Specialist ENT LARYNGECTOMY SPEECH

POST – LARYNGECTOMY SPEECH

Introduction:

The normal larynx produces an undifferentiated sound, which is moulded into intelligible speech by movements and positions of soft palate, tips, teeth and mandible. After total laryngectomy the patient is not able to speak using own vocal cords. Post laryngectomy speech is to enable the patient to speak after total laryngectomy.

Post laryngectomy patients can undergo 3 types of speech rehabilitation:

1) Using external voice prosthesis (artificial larynx).

2) Oesophageal speech.

3) Trachea-oesophageal fistula.

 

Normal larynx

Electrolarynx

Esophageal

Trachea-esophageal

Initiator

Pulmonary air

Battery

Esophageal air

Pulmonary air

Voice Source

Glottis

Vibrating membrane

Neopharynx

Neopharynx

Resonator

Vocal tract

Vocal tract

Vocal tract

Vocal tract

Articulator

Oral cavity, oropharynx

Oral cavity, oropharynx

Oral cavity, oropharynx

Oral cavity, oropharynx

I. The Artificial larynx:

Artificial larynx devices employ the use of either a new voice source (battery as in electrolarynx) or the use of an apparatus that utilises pulmonary air to produce voice (pneumatic larynx).

1. Pneumatic: Here air from the lungs is directed from the tracheostome via a device housing the vibrating reeds to the mouth.

Advantages of pneumatic larynx:

a) Can be used the day immediately after the surgery.

b) Vibrating membrane material can be selected according to the pitch and sound quality.

c) No battery, hence cheap.

Example:

Tokyo artificial larynx.

Specialist ENT Screenshot 2020 12 01 larynx 2020 new bs almost final edted 8 9 2020 2 docx14 1
  1. 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.
  • The battery-operated device is placed at the corner of the mouth or against the skin of the neck. When button on the device is pressed, it makes a vibrating sound. By moving the mouth and tongue, one can form this sound into words. Training is needed with a speech therapist to learn how to use it properly.

Advantage:

  1. a) No speech therapy required.
  2. b) Good speech quality.

Disadvantage: Expensive.

Specialist ENT Screenshot 2020 12 01 larynx 2020 new bs almost final edted 8 9 2020 2 docx15 1

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 reach the stomach. Air escapes past the oesophageal 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.

Specialist ENT Screenshot 2020 12 01 larynx 2020 new bs almost final edted 8 9 2020 2 docx16 1

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.

Specialist ENT Screenshot 2020 12 01 larynx 2020 new bs almost final edted 8 9 2020 2 docx17 1

We Are Always Ready to Help You.
Book An Appointment

Specialist ENT section img
Specialist ENT contact img