THROAT - Post-Laryngectomy speech

The normal larynx produces an undifferentiated sound, which is moulded into intelligible speech by movements and positions of soft palate, tips, teeth and mandible.

How post Laryngectomy speech rehabilation done?

Informing the patient and their relatives is an important part of the rehabilitation programme.
Thus post laryngectomy patient can undergo 3 types of speech rehabilitation. ..
1) Using external voice prosthesis (artificial larynx)
2) Oesophageal speech.
3) Trachea-oesophageal fistula

I. The artificial larynx are of two types :
1. Pneumatic : This is activated by the respiratory air coming from the tracheostomy.

Advantages of pneumatic larynx:
a) Can be used the day immediately after the surgery.
b) Vibrating membrane material can chosen to the pitch and sound quality can be selected.
c) No battery, hence cheap.

Example:
a) Tokyo artificial larynx
b) Memacon OSP-8

2. Electronic voice box
The patient uses his normal articulatory mechanism to speak.
The external vibrators have an adjustable pitch and intensity.
The voice however has a metallic quality.

Advantage:
a) No speech therapy required
b) Good speech quality
Disadvantage: Expensive
Example : Servox

 

II. Oesophageal Speech: This  is a very simple and cheap method to develop speech.

Mechanism: Air is ingested into the oesophagus and expelled without allowing it to each the stomach.

Air escapes past the pespophageal sphincter causing vibrations This can be done by 2 types:
a) Inhalation air method
b) Ingested air method

The quality of voice depends on the ability of the patient to control the air and produce sound.

III. Tracheo –oesophageal fistula
A. Surgical fistula is created between the trachea and pharynx. Air produces vibrations in the local tissues and audible speech can be generated.

Advantages:
a) Sound produced by exhalation of air hence there is better control
b) Not much speech therapy is required.

Disadvantage:
a) Stenosis
b) Aspiration

Example : Blom-Singer prosthesis.

 




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