pseudowords, and nonliteral sign reproduction. Results In noun, the most significant difference between the groups was the stronger activation of both lingual gyri in the volunteers. Pseudoword reading resulted in stronger activations in patients than in volunteers in the lingual gyri, the right cerebellum, the right Broca’s area, and the right parietal operculum. Reading phrases with pseudowords involved different parts of the Brodmann area 40. During nonliteral sign reproduction, there was a stronger activation of the left Broca’s area in volunteers and a stronger activation of the left premotor cortex in patients. Conclusion This study provides evidence of altered cortical activation in response to language tasks in patients after a laryngectomy compared with healthy volunteers, which may be considered brain plasticity in response to a laryngectomy.

The sound of a 3,000 year old mummified individual has been accurately reproduced as a vowel-like sound based on measurements of the precise dimensions of his extant vocal tract following Computed Tomography (CT) scanning, enabling the creation of a 3-D printed vocal tract. By using the Vocal Tract Organ, which provides a user-controllable artificial larynx sound source, a vowel sound is synthesised which compares favourably with vowels of modern individuals.

Background The main modalities for voice restoration after laryngectomy are the electrolarynx, and the tracheoesophageal puncture [Correction added on 30 January 2020 after first online publication: The preceding sentence has been revised. It originally read "The main modalities for voice restoration after laryngectomy are the electrolarynx and the tracheoesophageal puncture."]. All have limitations and new technologies may offer innovative alternatives via silent speech. Objective To describe a novel and personalized method of voice restoration using machine learning applied to electromyographic signal from articulatory muscles for the recognition of silent speech in a patient with total laryngectomy. Methods Surface electromyographic (sEMG) signals of articulatory muscles were recorded from the face and neck of a patient with total laryngectomy who was articulating words silently. These sEMG signals were then used for automatic speech recognition via machine learning. Sensor placement was tailored to the patient's unique anatomy, following radiation and surgery. A personalized wearable mask covering the sensors was designed using 3D scanning and 3D printing. Results Using seven sEMG sensors on the patient's face and neck and two grounding electrodes, we recorded EMG data while he was mouthing "Tedd" and "Ed." With data from 75 utterances for each of these words, we discriminated the sEMG signal with 86.4% accuracy using an XGBoost machine-learning model. Conclusions This pilot study demonstrates the feasibility of sEMG-based alaryngeal speech recognition, using tailored sensor placement and a personalized wearable device. Further refinement of this approach could allow translation of silently articulated speech into a synthesized voiced speech via portable devices.

Alaryngeal speech in laryngectomees has revolutionized the patient outlook toward the morbid procedure and the concept of permanent stoma unlike olden era when stigma of stoma with loss of voice was rampant. To analyse acceptance of voice rehabilitation options and their success and management of complications in a tertiary care centre. All patients who underwent laryngectomy from August 2014 to 2018 June at our institution were included in the study. The voice rehabilitation options like oesophageal speech, tracheao-oesophageal puncture and voice prosthesis insertion (TEP), and electrolarynx were explained to the patients. The options put forward to the patients, the importance of Taub test, Interval between treatment and secondary TEP insertion, life span of the prosthesis, Patients acceptance and success rates and the troubleshooting were noted. A total of 96 patients underwent total laryngectomy, 72 patients were willing for rehabilitation. 15% (11) patients had primary TEP, 22% (16) had secondary TEP insertion, esophageal speech in 36% (26) patients and 27% (19) patients opted for the electrolarynx. The rest 24 patients were not keen on any further interventions after laryngectomy. Speech rehabilitation is an integral part in surgical management of carcinoma of the larynx. Alaryngeal speech in laryngectomees have revolutionized the patient outlook towards the morbid procedure. Esophageal speech is the least successful method of rehabilitation but still the cheapest method and requires a lot of motivation. Primary and Secondary TEP insertions have similar success rates. Successful treatment for cancer of larynx ends with successful voice rehabilitation.

Communication adjustment from patients' perspective is paramount to ensure optimization of voice rehabilitation post laryngectomy. Very few specific self-rating tools exist with the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) having the most evidence regarding validity, reliability and clinical utility.This study aimed to translate and validate a Bahasa Malaysia version of SECEL (mSECEL) using a validated framework of transcultural adaptation.This cross-sectional study was conducted in the Otorhinolaryngology, Department of Universiti Kebangsaan Malaysia Medical Centre from February 2019 to May 2020. The mSECEL was produced following a rigorous forward and backward translation. Eighty-three laryngectomees (78 male, five female) using various methods of alaryngeal communication (47 voice prosthesis, 29 electrolarynx, three esophageal speech and four pen and paper), completed the mSECEL and mVHI-10 before head and neck and flexible laryngoscopic examinations. The mSECEL was repeated in 2 weeks via telephone interview or clinic visit. Its reliability was assessed using intraclass correlation. The Pearson product-moment correlation test was used to analyze correlation between the mSECEL and mVHI-10.The mSECEL questionnaire showed strong internal consistency with the Cronbach alpha of0.90 for total score, Environmental and Attitude subscale. The test-retest reliability for total mSECEL score was high with the intraclass correlation of 0.97. There was a highly significant positive correlation between the mSECEL total score and mVHI-10 (P0.001). Items in the General subscale showed poorer internal consistency with Cronbach alpha ranging 0.55-0.46 and poor correlation with mVHI-10.The Bahasa Malaysia version of the SECEL measure is a valid and reliable instrument to evaluate communication perception after laryngectomy. Future studies should consider subscale validation and further abbreviation of its items to make this measure clinically relevant.

Background/Aim: The purpose of this study was to provide preliminary data concerning the effect of clear speech (CS) on Cantonese alaryngeal speakers’ intelligibility. Methods: Voice recordings of 11 sentences randomly selected from the Cantonese Sentence Intelligibility Test (CSIT) were obtained from 31 alaryngeal speakers (9 electrolarynx [EL] users, 10 esophageal speakers and 12 tracheoesophageal [TE] speakers) in habitual speech (HS) and CS. Two naïve listeners orthographically transcribed a total of 1,364 sentences. Results: Significant effects of speaking condition on speaking rate and CSIT scores were observed, but no significant effect of alaryngeal communication methods was noted. CS was significantly slower than HS by 0.78 syllables/s. Esophageal speakers demonstrated the slowest speech rate when using CS, while EL users demonstrated the largest decrease in speaking rate when using CS compared to HS. TE speakers had the highest CSIT scores in HS (listener 1 = 81.4%; listener 2 = 81.3%), and esophageal speakers had the highest CSIT scores in CS (listener 1 = 87.5%; listener 2 = 89.7%). EL users experienced the largest increase in intelligibility while using CS compared to HS (9.1%) followed by esophageal speakers (8.9%) and TE speakers (1.4%). Conclusion: Preliminary data indicate that CS may significantly affect Cantonese alaryngeal speakers’ speaking rate and intelligibility. However, intelligibility appeared to vary considerably across speakers. Further research involving larger, heterogeneous groups of speakers and listeners alongside longer and more refined CS training protocols should be conducted to confirm that CS can improve Cantonese alaryngeal speakers’ intelligibility.

Voice is one of the essential mechanisms for communicating and expressing one’s intentions as a human being. There are several causes of voice inability, including disease, accident, vocal abuse, medical surgery, ageing, and environmental pollution, and the risk of voice loss continues to increase. Novel approaches should have been developed for speech recognition and production because that would seriously undermine the quality of life and sometimes leads to isolation from society. In this review, we survey mouth interface technologies which are mouth-mounted devices for speech recognition, production, and volitional control, and the corresponding research to develop artificial mouth technologies based on various sensors, including electromyography (EMG), electroencephalography (EEG), electropalatography (EPG), electromagnetic articulography (EMA), permanent magnet articulography (PMA), gyros, images and 3-axial magnetic sensors, especially with deep learning techniques. We especially research various deep learning technologies related to voice recognition, including visual speech recognition, silent speech interface, and analyze its flow, and systematize them into a taxonomy. Finally, we discuss methods to solve the communication problems of people with disabilities in speaking and future research with respect to deep learning components.

Objectives currently, only tracheostomy is available for people who have had a total laryngectomy, and no solution exist for people with swallowing disorders. Yet, muscles activity produces measurable vibrations, known as MechanoMyoGraphy (MMG), and is regarded as the mechanical counterpart of electromyography. Besides, we have already shown the possibility to control an artificial urinary sphincter with the MMG signal measured in the abdomen [1] . Therefore, the goal of this long-term work is to use this method to allow to predict a deglutition and command an active artificial larynx. So, the present paper analyses the MMG signal acquired in the submental area, which contains anterior suprahyoid (SH) muscles and the floor of the tongue. Indeed, one function of SH muscles is to support the tongue, which in turn is highly involved in the propulsive phase of swallowing and follow a relatively stereotypical pattern. Lastly, the localization of the bolus is of prime interest to defines the ultimate and available detection times. Thus, the swallowing sound was also recorded on the throat, as it has been shown to allow to locate the bolus. Material and methods we recorded MMG and swallowing sound signals with tow accelerometers in submental area and the throat of 39 people. Each participant completed water, saliva and solid food swallow, seated on a chair, and was asked to remain still. Four benchmarks were place in the signals to differentiate swallowing phases and signal's components and timings. We also looked for any influence of age, height and weight in corresponding timings. Results a characteristic pattern has been registered in most of recordings. The benchmarks allowed to display a minimum average available time of 0.324 sec (0.125–0.786). Age and weight had a noticeable impact on the timings. Conclusion these findings hint toward the possible detection of swallowing via MMG signals from submental area.

Purpose The purpose of this study was to report the variability of electrolarynx (EL) users' speech intelligibility in quiet and in multitalker babble. Method Ten EL users (five Servox® Digital, five TruTone™) who were at least 2 years postlaryngectomy provided recordings of five sentences from the 1965 Revised List of Phonetically Balanced Sentences. Recordings were judged by two groups of naïve listeners in quiet and in the presence of multitalker babble. Fifteen listeners orthographically transcribed a total of 750 sentences containing 3,750 key words in quiet, and another 15 listeners orthographically transcribed the same sentences mixed with multitalker babble. Results Significant differences in speech intelligibility were observed between listening conditions; 17.9% more key words were correctly identified in quiet compared to multitalker babble. Significant differences in fundamental frequency (F 0 ) standard deviation and range but not speech intelligibility were observed between EL device types. A positive correlation of moderate significance was observed between F 0 standard deviation and intelligibility for TruTone users in multitalker babble. Conclusions Findings suggest that listeners are able to identify a significantly higher percentage of EL users' speech in quiet compared to multitalker babble, but a large variability in EL users' speech intelligibility exists. Continued investigation involving a larger number of EL users is necessary to confirm this study's findings. Future research should explore the relationships among F 0 measures, speaker characteristics (e.g., rate of speech, articulatory precision), and speech intelligibility, in addition to improving alaryngeal rehabilitation training protocols for EL users.

This study evaluated the effectiveness of using visual feedback to facilitate pitch control by a speaker using a pressure sensitive onset controlled electrolarynx (EL). This proof-of-concept study was conducted with one healthy adult. The participant-speaker was provided with computer generated visual feedback over five sessions within a consecutive period of three weeks. Changes in force control accuracy were gathered and analyzed. An improvement in finger (thumb) force control accuracy from the first to the last training session was documented. The results of this study provide data toward the development of a clinical training protocol for the use of a pressure sensitive onset controlled EL by laryngectomized speakers. Further, these results highlight the importance of developing a relevant multimodality training protocol for the improvement of postlaryngectomy EL speech production.

Introduction The impact of advanced laryngeal cancer and its extensive surgical treatments cause significant morbidity for these patients. Total laryngectomy impacts essential functions such as breathing, communication and swallowing, and may influence the quality of life as well as affecting the social life of laryngeal cancer patients. Objective Describe the quality of life and analyze the factors associated with the reduced quality of life in patients who have undergone total laryngectomy. Method Observational cross-sectional study was carried out to evaluate the quality of life of patients who had undergone total laryngectomy due to laryngeal cancer. The fourth version of the UW-QOL Quality of Life Assessment Questionnaire from Washington University, validated for Portuguese, was used. Results The study population was 95 patients, and the mean composite score of the QOL was 80.4. In the subjective domains the majority of the patients (38.9%) reported they felt much better at present compared to the month before being diagnosed with cancer. When questioned about how they evaluated their health-related quality of life, there was a predominance of those who considered it good (43.2%), and most considered they had a good quality of life (46.3%) considering personal well-being. The overall quality of life was considered good to excellent by 83.2% of the patients. Patients with tracheoesophageal prosthesis reported a better quality of life, compared to patients using an electrolarynx or esophageal voice. Conclusion The high mean value of the composite score for quality of life revealed that the patients assessed their quality of life positively. The absence of vocal emission was the only variable associated with a lower quality of life within the composite score according to the UW-QOL questionnaire.

Voice is very important in our daily life. However, some people cannot speak because of throat surgery. Electrolarynx (EL) is a way for them to speak again but this voice is flat and noisy like a buzzer. Therefore, we propose a new Electrolarynx system based on WaveRNN. When we use it, the EL voice is converted into a voice close to the natural voice. We assume that this system will be provided as a smartphone application. In the experiment, we evaluated the converted voice by the system and found that naturalness improved.

PurposeTo assess feasibility of producing intelligible and comprehensible speech with an electrolarynx; measure anxiety, communication ease, and satisfaction before/after electrolarynx training; and identify barriers/facilitators.MethodsWe included tracheostomized adults from 3 units following commands, reading English, and mouthing words. On enrolment, we measured anxiety, ease, and satisfaction with communication. We gave electrolarynx instruction for ≤5 days then 2 independent raters assessed intelligibility, sentence comprehensibility (9-point difficulty scale), and Electrolarynx Effectiveness Score (EES), and re-evaluated anxiety, communication ease, and satisfaction. Interviews explored barriers/facilitators.Measurements and main resultsWe recruited 24 participants (Jan2015-Dec2016). Mean (SD) intelligibility was 45%(18%) words correct: 57%(21%) when facing. Mean comprehension difficulty was 6.4(2.0) overall, indicating moderate difficulty (5.5(2.5) scored visualizing). Mean EES was 2.9(1.0) (3 = improved lip-reading through recognizable sounds). Anxiety decreased from median 3.8 to 2.0 (P = .007). Communication was rated easier (median 15 vs 12, P = .04) whereas satisfaction remained similar (P = .06). Facilitators included device friendliness, patient independence, and word intelligibility. Barriers were patient weakness, difficulty positioning the device, and limited sentence as opposed to word intelligibility.ConclusionThe electrolarynx may aid intelligible speech for some tracheostomized patients if the communication partner can visualize the users face, and reduce anxiety and make patient perceived communication easier.

Purpose To determine the influence of clear speech on auditory-perceptual judgments of speech acceptability and listener comfort for electrolaryngeal speech. Method Voice recordings were obtained from 10 electrolaryngeal speakers. Each speaker read the Rainbow Passage in two conditions: habitual speech and clear speech. Speakers were encouraged to speak as clearly as possible and over-articulate in the clear speech condition. Auditory-perceptual rating tasks were completed by 20 normal-hearing adults who evaluated 20 randomized voice recordings. Two counterbalanced listening sessions were used to gather ratings of speech acceptability and listener comfort. Results A significant effect of speaking condition was found on listener judgments of speech acceptability, but not listener comfort. However, listener scores for speech acceptability and listener comfort were found to be significantly related. For all speakers, objective temporal measures indicated reduced speaking rates in the clear speech condition. Conclusions These findings suggest that volitional attempts to improve electrolaryngeal speech using clear speech might negatively impact listener judgments of speech acceptability, but not listener comfort. Further, the data suggest that speech acceptability and listener comfort might address unique perceptual entities. Overall, the strong relationship between these auditory-perceptual dimensions provide support for the use of scaled measurements to assess the impact of speech rehabilitation on individuals who use the electrolarynx.

Purpose Perceived listening effort is a perceptual dimension used to identify the amount of work necessary to understand disordered speech. The purpose of this study was to investigate the utility of perceived listening effort to provide unique information about disordered speech. The relationships between perceived listening effort and two current outcome measures (speech acceptability, intelligibility) were examined for listeners rating electrolaryngeal speech, along with their reliability and intra-rater agreement. Methods Ten healthy male speakers read low-context sentences using an electrolarynx. Twenty-five inexperienced listeners orthographically transcribed and rated the stimuli for perceived listening effort and speech acceptability using a visual analog scale. Strict reliability and agreement criteria were set. Results Perceived listening effort was moderately to strongly correlated with intelligibility (r = −0.76) and acceptability (r = −0.80), each of which contributed uniquely to ratings of perceived listening effort. However, only 17 listeners met stringent reliability and agreement criteria. Conclusions Ratings of perceived listening effort may provide unique information about the communicative success of individuals with communication disorders. There is great variability, however, among inexperienced listeners’ perceptual ratings of electrolaryngeal speech. Future research should investigate variables that may affect perceived listening effort specifically and auditory-perceptual ratings in general.

Background Esophageal speech (ES), tracheoesophageal speech (TES) and/or electrolarynx speech (ELS) are three speech rehabilitation methods which are commonly provided after total laryngectomy (TL). Methods A systematic review of the literature was conducted to evaluate comparative acoustic, perceptual, and patient-reported outcomes for ES, TES, ELS and healthy speakers. Results Twenty-six articles could be included. In most studies, methodological quality was low. It is likely that an inclusion bias exists, many studies only included exceptional speakers. Significant better outcomes are reported for TES compared to ES for the acoustic parameters, fundamental frequency, maximum phonation time and intensity. Perceptually, TES is rated with a significant better voice quality and intelligibility than ES and ELS. None of the speech rehabilitation groups reported clearly better outcomes in patient-reported outcomes. Conclusions Studies on speech outcomes after TL are flawed in design and represent weak levels of evidence. There is an urge for standardized measurement tools for evaluations of substitute voice speakers. TES is the favorable speech rehabilitation method according to acoustic and perceptual outcomes. All speaker groups after TL report a degree of voice handicap. Knowledge of caretakers and differences in health care and insurance systems play a role in the speech rehabilitation options that can be offered. Electronic supplementary material The online version of this article (doi:10.1007/s00405-017-4790-6) contains supplementary material, which is available to authorized users.

Background Effective interaction with orally intubated patients is important for critical care rehabilitation. An electrolarynx (EL) has reportedly proven useful for facilitating verbal communication during oral intubation. The EL allows patients to express their wishes instantly. Nevertheless, this method is not commonly applied, probably because articulation is often unsatisfactory. Here, we report a case of successful EL-based communication during early mobilization and describe the key factors involved in this success. Case An 82-year-old man, who was intubated and undergoing mechanical ventilation for the treatment of acute respiratory failure caused by severe pneumonia, was referred to the rehabilitation department for early mobilization. The patient tried to speak during the spontaneous awakening trials and breathing trials for weaning off mechanical ventilation. However, he was frustrated by communication difficulties and consequently exhibited negative behavior toward physical therapy. We attempted to use an EL to facilitate communication, but initially the patient failed to achieve intelligible articulation. We eventually established that the intubation tube should be located at the corner of the mouth to minimize the restriction of tongue movement. Intelligible sounds were recognized and successful communication between the patient and staff was subsequently achieved. Discussion The use of an EL is worthy of consideration during early mobilization of orally intubated patients. To achieve successful communication with an EL, both patient selection (Richmond Agitation-Sedation Scale score of 0 or -1) and the proper placement of the intubation tube are necessary to ensure intelligible articulation.

Background/Purpose: Hypopharyngeal squamous cell carcinomas (SCC) are generally diagnosed in an advanced disease stage. A total laryngopharyngoesophagectomy with gastric pull-up reconstruction is a time tested surgical treatment in our centre for resectable failures or recurrences after primary treatment with organ preservation protocols (radiotherapy or chemoradiation), or as a primary surgical treatment for very advanced hypopharyngeal tumors. We present the results of our approach in terms of success rate, postoperative complications and functional and oncologic outcomes. Methods: We retrospectively reviewed the charts of all patients with hypopharyngeal SCC, who underwent laryngopharyngoesophagectomy with gastric pull-up reconstruction during the period 1989-2015. Results: The cohort included 60 patients. Mean follow-up was 32 months. Stage III and stage IV disease was present in 35 and 60% of patients, respectively. Successful reconstruction by intended gastric transposition was possible in 98.3% of cases. The in-hospital mortality rate was 8.3%. Two-year and five-year actuarial overall survival were 39.5 and 21.1%, respectively. Two-year and five-year actuarial disease specific survival were 58.5 and 46.6%, respectively. Two-year and five-year actuarial locoregional recurrence free survival were both 49.5%. A significantly lower locoregional recurrence free survival was observed in patients with pN+ disease compared to pN0 (Log rank, p

Introduction Voice rehabilitation is the most important issue after total laryngectomy as source of vibration is removed. Three options are there like esophageal voice, electrolarynx and surgical prosthetic voice. Best is the prosthetic speech as voice is generated by lung powered air column. Provox prosthesis is the standard on and most commonly used. But it is costly for the class of patients presenting to our government hospitals. Duckbill prosthesis is very economical and may be helpful for them. There is very limited number of studies with duckbill prosthesis. Materials and Methods Twenty two post-laryngectomy patients was selected for this study. Proper counselling was done regarding cost, pros and cons of Provox and Duckbill prosthesis. Fifteen patient selected Duckbill where as seven patient have chosen Provox prosthasis. Voice analysis was done after one month of speech therapy by perceptual voice analysis protocol. Safety and complications arising from prosthesis were also noted. Results There was no significant difference in quality of voice.Both prosthesis are safe if prolong use is avoided. Conclusion There is no significant difference in the quality and safety of both the prosthesis, but huge difference in cost is present. More over it is recurrent cost as it should be changed every year or earlier. One Provox costs around rupees fifty thousand whereas a duckbill prosthesis costs rupees one thousand approximately in Indian market.

Surgical treatment of head and neck cancers may often be performed with a need for various degrees of neck dissection (ND). The extent of ND may vary from relatively local approaches to those that are more extensive. Additionally, ND may be done either unilaterally or bilaterally dependent upon the site and extension of the primary tumor. While ND is performed in order to achieve oncological safety, one of the more commonly reported postsurgical deficits is that related to changes in shoulder mobility. Further, decreases in the range of shoulder movement may often be associated with pain with subsequent limitations in functioning with secondary influence on quality of life. Collectively, restrictions in shoulder function may result in considerable levels of disability that limit the individual’s capacity to undertake a variety of tasks. While such changes may directly influence day-to-day physical activities and potentially vocational and avocational demands, shoulder deficits and the secondary disability can also create challenges for individuals who use the artificial electrolarynx or those who select tracheoesophageal puncture voice restoration as a postlaryngectomy alaryngeal communication option. This chapter addresses the structure and function of the shoulder complex, shoulder disability secondary to head and neck cancer treatment, and its potential consequences on a broad range of physical activities, providing information on its potential influence on postlaryngectomy voice and speech rehabilitation.

Modern methods of speech rehabilitation after a total laryngectomy have come to a great success by giving the patients a possibility to establish an intelligible and functional speech after an adequate rehabilitation treatment. The aim of this paper was to examine speech intelligibility of laryngectomized patients who use different types of vocal communication: esophageal speech, speech with tracheoesophageal prosthesis and speech with electronic laringeal prosthesis. The research was conducted on a sample of 125 laryngectomized patients of both sexes, between 48 and 85 years of age. For the subjective assessment of speech intelligibility, we used the phonetically balanced text. In the paper we used the descriptive statistics methods (the arithmetic mean with standard deviation, as well as minimum and maximum). The differences between the groups were determined by the t-test for independent samples. Pirson's correlation coefficient was used to examine the correlation between the two variables. The examinees are statistically different by the results achieved on the speech intelligibility test. The esophageal patients have the highest scores (1.13±0.86), while the patients with the vocal prosthesis and patients who use electrolarynx have similar scores (0.14±0.35; 0.15±0.36). The differences of the analyzed values were statistically significant (p lt 0.01). The results obtained in this research have shown that the patients who use tracheoesophageal vocal prosthesis have better achievement on the speech intelligibility test comparing to the esophageal patients and patients who use electrolarynx. Primenom savremenih metoda rehabilitacije nakon totalne laringektomije moguće je uspostavljanje razumljivog i funkcionalnog govora. Cilj ovog rada je utvrđivanje razlika u razumljivosti govora kod laringektomiranih bolesnika koji koriste različite oblike govorne komunikacije: ezofagealni govor, govor uz pomoć traheoezofagealne vokalne proteze i govor uz pomoć elektronske laringealne proteze. Istraživanje je izvršeno na uzorku od 125 laringektomiranih bolesnika, starosne dobi od 48 do 85 godina. Za subjektivnu procenu razumljivosti govora korišćen je fonetski izbalansirani tekst. U statističkoj obradi dobijenih podataka korišćene su: mere centralne tendencije, mere varijabilnosti, jednofaktorska analiza varijanse, t-test za nezavisne uzorke i Pirsonov koeficijent korelacije. Utrvrđene su statistički značajne razlike među ispitivanim grupama u postignućima na Testu razumljivosti govora. Ezofagealni pacijenti su ostvarili najviši prosečan skor (1,13±0,86), dok pacijenti iz grupe koja koristi vokalnu protezu imaju približno ista prosečna postignuća kao oni iz grupe koja koristi elektrolarinks (0,14±0,35; 0,15±0,36; p lt 0,01). Dobijeni rezultati su pokazali da pacijenti kojikoriste traheoezofagealne vokalne proteze ostvaruju bolja postignuća na Testu razumljivosti govora od ezofagealnih i pacijenata koji koriste elektrolarinks.

En Abstract Background Laryngeal cancer is the most common malignant tumor of the upper aerodigestive tract. Surgical treatment of advanced laryngeal cancer often requires a total laryngectomy (TL), resulting in a permanent tracheostomy and potential difficulties with a patient’s speech and communication. Objectives The aim of this study was to assess post-treatment voice changes, swallowing, and quality of life (QoL) of patients with carcinoma of the larynx treated with different treatment modalities. Patients and methods A total of 100 patients with laryngeal cancer treated with different treatment modalities were included in the present study. The primary treatment modality included TL (n = 46), partial laryngectomy (PL) (n = 7), transoral cordectomy (n = 9), radiotherapy (Rx) (n = 29), or combined treatment during the last 10 years with radiation after TL (TL and Rx, n = 9). Patients were subjected to full history taking, complete ENT examination, and assessment of: global QoL, voice, and acoustic parameters using the computerized speech lab at the outpatient clinic of Tanta University Hospitals (TUH). Evaluation of swallowing was carried out using a modified Arabic version of the QoL questionnaire called the Sydney Swallow Questionnaire. Patients having problems with swallowing were further evaluated using fiberoptic endoscopic evaluation of swallowing, at the outpatient clinic of TUH. Respiratory function of the larynx was evaluated by applying a modification of St George’s Respiratory Questionnaire. Results Results of voice analysis showed that the best voice was evident in patients who had undergone cordectomy, followed by those who had received radiotherapy. There was no significant difference in voice characteristics between patients using voice prosthesis, esophageal voice, or electrolarynx after TL and those using these aids after PL. Worst voice as well as swallowing was seen in patients who had undergone combined TL and postoperative radiotherapy. The best results of swallowing were seen in patients who had undergone cordectomy. Patients who had undergone TL or radiotherapy alone showed similar swallowing results, but better than those who had undergone PL, especially those who had undergone supracricoid laryngectomy. Assessment of respiratory function showed best results in patients who had undergone cordectomy, followed by those who had undergone TL and radiotherapy. Poorest results were seen in patients with combined surgery and Rx, and those who had been treated with PL. Conclusion Our study revealed that the best significant performance results were seen in patients who had undergone transoral cordectomy, followed by patients who had received radiotherapy only. This was followed by patients who had undergone TL and PL, with no significant difference between the two groups. The worst results were seen in patients who had undergone combined surgery and radiotherapy as the primary treatment modality.

This chapter presents a case study of a young patient, facing a series of surgeries and rehabilitation after an accident, who resists therapy from a provider with an electrolarynx.

Advanced stage laryngeal cancer patients have to undergo larynx removal surgery. Laryngeal retraction is done by laryngeal surgery. After the surgery, the laryngeal patients will lose the vocal cords and thus lose the ability to produce permanent sound. For post-laryngectomy patients, sound rehabilitation is necessary to able to conduct communication in other ways. There are 3 (three) ways of sound rehabilitation, namely esophageal speech, tracheoesophageal and electrolarynx. Sound has two kinds of intonation, namely high and low intonation that are used to emphasize certain words within sentences. Intonation also consists of three types of intonation, namely: dynamic pressure (low strong), tone pressure (high), and tempo pressure. The result will be used as the parameter to determine the start and the end of the sound. Electrolarynx is one of the tools used by the patient to talk in post-laryngectomy. In the previous research, electrolarynx prototype development is still needed to be improved, so that the optimal results to help human to be able to speak could be achieved. This research will describe the design of intonation control in electrolarynx using electromyograph sensor to raise human voice intonation in larynx (no larynx) and mute (deaf or speech impaired) in order not to sound monotone.

Dear Editor, The management of laryngeal cancer is focused on improvingsurvival while preserving function; nevertheless, total laryngectomy is often required for primary and recurrent disease. While total laryngectomy is undoubtedly an effective oncologicalsurgery, it profoundly alters speech, respiration and sense of smell and taste. Specifically, the loss of voicehas the impact on the psychosocial and economic consequencesfollowing laryngectomy.There are three methods of voice rehabilitation after totallaryngectomy: electrolarynx, oesophageal speech andtracheo-oesophageal (TE) speech. Historically, oesophagealspeech was the method of choice by which all otherswere compared, and patients who could not master oesophagealspeech used the electrolarynx. In 1969, Staffieri introduced a surgical voice restoration techniquecalled “phonatory neoglottis surgery”: this was a personaltechnique that allowed one-way air transit from the lungsto the hypopharynx or oesophagus through a fistula betweenthe trachea and the hypopharynx or oesophagus.In 1977, Amatsu with a different surgical technique thatincluded a posterior tracheal wall flap, namely the “Amatsutracheo-oesophageal shunt”, achieved similar results.Both authors addressed the issue of frequently occurringaspiration and the use of a trachea-oesophageal prosthesisplacement to manage failures. In 1972, Mozolewski firstdescribed a TE shunt prosthesis with a valve function. In1980, Singer and Blom proposed a simplified endoscopicmethod for voice restoration. They addressed the problemsof aspiration and stenosis (of the fistula) by meansof a valved prostheses placed inside the TE fistula. Thisprocedure was initially proposed as a secondary salvagetechnique for patients who failed oesophageal speech orthose who were displeased with the electrolarynx voice.Maves and Lingeman and Hamaker et al. were the firstto introduce TE puncture with voice prosthesis as a primarytechnique, performed at the time of laryngectomy.Nowadays, TEP with voice prosthesis is the gold standardfor voice rehabilitation after total laryngectomy.

Individuals who undergo laryngectomy as a radical treatment for laryngeal cancer lose their vocal cords and their voice; this also occurs with individuals suffering from amyotrophic lateral sclerosis when they are fitted with a respirator.

Background Loss of voice is the consequence of laryngectomy most disturbing for the patient. As such, the notion of performing a laryngectomy has always been directly linked to the possibility of voice rehabilitation. The multitude of different technical and surgical approaches pays testimony to the problems associated with rehabilitation of speech and swallowing after laryngectomy. Methods Scientific online search engines and library facilities were used to search for recent publications and historical medical documents. Important works were identified and summarized. Results Four different categories of voice rehabilitation can be identified: external (electrical) devices, esophageal speech, and tracheoesophageal shunts either with or without fistula valves/voice prosthesis. During the past three decades, fistula valves/voice prostheses have become the state of the art, with some patients still using esophageal speech or external devices as a back-up method in case of prosthesis failure.

Patients after total laryngectomy lose their ability to speak. Electrolarynx is a commonly used electronic device that helps these patients to verbally communicate. However, existing electrolarynx systems do not provide pitch control function, which is critical in speech communication especially for tonal languages. This study investigated the surface electromyographic (sEMG) activity of extrinsic laryngeal muscles in producing speech sounds of different pitches by normal speakers. In particular, the sEMG signals for producing different lexical tones of Cantonese were extracted and analyzed. The experimental results on Cantonese tone production confirmed that the sEMG signal from sternocleidomastoid muscle can be used to differentiate high-pitch tones from low-pitch tones. This reveals the potential of developing pitch-controlled EL systems for laryngectomees who speak Cantonese and other tonal languages.

The ability to speak and communicate with one's voice is a unique human characteristic and is fundamental to many activities of daily living, such as talking on the phone and speaking to loved ones. When the larynx is removed during a total laryngectomy (TL), loss of voice can lead to a devastating decrease in a patient's quality of life, and precipitate significant frustration over their inability to communicate with others effectively. Over the past 50 years there have been many advances in techniques of voice restoration after TL. Currently, there are three main methods of voice restoration: the electrolarynx, esophageal speech, and tracheoesophageal speech through a tracheoesophageal puncture (TEP) with voice prosthesis. Although TEP voice is the current gold standard for vocal rehabilitation, a significant minority of patients cannot use or obtain TEP speech for various reasons. As such, the electrolarynx is a viable and useful alternative for these patients. This article will focus on voice restoration using an electrolarynx with the following objectives: 1) To provide an understanding of the importance of voice restoration after total laryngectomy. 2) To discuss how the electrolarynx may be used to restore voice following total laryngectomy. 3) To outline some of the current electrolarynx devices available, including their mechanism of action and limitations. 4) To compare pros and cons of electrolaryngeal speech to TEP and esophageal speech.

The present study aimed to identify a feasible treatment strategy for hypopharyngeal cancer (HPC) with non-extensive invasion of the thyroid and/or cricoid cartilage. Between June 2008 and December 2014, patients with previously untreated HPC invading cartilage who had received either open partial laryngectomy (OPL) with tube-free tracheostomy or total laryngectomy (TL) with permanent tracheostomy and an artificial larynx (pneumatic tube) were retrospectively reviewed. The patients with extensive cartilage invasion and those with inoperable or T4b disease were excluded for OPL. Outcomes and quality of life were compared between the two treatment modalities. A total of 44 patients were included. The survival rates, complications, and Dysphagia Score were compared between the two treatment modalities. The outcome of the Voice Handicap Index (P=0.032), understandability of speech (P

Speech is the best way to express the thoughts and feelings among the human beings. But for many reasons the sound produced by human beings becomes disordered voice and termed with many names based on the cause as stammering, dys-theria, apraxia and so on. In the above mentioned few examples, the voice becomes disordered because of the underperformance of body's organ. The larynx is removed in some human beings because of cancer. For them an artificial larynx transducer (ALT) is used to produce the sounds. The above all sounds are categorized as disordered voice and the sound produced by ALT is also called as Substitution voice. In this paper, a method is used to improve the quality of substitution voice produced by ALT. Algorithm is developed to estimate undesired audio components from the device output and remove the same using Non Linear Spectral Subtraction (NLSS) technique. Further, Fundamental (F0) contour and novel parameter F1 formant deviation of healthy speech (HE) and ALT speech are determined. The above two parameters are estimated and stored during the training phase of the system. In the test phase, the above mentioned parameters are estimated and they are used to scale down the database to reduce overall enhancement time. Next step is template matching done by mapping test data with training data using Dynamic Time Warping (DTW) Technique. The data base with least distance estimation is recognized as the utterance and the same is played back.

Organ loss due to late-stage cancer is a heavy burden on both the patient and the health care system. This letter describes a patient who received an artificial larynx to replace lost laryngeal functions and who underwent 16 months of follow-up.

In this chapter, the author discusses an artificial electro-larynx that can produce intonation and fluctuation of the larynx voice for speech disorders, especially for laryngectomees. In the design of the artificial larynx, he emphasizes that many hints were taken from the vocalization mechanism of a talking bird, the mynah. The author also introduces a voice synthesizer called “Let’s talk by a finger” for people with articulation disorders that make it hard to control their voice organs because of neuromuscular disease or speech apraxia. The synthesizer, which can produce any speech sound just by touching and stroking the touchpad of a mobile phone, was modeled after the vocalization mechanism of a ventriloquist who can produce any speech sound without moving his lips. Furthermore, evaluation methods are indicated for aids and treatment of speech organ disorders caused by a cleft palate and a reversed occlusion.

The majority of laryngectomees use the electrolarynx as their primary mode of verbal communication after total laryngectomy surgery. However, the archetypal electrolarynx suffers from a monotonous tone and the inconvenience of requiring manual control. This paper presents the potential of pattern recognition to support electrolarynx use by predicting fundamental frequency (F0) and voicing state (VS) from surface EMG of the infrahyoid and suprahyoid muscles, as well as from a respiratory trace. In this study, surface EMG signals from the infrahyoid and suprahyoid muscle groups and respiratory trace were collected from 10 able-bodied, adult males (18–60 years old). Participants performed three kinds of vocal tasks – tones, legatos and phrases. Signal features were extracted from the EMG and respiratory trace, and a Support Vector Machine (SVM) classifier with radial basis function kernels was employed to predict F0 and voicing state. An average root mean squared error of 2.81 ± 0.6 semitones was achieved for the estimation of vocal frequency in the range of 90–360 Hz. An average cross-validation (CV) accuracy of 78.05 ± 6.3% was achieved for the prediction of voicing state from EMG and 65.24 ± 7.8% from the respiratory trace. The proposed method has the advantage of being non-invasive compared with studies that relied on intramuscular electrodes (invasive), while still maintaining an accuracy above chance. Pattern classification of neck-muscle surface EMG has merit in the prediction of fundamental frequency and voicing state during vocalization, encouraging further study of automatic pitch modulation for electrolarynges and silent speech interfaces.

Background Most patients perceive total laryngectomy as a mutilation carrying with it a loss of physical and psychological integrity. Thus, an artificial larynx system that can replace the laryngeal functions would significantly improve the quality of life for the afflicted patients. Methods This report, with accompanying video, presents the first case in an ongoing clinical trial of laryngeal rehabilitation using an artificial larynx after total laryngectomy for squamous cell carcinoma, for an 8-month follow-up period. We depict the prosthesis' features, our 2-step surgical procedure, and the outcome. The prosthesis is formed of 2 parts: (1) a tracheal prosthesis with a porous titanium junction with trachea, which was implanted in the first step to ensure its colonization, and (2) a removable part composed of concentric valves that enable inhalation and exhalation. The second part was implanted endoscopically. The implant was monitored with a retrograde nasofibroscopy of the tracheal prosthesis lumen and CT scans over a course of 8 months. Results The patient's functioning in the relevant postoperative problem areas, such as swallowing, breathing, and smelling, has significantly improved. The patient was able to talk in a whispering fashion while the tracheostomy was temporarily closed. The implant's porous part was in the process of being colonized by the surrounding tissue and no fistulas were observed as evidenced by barium swallow. Conclusion As the current case shows, tracheotomy closure can be performed, and laryngeal functions are restored, by means of an implant. With further improvements, this system can alleviate the need for a permanent tracheostomy after total laryngectomy, while maintaining important larynx functions intact. © 2014 Wiley Periodicals, Inc. Head Neck 36: 1669–1673, 2014

To investigate voice-related quality of life in an effort to index self-assessed voice disability in speakers who use the electrolarynx and to determine the perceived level of influence of the electrolarynx on vocal communication.Prospective study.This study was conducted at a tertiary care facility.Forty laryngectomized adults (25 men, 15 women) who used the electrolarynx as a primary method of communication served as participants. The Voice-Related Quality of Life measure was administered and scored in standard fashion and descriptive data generated for physical, social-emotional, and total scores.Data indicate substantial variability in self-perceived quality of life specific to voice use; a wide range of physical, social-emotional, and total scores were observed. Only one-quarter of these participants rated themselves as having "poor/fair" voice-related quality of life.Our findings suggest that use of the electrolarynx as a postlaryngectomy method of verbal communication has a wide-ranging influence on self-perceived voice-related quality of life and that mean scores from prior studies may not accurately reflect the potential value of the electrolarynx. Communication disability related to electrolarynx use does in fact vary; however, it is not uniformly poor, and some may be highly proficient users. Consequently, the Voice-Related Quality of Life measure may also serve as a useful tool for clinical documentation of rehabilitation outcomes in those who use the electrolarynx as a postlaryngectomy method of speech.

Larynx has a complex structure with joints and multiple functions. In order to study the artificial larynx and artificial auricle scaffold, a three-dimensional digital model of laryngeal joint is established in this paper using MIMICS with its biomechanical properties analyzed and calculated by using the finite element method. This model is based on the CT scanned images of 281 layers with an interlamellar spacing of 1.25 mm. The obtained data are denoised, segmented and smoothed before being loaded into MIMICS. By further optimizations, an accurate and complete 3D model can be obtained. Subsequently, a 3D FEM of the normal larynx joint is performed which allows observations from any dimensions and angles. Compared with natural laryngeal joint, this model has good geometric similarity and mechanically similar throat voicing functions.

Background/Objectives Mechanical prosthetic valve rehabili tation after total laryngectomy have a success rates of 90% in restoring voice. The effective speech is achieved better with mechanical voice prosthesis when compared to esophageal speech and electrolarynx. Candidal growth and tubal blockage are the commonest cause of peri and endotubal leakage causing prosthesis failure. Case report A 50-year-old male who had undergone wide field laryngectomy with primary tracheoesophageal puncture (TEP) with voice prosthesis 18 months back complained of blocked voice prosthesis and peritubal leakage. The tip of the cleaning brush which had blocked the opening was removed in the outpa tients under topical anesthesia and the peritubal block reduced. Conclusion Mechanical valve prosthesis rehabilitation after primary tracheoesophageal puncture is the standard voice rehabilitation of laryngectomized patients. Patient education regarding maintenance of the prosthesis and the care for the tracheostoma is important in reducing the complications. How to cite this article Halkud R, Shenoy AM, Sunil KC, Samskruthi M, Sarvadyna J, Biswas S, Chavan P, Siddappa KT, Shivappa A, Naik SM. Blocked voice Prosthesis: A Common Complication Reducing the Prosthesis Longevity. Int J Head Neck Surg 2014;5(2):66-71.

Background There is debate about the optimal voice restoration method and technique for patients who have undergone total laryngopharyngectomy, esophagectomy, and gastric pull-up. The purpose of this study was to report a series of patients who underwent awake, secondary tracheoesophageal puncture (TEP) after this procedure. Methods A retrospective chart review was performed at a tertiary referral center. All subjects who underwent TEP placement under transnasal esophagoscopy guidance between 2003 and 2013 were included. Results All patients underwent uncomplicated TEP in the clinic. At the time of last follow-up, all patients had functional TEP speech that they were using preferentially over an available electrolarynx. Conclusion In-office placement of secondary TEP using transnasal esophagoscopy is an efficient means of providing a conduit for voice prostheses in patients who have undergone laryngopharyngectomy with gastric pull up reconstruction. This procedure can be performed with minimal complications and with expectation of voice outcomes comparable to that seen with standard laryngectomy. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

The feasibility of using a motion sensor to replace a conventional electrolarynx(EL) user interface was explored. Forearm motion signals from MEMS accelerometer was used to provide on/off and prosody control. The small transducer was placed against the throat using support bandage. A battery operated ARM-based small control unit was developed and placed on the wrist. The control unit can convert the tilt angle into the pitch frequency. Speech generation was tested with various forearm movements, and then a simple and small action was chosen to control the device. A simple comparison study has been made with well-trained normal speakers. Results of the study showed that the prototype system was able to produce the pitch patterns similar to those in natural utterances.