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Aim of the paper. The goal of this work is to outline the methods for regaining vocal, swallowing and respiratory function, based on the type of surgical intervention. Objective of the study. We present some therapeutic procedures for learning vocal, swallowing and breathing exercises. Materials and method. Patients admitted to the ENT Clinic in Craiova over a five-year period with laryngeal neoplasms underwent various surgical interventions, depending on tumor extension. Results. A total of 188 patients underwent surgical procedures, including total laryngectomies, partial laryngectomies (supraglottic horizontal, frontolateral, bicordocomissural) and cordectomies. Discussion. We studied the functional recovery possibilities for the patients’ group, assessing the preservation conditions and the vital function alterations. Patients chose various phonatory recovery procedures, either spontaneously, or through phoniatric exercises. Esophageal voice was achieved through logopedic exercises and, depending on motivation, ability or personal motivation, through tracheoesophageal prosthetic communication – the voice button. Conclusions. The oncologic surgical procedures on the larynx allow for functional recovery and socio-professional reintegration, even in the case of total laryngectomy. [ABSTRACT FROM AUTHOR]

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Tracheoesophageal speech is the most common voicing method used by laryngectomees. This method requires the installation of tracheoesophageal prosthesis (TEP), which requires continuous maintenance to achieve optimal speaking abilities and prevent fluid leakage from the esophagus to the trachea. The present manuscript describes the available types of TEPs, the procedures used to maintain them, the causes for their failure due to fluid leakage, and the methods used for their prevention. Knowledge and understanding of these issues can assist the otolaryngologist in caring for laryngectomees who use tracheoesophageal speech.

Tracheoesophageal speech is the most common voicing method used by laryngectomees. This method requires the installation of tracheoesophageal prosthesis (TEP), which requires continuous maintenance to achieve optimal speaking abilities and prevent fluid leakage from the esophagus to the trachea. The present manuscript describes the available types of TEPs, the procedures used to maintain them, the causes for their failure due to fluid leakage, and the methods used for their prevention. Knowledge and understanding of these issues can assist the otolaryngologist in caring for laryngectomees who use tracheoesophageal speech. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the effect of education on self-care agency given to the patients with total laryngectomy. Material and Methods: The study utilised a quasiexperimental design; it was conducted with 100 patients with total laryngectomy, 50 controls and 50 experimental group patients, who received inpatient treatment for larynx cancer at Otorhinolaryngeology Service in Balcalı Hospital of Çukurova University Faculty of Medicine between March 2011 and December 2015. Data were collected using the “Patient Identification-Information Form”, “Patient Pre-Test and Final-Test Form”, “Self-care Agency Scale”, “Special Periodic Education Plan for Patients”, and “Visual Analog Scale” form to detect patient satisfaction. Results: Initial knowledge level of both groups was found to be equivalent to each other. However, a statistically significant increase was found in the knowledge level of the experimental group provided with education. Analysis of the data showed that the mean score of the self-care agency was 76.5±15.3 for the control group patients while it was 120.0±12.2 for the experimental group patient. It was found that the education made a statistically significant difference. Conclusion: Results of this study indicated that the education given to the patients was effective, and significant increases were detected in the patients knowledge level about treatment and care, self-care agency, and satisfaction [ABSTRACT FROM AUTHOR]

The Laryngectomee patient has damage in vocal cord and leads to loss of speech; therefore, patient uses electrolarynx (EL) device during speech for speech clarity. The EL device consists of a vibrator placed over the vocal surface during speech, and the speech signal modulates with the vibrator signal for clarity in speech. However, vibration from the EL device produces a constant signal and produces less speech clarity during various environmental conditions such as indoor, outdoor and populated area. In this paper, the above problem is alleviated by generating automated vibration signal with manual tuning for speech clarity in different environmental conditions. The proposed Smart Larynx (SL) device replaces the electrolarynx (EL) which consists of a Smart Phone and Vibrator App with frequency ranging from 250 to 450 Hz. From the experimental result, the speech attains about 85% clarity of normal speech after processing with Radial Dilation Wavelet Transform algorithm. The SL device validates the clarity of the speech based on monosyllable, bisyllable and trisyllable in Tamil Language. [ABSTRACT FROM AUTHOR]

Background The German multicenter randomized phase II larynx organ preservation (LOP) trial DeLOS-II was carried out to prove the hypothesis that cetuximab (E) added to induction chemotherapy (IC) and radiotherapy improves laryngectomy-free survival (LFS; survival with preserved larynx) in locally advanced laryngeal/hypopharyngeal cancer (LHSCC). Patients and methods Treatment-naïve patients with stage III/IV LHSCC amenable to total laryngectomy (TL) were randomized to three cycles IC with TPF [docetaxel (T) and cisplatin (P) 75 mg/m2/day 1, 5-FU (F) 750 mg/m2/day days 1–5] followed by radiotherapy (69.6 Gy) without (A) or with (B) standard dose cetuximab for 16 weeks throughout IC and radiotherapy (TPFE). Response to first IC-cycle (IC-1) with ≥30% endoscopically estimated tumor surface shrinkage (ETSS) was used to define early responders; early salvage TL was recommended to non-responders. The primary objective was 24 months LFS above 35% in arm B. Results Of 180 patients randomized (July 2007 to September 2012), 173 fulfilled eligibility criteria (A/B: larynx 44/42, hypopharynx 41/46). Because of 4 therapy-related deaths among the first 64 randomized patients, 5-FU was omitted from IC in the subsequent 112 patients reducing further fatal toxicities. Thus, IC was TPF in 61 patients and TP in 112 patients, respectively. The primary objective (24 months LFS above 35%) was equally met by arms A (40/85, 47.1%) as well as B (41/88, 46.6%). One hundred and twenty-three early responders completed IC+RT; their overall response rates (TPF/TP) were 94.7%/87.2% in A versus 80%/86.0% in B. The 24 months overall survival (OS) rates were 68.2% and 69.3%. Conclusions Despite being accompanied by an elevated frequency in adverse events, the IC with TPF/TP plus cetuximab was feasible but showed no superiority to IC with TPF/TP regarding LFS and OS at 24 months. Both early response and 24 months LFS compare very well to previous LOP trials and recommend effective treatment selection and stratification by ETSS. Clinical trial information NCT00508664. [ABSTRACT FROM AUTHOR]

Objective: We used a questionnaire to investigate olfactory function and the present state of olfactory rehabilitation for laryngectomized patients in Japan.Methods: This study was conducted using a questionnaire survey. We mailed questionnaires to 190 members of a Japanese laryngectomized patient group (the nonprofit organization YOUSAY-KAI). The survey queried the following items: (1) basic information (age, sex, alaryngeal speech method, etc.); (2) questions about olfactory rehabilitation, such as the individual's experience of olfactory rehabilitation, the number of days from laryngectomy to the start of olfactory rehabilitation, and the location of rehabilitation (i.e., hospital or patient association); (3) free comments; and (4) the self-administered Odor Questionnaire (SAOQ).Results: We received 121/190 questionnaires by the submission deadline. Of these, 105 questionnaires were valid. All 105 responders used the Provox voice prosthesis as the alaryngeal speech method. Only 4.7% (5/105) of the patients received olfactory rehabilitation in hospitals. Many comments in the free comment column included demands for olfactory rehabilitation such as "I want to know where we can have olfactory rehabilitation" and "I want to have rehabilitation if olfaction recovers." The SAOQ score was significantly higher in the rehabilitation group (mean, 42.5%) compared to the nonrehabilitation group (mean, 22.1%) (p<0.05). There was no correlation between the SAOQ score and the number of days from laryngectomy to the start of rehabilitation (r=0.08, p=0.76)． CONCLUSION: Patient demand for olfactory rehabilitation is strong, but this therapy is not widely offered to laryngectomized patients in Japan. Notably, the SAOQ scores showed that olfactory rehabilitation may have an effect, even if it is initiated after laryngectomy. We believe that when patients choose voice prosthesis for speech, their olfaction deteriorates unless they undergo olfactory rehabilitation separately from speech rehabilitation. It is therefore necessary to administer olfactory rehabilitation for laryngectomized patients who have never received olfactory rehabilitation, as well as for patients scheduled to undergo laryngectomy. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of the phenomenon of phantom larynx in post total laryngectomy. Study Design: Descriptive cross section study. Place and Duration of Study: Department of Otorhinolaryngology Head and Neck Surgery, Combined Military Hospitals Rawalpindi and Lahore from Sep 2015 to Aug 2016. Material and Methods: A total of 51 patients were assessed at six months and 1-year interval of laryngectomy. A questionnaire containing six questions was presented at six months and one year to total laryngectomy patients. More than 4 positive responses indicated presence of phantom larynx phenomenon. The questionnaire assesses nasal airway and breathing, functions of larynx and adaptations after laryngectomy. Results: All the patients were males. The Patients were divided in to two groups depending whether they were assessed at six months or at one year Patients varied in age from 48 years to 74 years. Mean age of patients was 62 years. Thirteen patients (81%) showed positive phantom larynx phenomenon at six months whereas eighteen patients (51%) showed positive phenomenon at one year after operation. Phantom larynx phenomenon was compared between two groups assessed at six months and one year. No significant difference in trends between the two groups was observed except for the question pertaining to straining while lifting (81% vs 68%). Conclusion: In our study we identified phantom larynx phenomenon in post-operative patient's total laryngectomy patients. The phenomenon persisted strongly for six months while it was also found at one year postoperatively. It can result in lot of anxiety and even depression in laryngectomy patients which could greatly hamper rehabilitation process in these patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: Very few cases of conservative laryngectomy in recurrent carcinoma of subglottis postradiotherapy have been reported. Technical aspects of conservative resection and reconstruction in subglottic carcinoma have not been well described. Methods: Herein, we present a case of recurrent carcinoma of subglottis for which conservative resection with adequate margins was done with endoscope assistance and defect reconstructed by buccal mucosa, conchal cartilage, and temporoparietal free flap. The technique of resection, reconstruction, complications, postoperative outcome, and our suggestions are described. Results: The lesion could be removed with wide margins. Reconstruction could preserve the voice, and deglutition was unaffected. There was no donor site‐related complication. Complications were a result of the choice of the stent, which included infection and difficulty in removal. Conclusion: Selected cases of recurrent carcinoma of the subglottis can be managed by conservative resection with adequate margins and appropriate reconstruction with good functional outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Total laryngectomy (TL) with neck dissection (ND) is considered as crucial management for advanced-stage of laryngeal cancer. Shoulder dysfunction has long been recognized as a potential complication resulting from neck dissection. The aim of this study was to evaluate the effect of early prophylactic rehabilitation program in patients who underwent TL with ND.Methods: A prospective, nonrandomized design was used. Seventy-six participants who underwent TL with ND were assigned into either an intervention or a control group. The control group received current standard care with no formal shoulder exercise provided, while the intervention group attended early preventive rehabilitation lasting 12 weeks. Participants were assessed at baseline, and at 3 and 6 months after surgery. Measured outcomes included shoulder function and patient-reported quality of life. General linear models with repeated measures were used to examine outcome changes in both groups over the designated assessment intervals.Results: Improvement in shoulder function and patient-reported quality of life were both statistically significant over time, with no significant difference between control or intervention groups, indicating little or no benefit of preventative intervention on shoulder function outcomes. Analysis involving five subscales and the summary score of the quality of life questionnaire had only statistically significant improvement over time for both the control or intervention groups, except for physical well-being domain which had statistical significance both over time and between the control and intervention groups.Conclusion: In this study, preventative exercise program initiated immediately after surgery had a limited impact on both shoulder function and perceived quality of life. [ABSTRACT FROM AUTHOR]

Background: Incidences of pharyngocutaneous fistulization (PCF) after total laryngectomy (TL) reported in the literature vary widely, ranging from 2.6 to 65.5%. Comparison between different centers might identify risk factors, but also might enable improvements in quality of care. To enable this on a national level, an audit in the 8 principle Dutch Head and Neck Centers (DHNC) was initiated.Methods: A retrospective chart review of all 324 patients undergoing laryngectomy in a 2-year (2012 and 2013) period was performed. Overall PCF%, PCF% per center and factors predictive for PCF were identified. Furthermore, a prognostic model predicting the PCF% per center was developed. To provide additional data, a survey among the head and neck surgeons of the participating centers was carried out.Results: Overall PCF% was 25.9. The multivariable prediction model revealed that previous treatment with (chemo)radiotherapy in combination with a long interval between primary treatment and TL, previous tracheotomy, near total pharyngectomy, neck dissection, and BMI < 18 were the best predictors for PCF. Early oral intake did not influence PCF rate. PCF% varied quite widely between centers, but for a large extend this could be explained with the prediction model. PCF performance rate (difference between the PCF% and the predicted PCF%) per DHNC, though, shows that not all differences are explained by factors established in the prediction model. However, these factors explain enough of the differences that, compensating for these factors, hospital is no longer independently predictive for PCF.Conclusions: This nationwide audit has provided valid comparative PCF data confirming the known risk factors from the literature which are important for counseling on PCF risks. Data show that variations in PCF% in the DHNCs (in part) are explainable by the variations in these predictive factors. Since elective neck dissection is a major risk factor for PCF, it only should be performed on well funded indication. [ABSTRACT FROM AUTHOR]

Objectives Evaluation of the influence of a smooth surface moulding technique of silicone rubber indwelling voice prostheses on in vitro biofilm formation and analysis of the clinical in situ lifetime. Design Biofilm formation on smooth and Groningen ultra low resistance ( URL) prostheses was studied in an artificial throat model. The clinical lifetime of smooth voice prostheses was compared to the previous lifetime of URL by counting the number of replacements in a consecutive 6-month period in the same patient. Participants: Eleven laryngectomised patients in follow-up who required frequent replacement of their voice prostheses. Settings Tertiary University Medical Center. Results Use of a smoother mould and less viscous silicone rubber yielded a decrease in surface roughness from 46 to 8 nm and was accompanied by a 40% reduction in the prevalence of bacteria and yeast in in vitro formed biofilms. Clinically, the lifetime was significantly ( P<.005) increased by a factor of 2.1. Conclusions This combined in vitro and clinical study suggests that the choice of material and in particular its surface finishing may be determining factors with respect to the clinical lifetime of silicone rubber implants and devices failing due to biofilm formation. [ABSTRACT FROM AUTHOR]

The article reports that between 2008 and 2014, 118 paediatric and 200 adult tracheostomy- or laryngectomy-related incidents were reported.Overall, there was a bimodal distribution to severity of events with 49% events recorded as Grade 1 and 40.6% recorded as Grade 4 (life-threatening).The frequency of incidents in the paediatric population has decreased over the time period. Adult Grade 1 events haveincreased in frequency although Grade 4 events appear to be becoming less common.

ABSTRACT Background Heat and moisture exchangers (HMEs) improve respiratory function after laryngectomy, but there is virtually no information on the benefit of traditional stoma cloths or other covers. Methods Two sequential studies were performed: (1) an ex vivo test was used to compare the humidifying capacity of stoma cloths to other coverings; and (2) a 4-week randomized trial was then performed to assess patient acceptability of cloths both alone and with an HME ( N = 18). Results The humidifying capacity of the coverings tested varied widely. For stoma cloths, a humidifying capacity of 13.7 mg/L was found to decrease to 8.5 mg/L if air-leaks around the cloth occurred. Patients who used HMEs disliked stoma cloths because they interfered with voicing, they became soiled more easily, and were less effective at reducing coughing and mucus production. Conclusion Although less acceptable to patients who use an HME, stoma cloths do provide significant humidifying capacity and should be encouraged when HMEs are unavailable or inappropriate. © 2017 Wiley Periodicals, Inc. Head Neck 39: 921-931, 2017 [ABSTRACT FROM AUTHOR]

The objective is to clarify whether social support and acquisition of alternative voice enhance the psychological adjustment of laryngectomized patients and which part of the psychological adjustment structure would be influenced by social support. We contacted 1445 patients enrolled in a patient association using mail surveys and 679 patients agreed to participate in the study. The survey items included age, sex, occupation, post-surgery duration, communication method, psychological adjustment (by the Nottingham Adjustment Scale Japanese Laryngectomy Version: NAS-J-L), and the formal support (by Hospital Patient Satisfaction Questionnaire-25: HPSQ-25). Social support and communication methods were added to the three-tier structural model of psychological adjustment shown in our previous study, and a covariance structure analysis was conducted. Formal/informal supports and acquisition of alternative voice influence only the 'recognition of oneself as voluntary agent', the first tier of the three-tier structure of psychological adjustment. The results suggest that social support and acquisition of alternative voice may enhance the recognition of oneself as voluntary agent and promote the psychological adjustment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to describe the characteristics and experiences of individuals who use technology to support telephone or face-to-face communication after total laryngectomy. Method: An online questionnaire was used to identify potential participants. Seventeen individuals met inclusion criteria and participated in an in-depth survey. They were compared with a reference group matched for age, gender, and time postsurgery who did not use these technologies. Open-ended responses were summarized. Results: Compared with the matched reference group, individuals who used technology to support verbal communication had undergone more aggressive cancer treatment and used more communication methods. They were less likely to use an alaryngeal speech method, had greater difficulty over the telephone, and used more repair strategies in face-to-face communication. The 2 groups did not differ significantly in the frequency or success of their communication, however. Open-ended responses revealed great variety with regard to their reasons, purposes, and timing of technology use. Conclusions: There is a subset of individuals using technology to support verbal communication very successfully after laryngectomy. Usage was not limited to those who were unable to communicate verbally and often continued long after the initial postoperative period in many settings, for various purposes, and in combination with other methods of communication. [ABSTRACT FROM AUTHOR]

Background Medicaid and uninsured patients anecdotally incur higher cost and length of stay because of nonmedical, discharge-related factors. The purpose of this study was to investigate the association between primary payer and length of stay and cost, controlling for comorbidities and complications, in patients undergoing total laryngectomy. Methods The sample included 4128 patients who underwent total laryngectomy in the 2005 to 2010 National Inpatient Sample (NIS). Patients were categorized into 4 subgroups based on payer status: Medicare, Medicaid, uninsured, and private insurance. Using multilevel modeling, we examined differences in length of stay and hospitalization costs. Results The odds of being in the top quartile of length of stay increased for Medicaid patients by 41% (odds ratio [OR] = 1.41; 95% confidence interval [CI] = 1.03-1.92) compared with privately insured patients. Conclusion After controlling for medical factors, Medicaid patients had increased lengths of stay. Overall costs were highest for those with public insurance, but no difference was seen for the adjusted cost. © 2016 Wiley Periodicals, Inc. Head Neck 39: 311-319, 2017 [ABSTRACT FROM AUTHOR]

Objectives The short-term and long-term beneficial effects of HME use by laryngectomees are well described in literature. In this study, we document how laryngectomised patients, who previously did not use an HME, get accustomed to the use of HME and attachments. Participants Thirty patients, who were at least 3 months post-laryngectomy and previously did not use an HME, were followed for 12 weeks and were asked to complete questionnaires about their experiences with the HME and attachments. Results Results show that when patients start using an HME, they report some difficulties with breathing resistance during the first 2 weeks of use. However, after 6 weeks, they have become accustomed to the breathing resistance and after 12 weeks over 96% reports that breathing was equal or less strenuous compared with breathing though an open stoma. Only a small proportion of patients experienced problems with increased coughing when starting HME use. Conclusions This study provides insight in the way laryngectomised patients are experiencing the use of HMEs in the first weeks. These outcomes can contribute to a better knowledge of HME use by healthcare providers and help them to manage patient expectations and improving support to patients in achieving compliant HME use. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the acoustic properties of 6 Taiwan Southern Min vowels produced by 10 laryngeal speakers (LA), 10 speakers with a pneumatic artificial larynx (PA), and 8 esophageal speakers (ES). Method: Each of the 6 monophthongs of Taiwan Southern Min (/i, e, a, ɔ, u, ə/) was represented by a Taiwan Southern Min character and appeared randomly on a list 3 times (6 Taiwan Southern Min characters × 3 repetitions = 18 tokens). Each Taiwan Southern Min character in this study has the same syllable structure, /V/, and all were read with tone 1 (high and level). Acoustic measurements of the 1st formant, 2nd formant, and 3rd formant were taken for each vowel. Then, vowel space areas (VSAs) enclosed by /i, a, u/ were calculated for each group of speakers. The Euclidean distance between vowels in the pairs /i, a /, /i, u/, and /a, u / was also calculated and compared across the groups. Results: PA and ES have higher 1st or 2nd formant values than LA for each vowel. The distance is significantly shorter between vowels in the corner vowel pairs /i, a/ and /i, u/. PA and ES have a significantly smaller VSA compared with LA. Conclusions: In accordance with previous studies, alaryngeal speakers have higher formant frequency values than LA because they have a shortened vocal tract as a result of their total laryngectomy. Furthermore, the resonance frequencies are inversely related to the length of the vocal tract (on the basis of the assumption of the source filter theory). PA and ES have a smaller VSA and shorter distances between corner vowels compared with LA, which may be related to speech intelligibility. This hypothesis needs further support from future study. [ABSTRACT FROM AUTHOR]

Abstracts of several articles related to motility/neurogastroenterology, on topics including oesophageal bolus perception during swallowing, role of inhaled methoxyflurane in success of nasogastric probe insertion; and prevalence of oesophageal dysmotility in laryngectomy patients, are presented.

Objective: Pharyngocutaneous fistula (PCF) is the most frequent complication after total laryngectomy. However, delayed oral feeding and inserting a nasogastric tube has been considered as a safe practice among head and neck surgeons, and there is no general agreement on the initiation of the oral intake. The aim of the study is to determine the incidence of PCF after primary total laryngectomy in a large homogenous case series and to evaluate whether fistula and early oral feeding are related.Methods: Patients who underwent total laryngectomy/laryngopharyngectomy with primary closure of pharynx between 1990 and 2014 were reviewed. Patients who had a history of previous radiotherapy, chemotherapy or chemoradiotherapy, and patients who underwent more complex reconstruction techniques (e.g. pedicled or free flaps) for closure were excluded. In total, 602 patients underwent total laryngectomy (n=580) or total laryngectomy plus partial pharyngectomy (n=22).Results: The overall PCF rate was 12%. In 582 of the 602 patients (99.8%), a nasogastric tube was not inserted. In 95.7% of the patients (576/602), oral feeding was started within 3 days of surgery. Among the patients who developed PCF (72/602), PCF rate was not significantly higher in early oral fed patients (69/582, 11.8%) than the patients with nasogastric tube insertion (3/20, 15%) (p=0.722).Conclusion: The low PCF rate in our study indicates that early oral feeding is a safe and effective method in primary total laryngectomy. [ABSTRACT FROM AUTHOR]

Critical Care Unit (CCU) beds are a limited resource and in increasing demand. Studies have shown that complex head and neck patients can be safely managed on a ward setting given the appropriate staffing and support. This retrospective case series aims to quantify the CCU care received by patients following total laryngectomy (TL) at a District General Hospital (DGH) and compare patient outcomes in an attempt to inform current practice. Data relating to TL were collected over a 5-year period from 1st January 2010 to 31st December 2015. A total of 22 patients were included. All patients were admitted to CCU postoperatively for an average length of stay of 25.5 hours. 95% of these patients were admitted to CCU for the purpose of close monitoring only, not requiring any active treatment prior to discharge to the ward. 73% of total complications were encountered after the first 24 hours postoperatively at which point patients had been stepped down to ward care. Avoiding the use of CCU beds and instead providing the appropriate level of care on the ward would result in a potential cost saving of approximately £8,000 with no influence on patient morbidity and mortality. [ABSTRACT FROM AUTHOR]

The objective of this study is to assess surgical parameters correlating with voice quality after total laryngectomy (TL) by relating voice and speech outcomes of TL speakers to surgical details. Seventy-six tracheoesophageal patients' voice recordings of running speech and sustained vowel were assessed in terms of voice characteristics. Measurements were related to data retrieved from surgical reports and patient records. In standard TL (sTL), harmonics-to-noise ratio was more favorable after primary TL + postoperative RT than after salvage TL. Pause/breathing time increased when RT preceded TL, after extensive base of tongue resection, and after neck dissections. Fundamental frequency (f0) measures were better after neurectomy. Females showed higher minimum f0 and higher second formants. While voice quality differed widely after sTL, gastric pull-ups and non-circumferential pharyngeal reconstructions using (myo-)cutaneous flaps scored worst in voice and speech measures and the two tubed free flaps best. Formant/resonance measures in/a/indicated differences in pharyngeal lumen properties and cranio-caudal place of the neoglottic bar between pharyngeal reconstructions, and indicate that narrower pharynges and/or more superiorly located neoglottic bars bring with them favorable voice quality. Ranges in functional outcome after TL in the present data, and the effects of treatment and surgical variables such as radiotherapy, neurectomy, neck dissection, and differences between partial or circumferential reconstructions on different aspects of voice and speech underline the importance of these variables for voice quality. Using running speech, next to sustained/a/, renders more reliable results. More balanced data, and better detail in surgical reporting will improve our knowledge on voice quality after TL. [ABSTRACT FROM AUTHOR]

Background: Total laryngectomy with or without adjuvant (chemo)radiation often induces speech, swallowing and neck and shoulder problems. Speech, swallowing and shoulder exercises may prevent or diminish these problems. The aim of the present paper is to describe the study, which is designed to investigate the effectiveness and cost-utility of a guided self-help exercise program built into the application "In Tune without Cords" among patients treated with total laryngectomy.Methods/design: Patients, up to 5 years earlier treated with total laryngectomy with or without (chemo)radiation will be recruited for participation in this study. Patients willing to participate will be randomized to the intervention or control group (1:1). Patients in the intervention group will be provided access to a guided self-help exercise program and a self-care education program built into the application "In Tune without Cords". Patients in the control group will only be provided access to the self-care education program. The primary outcome is the difference in swallowing quality (SWAL-QOL) between the intervention and control group. Secondary outcome measures address speech problems (SHI), shoulder disability (SDQ), quality of life (EORTC QLQ-C30, QLQ-H&N35 and EQ-5D), direct and indirect costs (adjusted iMCQ and iPCQ measures) and self-management (PAM). Patients will be asked to complete these outcome measures at baseline, immediately after the intervention or control period (i.e. at 3 months follow-up) and at 6 months follow-up.Discussion: This randomized controlled trial will provide knowledge on the effectiveness of a guided self-help exercise program for patients treated with total laryngectomy. In addition, information on the value for money of such an exercise program will be provided. If this guided self-help program is (cost)effective for patients treated with total laryngectomy, the next step will be to implement this exercise program in current clinical practice.Trial Registration: NTR5255 Protocol version 4 date September 2015. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine how sentence intelligibility relates to self-reported communication in tracheoesophageal speakers when speech intelligibility is measured in quiet and noise. Method: Twenty-four tracheoesophageal speakers who were at least 1 year postlaryngectomy provided audio recordings of 5 sentences from the Sentence Intelligibility Test. Speakers also completed self-reported measures of communication—the Voice Handicap Index-10 and the Communicative Participation Item Bank short form. Speech recordings were presented to 2 groups of inexperienced listeners who heard sentences in quiet or noise. Listeners transcribed the sentences to yield speech intelligibility scores. Results: Very weak relationships were found between intelligibility in quiet and measures of voice handicap and communicative participation. Slightly stronger, but still weak and nonsignificant, relationships were observed between measures of intelligibility in noise and both self-reported measures. However, 12 speakers who were more than 65% intelligible in noise showed strong and statistically significant relationships with both self-reported measures (R2 = .76–.79). Conclusions: Speech intelligibility in quiet is a weak predictor of self-reported communication measures in tracheoesophageal speakers. Speech intelligibility in noise may be a better metric of self-reported communicative function for speakers who demonstrate higher speech intelligibility in noise. [ABSTRACT FROM AUTHOR]

The objectives of this study were to demonstrate that the length of the tracheoesophageal voice prosthesis changes over time and to determine whether the prosthesis length over time increased, decreased, or showed no predictable change in size. A retrospective chart review was performed at a tertiary care referral center. Patients who underwent either primary or secondary tracheoesophageal puncture between January 2006 and August 2014 were evaluated. Patients were excluded if the tracheoesophageal prosthesis size was not consistently recorded or if they required re-puncturing for an extruded prosthesis. Data analyzed included patient demographics and the length of the tracheoesophageal voice prosthesis at each change. A total of 37 patients were identified. The mean age was 64 years. Seventy-six percent were male. 24 % underwent primary tracheoesophageal puncture and 76 % underwent secondary tracheoesophageal puncture. The length of the prosthesis decreased over time (median Kendall correlation coefficient = −0.60; mean = −0.44) and this correlation between length and time was significant ( p = 0.00085). Therefore, in conclusion, tracheoesophageal prosthesis length is not constant over time. The tracheoesophageal wall thins, necessitating placement of shorter prostheses over time. Patients with a tracheoesophageal voice prosthesis will require long-term follow-up and repeat sizing of their prosthesis. Successful tracheoesophageal voicing will require periodic reevaluation of these devices, and insurers must, therefore, understand that long-term professional care will be required to manage these patients and their prostheses. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to report the post-surgical and oncologic outcomes of patients who underwent supracricoid partial laryngectomy (SCPL). Methods: 90 patients who underwent SCPL between 1994 and 2014 were reviewed. 45 patients underwent cricohyoidopexy (CHP) and 45 patients cricohyoidoepiglottopexy (CHEP). Median nasogastric (NG) tube removal time, decannulation time, overall survival, disease-free survival and local control rates were calculated. The effect of the type of surgery on functional and oncologic outcomes were assessed. Results: Median NG tube removal time was 16.5 days (IQR = 10) and 14 days (IQR = 9) in CHP and CHEP patients, respectively (p > 0.05). Median decannulation time was 30 days (IQR = 26) and 19 days (IQR = 15) in CHP and CHEP patients, respectively (p < 0.05). Resection of one arytenoid significantly increased NG tube removal time. Median follow-up time was 55 months. There were 15 oncologic failures and the median time interval for tumor recurrence was 9 months. Five-year overall survival rate was 80.4%. The 3- and 5-year disease-free specific survival rates were 81.7 and 76.7%, respectively. Conclusions: Given the more extensive surgery applied for CHP, functional outcomes were better in patients with CHEP. Resection of an arytenoid had a negative outcome on swallowing. [ABSTRACT FROM AUTHOR]

O presente estudo teve como objetivo identificar como os pacientes submetidos à laringectomia parcial ou total tem compreendido as informações referentes ao procedimento cirúrgico. Utilizamos a técnica de entrevista através de questões abertas com pacientes de um hospital governamental, voltado para a assistência, o ensino e a pesquisa. Através das cinco categorias temáticas identificadas, podemos concluir que o respeito pela autonomia do paciente não está sendo exercido pela equipe médica e de enfermagem, pois as informações são processadas de forma inadequada por esses profissionais e não se considera a autonomia do paciente em alguns casos.El presente estudio tuvo como objetivo identificar como los pacientes sometidos laringectomía total o parcial han comprendido las informaciones sobre el procedimiento quirúrgico. Utilizamos la técnica de entrevista a través de preguntas abiertas con pacientes de un hospital gubernamental, orientado a la asistencia, la enseñanza y la investigación. A través de las cinco categorías temáticas identificadas, concluimos que el respeto por la autonomía del paciente no está siendo ejercido de manera correcta por el equipo médico y de enfermería, pues las informaciones son procesadas de forma inadecuada por estos profesionales y no se considera la autonomía del paciente en algunos casos.This study aimed at identifying how patients submitted to partial or total laryngectomy understand the information on the surgical procedure. Authors used the technique of semi-structured interview through open questions with patients admitted at a government hospital characterized by the development of activities centered on the care, teaching and research. Based on the identified five thematic categories, authors concluded that the respect for patient's autonomy is not being correctly performed by the medical and nursing team, as information are being processed in an inadequate way and they are not considering patients' individuality in some cases.

Larynx cancer is one of the most susceptible form of cancer susceptible to induce alteration of the patient's psychological profile due to the social role that the larynx has in communication. Oral communication is severely impaired even after voice rehabilitation of the laryngectomized patients, so that the social rehabilitation is somewhat not only a medical but also a social problem. The psychological profile of these patients is altered in a way that dealing with the disease is sometimes neglected and the interaction with the outside world in terms of oral communication is totally abandoned. The starting point for depression in these cases is the acknowledgement of the disease and is, in some cases, the entire medical environment. Facial scarring, the inability to verbally interact with other human, as well as the presence of the tracheostoma, are all deciding factors in the presence of a low self-esteem for these particular patients. Psychological counseling is a mandatory approach for laryngectomized patients, in order to improve their ability to cope with cancer and providing better recovery chances. [ABSTRACT FROM AUTHOR]

The loss of the best communication port after total laryngectomy surgery makes speech rehabilitation an important goal. Our aim was to improve the quality of esophageal speech ( ES) using online esophageal multichannel intra-luminal impedance ( MII) as a new biofeedback method. Twenty-six total laryngectomized patients were included. Before ES therapy, an esophageal motility test was carried out. MII catheters were placed in all subjects who were then randomized into two groups. Group 1 included 13 cases, who were retrained according to the classical method. Group 2 included 13 cases, who were retrained according to the simplified animation of air movements within the esophagus and upper stomach resulting from the modifications of intra-esophageal air kinetics gained by MII. The level of speech proficiency was evaluated relative to pretraining levels using perceptual scales in the third and sixth months. Acoustic voice was analyzed. The number of syllables read per minute and the intelligibility of monosyllabic and dissyllabic words were calculated. In this study, MII was used for the first time in alaryngeal speech rehabilitation as a biofeedback method; an overall sufficient speech level was achieved by 68.4% at the end of therapy, whereas attendance was 90%. A statistically significant improvement was found in both groups in terms of ES level compared with the pretraining period although there was no significant difference between groups. Although we did not observe the expected difference between groups suggested by our hypothesis, MII may be used as an objective tool to show patients how to swallow and regurgitate air during training, and may thus expedite ES theraphy both for the speech therapist and the patient in the future. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the effects of voice rehabilitation with indwelling voice prosthesis on quality of life, depression, anxiety, self-esteem, and sexual functions in laryngectomy patients. Provox-1™ was applied to 30 patients who underwent total laryngectomy by opening a tracheoesophageal fistula. WHO Quality of Life-BREF, Beck Depression Inventory, Beck Anxiety Inventory, Rosenberg Self-Esteem Scale, Arizona Sexual Experience Scale forms were asked to be filled out by the patients before voice prosthesis application. These tests were asked to be filled out again 3 months later after the voice prosthesis application. Paired samples and Wilcoxon tests were used to compare before and after operation values. Indwelling voice prosthesis was found to improve quality of life, self-esteem, and sexual function ( p < 0.05). Additionally, symptoms of depression and anxiety were regressed ( p < 0.05). Indwelling voice prosthesis was found to especially increase the quality of life and decrease depression ( p < 0.05). This study is an uncontrolled single-arm study comparing patients' psychosocial statuses pre- and post-voice prosthesis. [ABSTRACT FROM AUTHOR]

After total laryngectomy, inspired air is no longer optimally conditioned by the upper airways. Impaired mucociliary clearance and histological changes of respiratory epithelium, such as loss of ciliated cells, have been described in laryngectomized patients. Heat and moisture exchangers (HMEs) are passive humidifiers that re-condition the inspired air. Aim of this study was to assess the effect of HMEs on tracheal epithelium and tracheal mucus transport velocity (TMV). Tracheal brush biopsies were collected in three groups of TLE patients: 21 long-term HME users, 10 non-HME users, and 16 non-HME users before and after 4-9 months HME use. Tracheal epithelium biopsies were assessed using a digital high-speed camera mounted onto a light microscope. TMV was determined by scintigraphy in the first two patient groups. Significantly more ciliated cells were found in HME users compared to non-HME users ( p = 0.05). TMV was higher in HME users (median 2 mm/min; 0-7.9) compared to non-HME users (median 0.8 mm/min; 0-12.3), but this difference was not significant ( p = 0.37). One-hour breathing without HME in long-term HME users did not measurably decrease TMV ( p = 0.13). The long-term use of an HME restores/prevents the loss of tracheal ciliated cells. A significant improvement in TMV was not found. Short-term (one hour) detachment of an HME has no measurable effect on TMV. [ABSTRACT FROM AUTHOR]

Tracheoesophageal puncture enlargement in laryngectomized patients is a significant problem due to complications such as aspiration pneumonia. There are several management methods including conservative and nonconservative techniques. A total closure of the enlarged tracheoesophageal puncture is needed in some cases when conservative approaches have failed. At this point, the insertion of a silicone septal button in the puncture site is a useful, inexpensive, and simple technique. The follow-up of 4 patients managed with this technique revealed satisfactory long-term results. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Early oral feeding for patients who underwent total laryngectomy is still controversial. The purpose of this study was to evaluate the safety of initiating early oral feeding after total laryngectomy regarding pharyngocutaneous fistula. The survey included research in MEDLINE, EMBASE, and LILACS. Methods The intervention analyzed was early oral feeding (<5 days), whereas the control group received late oral feeding (>7 days) after total laryngectomy. Results From 304 studies, 4 randomized clinical trials with 180 patients were selected. In the early oral feeding group, the incidence was 6.7%, whereas in the late oral feeding group it was 10%, with no statistically significant difference (IC95% −0.11 to 0.05; p = .42; I2 = 0%). Four cohort studies with 490 patients were also selected. In the early oral feeding group, the incidence was 12.2%, whereas in the other group, it was 10.1%, with no statistically significant difference (IC95% −0.05 to 0.08; p = .67; I2 = 0%). Conclusion There is no increase in pharyngocutaneous fistula rates in patients who receive early oral feeding after total laryngectomy. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1532-1535, 2015 [ABSTRACT FROM AUTHOR]

Background Laryngeal cancer management should pursue function-sparing therapeutic options. Even though demolitive surgery provides better control of disease at intermediate to advanced stages when compared to chemoradiotherapy, it does not preserve laryngeal function. Supratracheal partial laryngectomy has been described as a function-sparing surgical technique for laryngeal cancer with subglottic extension. Methods In this retrospective study, we analyzed the clinical outcomes of 115 patients who underwent supratracheal partial laryngectomy. Results At 5 years, overall survival (OS), disease-free survival (DFS), and locoregional control rates were 78.9%, 68.5%, and 69.6%, respectively; DFS and locoregional control prevalences were greatly affected by pT4a classification (49.0% and 51.4%, respectively); and laryngeal function preservation was maintained in 78.3% of patients despite being affected by pT4a classification (59.3%) and age ≥65 (64.6%). Conclusion For cases with glottic tumors and with subglottic extension, the choice of supratracheal partial laryngectomy versus chemoradiotherapy can be considered to be effective in terms of prognostic and functional results. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1417-1424, 2015 [ABSTRACT FROM AUTHOR]

The fundamental objective in restoring a defect created after total laryngectomy with a custom made silicone prosthesis is to enable the patient to cope better with the difficult process of rehabilitation after a major surgery has been performed. A cosmetically acceptable prosthesis that reproduces the color and form and allows the patient to return to his/her accustomed lifestyle. A sequence of steps for construction of custom-made laryngeal prosthesis is outlined in this case report using the readily available materials and method which any prosthodontist can readily understand and deliver. [ABSTRACT FROM AUTHOR]

Purpose: A total laryngectomy (TLE) leads to a variety of functional restrictions, which reduce the quality of life of cancer patients as well as their spouses. However, to date, there is little research focusing on the psychological distress of spouses of total laryngectomised cancer patients. The current study assesses psychological distress, need for psycho-oncological treatment and use of professional psychological care among spouses of total laryngectomised cancer patients. Methods: A prospective multi-centre cohort study was conducted. Participants were interviewed in person 1, 2 and 3 years subsequent to their spouses' TLE with standardised questionnaires (HADS, Hornheide Screening) and self-designed items. Results: One year after their partners' TLE, 154 spouses were interviewed. Over half of spouses (57 %) reported a high level of psychological distress and 33 % reported restlessness. Majority of spouses (21 %) reported wanting to learn relaxation methods and eight (5 %) had received psychological treatment in the past. Sixty-two spouses took part in the complete study. Over all three time points, psychological distress, the need for psycho-oncological support and the use of professional support among spouses remained stable. The need for additional professional counselling was low. Conclusions: In view of the stability of psychological distress among half of the spouses within 3 years after TLE and their refusal of professional support, there is a need for the development and evaluation of new treatment strategies to help spouses cope with psychological distress. Our results indicated the most common additional professional need was learning relaxation methods, which may be used as a starting point for the investigation of new coping strategies in future studies. [ABSTRACT FROM AUTHOR]

Introduction: Acoustic evaluation of alaryngeal voices is among the most prominent issues in speech analysis field. In fact, many methods have been developed to date to substitute the classic perceptual evaluation. The Aim of this study is to present our experience in erygmophonic speech objective assessment and to discuss the most widely used methods of acoustic speech appraisal. through a prospective case-control study we have measured acoustic parameters of speech quality during one year of erygmophonic rehabilitation therapy of Moroccan laryngectomized patients. Methods: We have assessed acoustic parameters of erygmophonic speech samples of eleven laryngectomized patients through the speech rehabilitation therapy. Acoustic parameters were obtained by perturbation analysis method and linear predictive coding algorithms also through the broadband spectrogram. Results: Using perturbation analysis methods, we have found erygmophonic voice to be significantly poorer than normal speech and it exhibits higher formant frequency values. However, erygmophonic voice shows also higher and extremely variable Error values that were greater than the acceptable level. And thus, live a doubt on the reliability of those analytic methods results. Conclusion: Acoustic parameters for objective evaluation of alaryngeal voices should allow a reliable representation of the perceptual evaluation of the quality of speech. This requirement has not been fulfilled by the common methods used so far. Therefore, acoustical assessment of erygmophonic speech needs more investigations. [ABSTRACT FROM AUTHOR]

Summary Objective This study explored the long-term impact of a Total Laryngectomy (TL) on the partner and on the relationship between laryngectomees and their partners. Methods 151 laryngectomees and 144 partners completed questionnaires assessing the psychosocial impact of a TL on the partner (quality of life, anxiety and depression, loss of control, fear, hopelessness, post-traumatic growth, caregiving burden) and on the spousal relationship (change in the quality of the spousal relationship and openness to discussion of the illness in the family). Results A considerable number of partners of laryngectomees experience a psychosocial impact of the consequences of the TL, specifically on their social life (35%) and on their sexual relationship (31%). Also, the tendency of other people to neglect their laryngectomized life companion, affects more than half of the partners negatively. Clinical levels of anxiety and depression were found in around 20% of the partners. The consequences of a TL has a negative change on the sexual functioning for more than 30% of both laryngectomees and partners, the communication for around one fifth of both laryngectomees and partners, and feelings of dependency of the partner for one third of the laryngectomees. Conclusions A TL has a considerable impact on the psychosocial life of partners of laryngectomees and on the spousal relationship. The findings of this explorative study sets the stage for structural screening on the need for support, not only for patients, but also for their partners. Sexuality and intimacy should be part of this screening. [ABSTRACT FROM AUTHOR]

Objectives To evaluate safety of positioning and distending the functional lumen imaging probe in the pharyngo-oesophageal segment in adults with known pharyngo-oesophageal segment dysfunction and to obtain preliminary measurements of pharyngo-oesophageal segment distensibility and opening during swallowing in a clinical group. Methods Prospective case series of ten adults post total laryngectomy (61-75 years) recruited from an outpatient ENT clinic. Functional lumen imaging probe was inserted trans-nasally, and the balloon was positioned in the pharyngo-oesophageal segment. Two 20- mL ramp distensions were completed, and subjects performed two dry and two 5- mL and 10- mL liquid swallows at a 12- mL balloon volume. Pharyngo-oesophageal segment distensibility was calculated from cross-sectional area (mm2) and intraballoon pressure (mmHg) measures. During swallowing, extent (mm) and duration (secs) of pharyngo-oesophageal segment opening and intraballoon pressure drop (mmHg) were evaluated. Results Functional lumen imaging probe could be passed through the pharyngo-oesophageal segment in seven subjects, all of whom completed the protocol. During distensions, pharyngo-oesophageal segment cross-sectional area increased significantly (19.47-148.3 mm2, P < 0.001), and intraballoon pressure increased significantly (15- to 20- mL balloon volume, P = 0.005). Pharyngo-oesophageal segment diameter (5.1 mm) increased during dry (7.4 mm), 5- mL (7.3 mm) and 10- mL (7.7 mm) liquid swallows ( P = 0.018). Pharyngo-oesophageal segment opening duration varied across dry (1 s), 5- mL (0.8 s) and 10- mL (1.6 s) liquid swallows. Resting intraballoon pressure (25.5 mmHg) did not alter significantly during swallowing ( P = 0.656). Conclusion Functional lumen imaging probe provides novel quantitative information regarding pharyngo-oesophageal segment distensibility and opening during swallowing in adults post total laryngectomy. No adverse events were observed in this first clinical study. Data were easy to acquire, and measures may direct candidacy for and establish effectiveness of interventions to alter pharyngo-oesophageal segment tone. [ABSTRACT FROM AUTHOR]

Advanced glottic cancer (T3,N+ & T4) is usually treated in the majority of centres by total laryngectomy. Carcinoma of the larynx is one of the very few subsets of all cancers which have shown a decrease in the 5 year survival rate and this phenomenon has been attributed to a Pharyngo-cutaneous fistula is the most common complication after total laryngectomy. Comparative study between double layered repair of pharyngeal mucosa against routine single layered repair in cases of 'total laryngectomy with partial pharyngectomy'. All patients with the principal procedure of 'total laryngectomy with partial pharyngectomy' in department of otorhinolaryngology and head-neck surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India were included in this study. Out of the 20 patients who had undergone total laryngectomy irrespective of the type of mucosal repair, 5 (25 %) patients developed pharyngocutaneous fistula. Out of the 8 patients, with double layered mucosa repair, 1 (12.5 %) patient developed pharyngocutaneous fistula. Out of the 12 patients, with single layered mucosa repair, 4 (33 %) patients developed pharyngocutaneous fistula. Double layered repair of pharyngeal mucosa is associated with a lower incidence of pharyngocutaneous fistula formation and no increased incidence of dysphagia after complete radiotherapy as compared to single layered repair. [ABSTRACT FROM AUTHOR]

Purpose: to compare acoustic data obtained through the phonatory deviation diagram of voices of dysphonic patients submitted to partial laryngectomy with voices of subjects of the same age range, however, without vocal complaint. Methods: the voices of 28 subjects were studied, being 14 partial laryngectomized patients and 14 subjects without vocal complaints, composing a control group. Both groups of males with same age and education level. The perceptual analysis of voices was conducted by GRBASI scale double-blind and through acoustic analysis software VOXMETRIA®. Results: partial laryngectomees voices 100% were distributed outside the normal quadrant, 64,3% were located in the right upper quadrant, 100% presented horizontal deviation of jitter and shimmer and 85,7% had a vertical deviation. The control group 28,5% were distributed within the normal quadrant, 71,5% were located in the right lower quadrant, 57,2% presented in the horizontal shimmer and 7,2% in jitter. Only 7,2% had a vertical deviation in the control group. Statistical significance was observed regarding the parameters of jitter, shimmer and GNE (glottal to noise excitation) and between the distribution of the voices in the upper right and left quadrants of the diagram in the presence of altered voices. Conclusion: the diagram allowed to analyze and discriminate the performance of normal and pathological voice differentiating them through their parameters, distribution, location and type of voice is considered a useful resource for voice analysis. [ABSTRACT FROM AUTHOR]

In the past 30 years, the use of voice prostheses has become the gold standard for voice rehabilitation after total laryngectomy. The placement of a voice prosthesis is a simple procedure that is associated with only a minor increase in operating time and a low rate of complications. Most problems with voice prostheses are minor and can be easily managed. Enlargement of the tracheo-oesophageal fistula, however, can be a severe complication. Approximately 25 % of all patients with voice prostheses develop periprosthetic leakage with aspiration within 1-4 years after the placement of a voice prosthesis. Depending on the severity of fistula enlargement, treatment ranges from conservative approaches to maximally invasive procedures. In some cases, however, these measures prove unsuccessful. The causes of treatment failure and fistula enlargement are not yet fully understood. Apart from a discussion of treatment options, an algorithm for the management of this complication is presented on the basis of the literature and the experience that we have accumulated at our institution during the past 20 years in the treatment of 232 laryngectomised patients. [ABSTRACT FROM AUTHOR]