Vocal rehabilitation after total laryngectomy using the Provox voice prosthesis

Vocal rehabilitation in laryngectomized patients can be attained by surgical (tracheoesophageal speech) or conservative methods (oesophageal speech or artificial larynx). We prospectively studied voice restoration in 37 patients who underwent total laryngectomy in the period from February 1991 to February 1993. The patients were given the opportunity to assess both non-shunt oesophageal speech and shunt oesophageal speech using the Provox voice prosthesis. The Provox low resistance, self-retaining voice prosthesis is a biflanged device made of silicon rubber. A primary tracheoesophageal puncture was made in 28 patients, while a secondary puncture was performed in another nine patients. The results were assessed according to criteria established at the ‘Third International Congress on Voice Prosthesis’ in Groningen (1988). Functional tracheoesophageal speech after primary puncture was achieved in 95% of patients 12 months after puncture, while oesophageal voice was acquired by 55%. Only minor surgical and prosthesis-related complications were encountered during this follow-up period in 29% of the patients. The device lifetime varied from 3 months to at least 2 years (mean 5.4 months).     

双瓣式发音钮全喉切除术后发音重建

为解决无喉者发音问题，从１９９３年３月～１９９６年１１月，利用自行研制的双瓣式喉发音钮及安装器为全喉切除术后患者应用９７例，其中男８４例，女１３例，年龄３５岁～７８岁。全喉切除术后Ⅰ期安装２０例，Ⅱ期安装７７例，效果满意，患者均能清晰说话，语言流利，地方语言特色明显。部分患者能唱歌，随访观察：在发音钮有效使用时间（１～２年）内，配戴满２年者６８例，发音有效率１００％，误咽率为零。该发音钮具有安装、更换方便，使用时间长，术后不用鼻饲等优点，为无喉者发音提供了又一有效途径。     

喉全切除后气管造口及发音管的应用研究

目的探讨喉全切除术后建造不狭窄的气管造口同时防止造口处“碗状”塌陷形成的术式。方法回顾分析１９９６年以来我科应用ＢｌｏｍＳｉｎｇｅｒ技术行喉全切除后重建气管食管音患者２５例,采用五种方法行气管造口术,其中６例在一期手术中采用颈前“Ｕ”形切口＋切断双侧胸锁乳突肌胸骨端＋Ｇｒｉｆｉｔｈ气管造口扩大术（综合法）,并安装常植式发音管和呼吸瓣膜器。结果２５例中２３例成功发音,成功率９２％,气管造口方法中皮肤与气管环直接缝合者７例,Ｍｙｅｒｓ法３例,Ｇｒｉｆｉｔｈ法６例,道士名仁法３例,术后均需戴管半年以上并出现不同程度的造口狭窄及“碗状”塌陷形成。采用综合法行气管造口术６例术后不需戴管,随访半年以上造口基本不狭窄,且无“碗状”塌陷形成。结论采用综合法行气管造口术方便了发音管及呼吸瓣膜器的安装、护理以及更换;常植式发音管的音质最好;呼吸瓣膜器的应用不需要患者用手指堵住气管造口进行发音。     

The VoiceMaster voice prosthesis for the laryngectomized patient

Since the introduction and performance of total laryngectomy, voice restoration has become an important issue. Voice prostheses are widely used for this purpose. Based on experience with previous and current prostheses, the important characteristics for any voice prosthesis can be defined. These characteristics are: indwelling fixation, low resistance to airflow, less bothersome and easier insertion into the tracheoesophageal (TE) fistula. Also, predictable long device life span (resistance to Candida deterioration) and easy removal of the prosthesis to allow inspection or cleaning and consequent re-insertion are desirable. The VoiceMaster voice prosthesis was developed with these characteristics in mind. The VoiceMaster prosthesis is described in this paper. The first results from the preliminary study in which the currently available VoiceMaster was tested are very encouraging.     

Female-pitched sound-producing voice prostheses – initial experimental and clinical results

In order to improve voice quality in female laryngectomees and/or laryngectomees with a hypotonic pharyngo-oesophageal segment, a sound-producing voice prosthesis was designed. The new source of voice consists of either one or two bent silicone lips which perform an oscillatory movement driven by the expired pulmonary air that flows along the outward-striking lips through the tracheo-oesophageal shunt valve. Four different prototypes of this pneumatic sound source were evaluated in vitro and in two female laryngectomees, testing the feasibility and characteristics of this new mechanism for alternative alaryngeal voice production. In vivo evaluation included acoustic analyses of both sustained vowels and read-aloud prose, videofluoroscopy, speech rate, and registration of tracheal phonatory pressure and vocal intensity. The mechanism proved feasible and did not result in unacceptable airflow resistance. The average pitch of voice increased and clarity improved in female laryngectomees. Pitch regulation of this prosthetic voice is possible with sufficient modulation to avoid monotony. The quality of voice attained through the sound-producing voice prostheses depends on a patient’s ability to let pulmonary air flow easily through the pharyngo-oesophageal segment without evoking the low-frequency mucosal vibrations that form the regular tracheo-oesophageal shunt voice. These initial experimental and clinical results provide directions for the future development of sound-producing voice prostheses. A single relatively long lip in a container with a rectangular lumen that hardly protrudes from the voice prosthesis may have the most promising characteristics. Received: 20 June 2000 / Accepted: 10 April 2001     

Voice rehabilitation with Provox2 voice prosthesis following total laryngectomy for laryngeal and hypopharyngeal carcinoma

OBJECTIVE: To analyze the effectiveness of the Provox2 voice prosthesis for voice rehabilitation following total laryngectomy. METHODS: From September 2000 to December 2004, the Provox2 voice prosthesis was used for voice rehabilitation in 32 patients following total laryngectomy. The quality of speech with the Provox2 voice prosthesis was analyzed using the HRS rating scale, the maximum phonation time (MPT), incidence of complications and the in situ lifetime. The rate of speech restoration was further analyzed in 129 patients with total laryngectomy from 1996 to 2004. RESULT: Twenty-nine of 32 patients were able to restore speech using the Provox2 voice prosthesis, a speech restoration rate of 90.6%. The maximum phonation time (MPT) was measured in 18 patients using the Provox2 voice prosthesis. The mean MPT was 15.1 s, with a range of 8-28 s. MPT was not influenced by age, concurrent radiotherapy treatment, the location of the primary tumor or use of reconstructive surgery. The average lifetime of the Provox2 in patients with laryngeal carcinoma (12 patients) and hypopharyngeal carcinoma (17 patients) was 27.2 and 16.6 weeks, respectively, which was significantly different (P=0.024, non-parametric Mann-Whitney's U-test). The rate of speech restoration by the use of esophageal speech, and insertion of an artificial larynx was 62.7% for laryngeal carcinoma (59 cases) and 38.6% for hypopharyngeal carcinoma (70 cases), which was also significantly different (P<0.01, chi-square test). CONCLUSION: Provox2 voice prosthesis speech was very useful due to the higher rate of speech restoration, longer phonatory time, and better intelligibility. It was also thought that voice prosthesis speech was useful in conjunction with esophageal speech and an artificial larynx depending on the patient's condition or wishes.     

喉全切除发音重建术远期疗效分析

为了评价喉全切除术后发音重建术的效果，１９７７年８月到１９９４年１２月，对喉癌患者共行各类喉全切除发音重建术１２５例。男１１９例，女６例，年龄最大７０岁，最小３０岁，平均５５．３岁。临床分期：Ⅱ期２例，Ⅲ期４５例，Ⅳ期６６例，治疗后复发１２例。喉重建术式有：咽气管吻合术１８例，气管－食管造瘘术１０７例，后者包括直接法３４例（其中１２例安装发音钮），管道法１９例，瓣膜法５４例。１２５例中除１１例失访外，皆获随访，最长１８年，最短１３个月，３、５、１０年生存率分别为：７８．２％，６１．４％，４０．５％。按听距法评价发音效果，总有效率：术后３周：８４．６％，１年：８１．１％，５年：６７．５％。发音重建失败的原因有：术后造瘘口闭锁１５例，术后误咽而关闭瘘口８例，原因不明３例。喉全切除发音重建术可明显改善发音功能，合并症少，有较高的临床使用价值。     

A new prosthesis for voice rehabilitation after laryngectomy

Summary Since the first laryngectomy, several surgical and prosthetic techniques have been developed in order to restore voice. Problems encountered with these techniques include: Leakage through the tracheoesophageal fistula, spontaneous closure of the fistula, dislodgement of the prosthesis, and the use of adhesives for fixation. We now introduce a new silicone voice prosthesis that overcomes these problems. The prosthesis is easily inserted as a one-stage procedure during total laryngectomy. Successful acquisition of voice was achieved in 30 of 33 patients, irrespective of preoperative or postoperative radiotherapy. Average device life proved to be approximately 100 days. The high rate of success with minimal morbidity merits further investigation of this one-stage voice rehabilitation technique.     

Sealing of small postlaryngectomy pharyngocutaneous fistulas with voice prosthesis

Pharyngocutaneous fistulas (PCFs) following total laryngectomy is a common complication. The standard therapy is conservative management, and if this is not successful, surgical closure. There is a group of patients with limited survival chance who have small PCFs. In these patients who are not candidates for surgery, sealing of the PCF with a voice prosthesis can significantly improve the functionality of these patients allowing them to swallow and phonate. Laryngoscope, 2010     

喉全切除术后气管食管穿刺发声重建的远期效果

目的：探讨气管食管穿刺(TEP)安放Blom-Singer发音管发声重建在喉全切除术后患者中的远期效果。方法：回顾性分析134例资料完整的喉全切除术后TEP安放Blom-Singer发音管发声患者的临床资料。应用多维语音分析系统(MDVP)对其中18例发音管发声患者的声学参数进行检测分析。结果：所有病例均随访2～15年。1986～1989年12例中7例获得满意结果,成功率58．3％。1990年以后的122例中,114例效果满意,成功率93．4％,总成功率90．3％。MDVP检测的发音管发声主要声学参数值都远远偏离正常。常见并发症有瘘口肉芽增生,早期感染,气、食管瘘口过大出现漏液等。结论：TEP安放发音管,操作简单,并发症少,成功率高,质量好,远期效果稳定,是一种目前让无喉患者开口讲话较好的手术方法。咽、食管括约肌切开术能提高BlomSinger发音管发声重建的成功率。     

喉全切除术后气管食管造口发音重建术

目的 评价喉全切除术后气管食管造口发音重建术的临床应用价值.方法 回顾性分析天津医科大学附属肿瘤医院头颈科1981年7月至2006年8月127例喉全切除术后气管食管造121发音重建术的临床资料.结果 本组127例患者中,105例获得满意的发音效果,发音总成功率为82.7%(105/127).所有发音成功的患者经2～27年的随访,发音效果良好,未发生并发症.分析22例患者发音失败的原因,手术技术操作不当的9例(造成造口过小的7例,造口过大的2例);术后感染13例(造成造口过小的10例,造口过大的3例).造口的大小是发音成败的关键,手术技术操作不当和术后感染是发音失败的主要原因.结论 喉全切除术后气管食管造口发音重建术发音成功率高,并发症较低,简单易行,适宜在临床推广.     

喉全切除术后Blom-Singer法发音重建术并发症分析及处理

目的 探讨喉全切除术后安放Blom-Singer发音管发音重建术的并发症及处理策略。方法 回顾性分析1986年11月—2004年6月期间151例喉全切除术后患者安装Blom—Singer发音管的临床资料。结果 所有病例均随访6个月～15年。151例中，138例获得满意的发音效果，发音总成功率91．4％；出现并发症15例，发生率9．9％，其中造口肉芽增生6例，4例行激光切除，2例三氯醋酸烧灼去除，其中有2例发音失败；早期感染2例且并发咽后壁脓肿，其中1例累及上纵隔，均经局部切开负压引流及应用抗生素治愈；2例管周漏液，取出发音管一段时间后，造口缩窄，重新置入发音管；发音管脱落2例，重新置入；造口狭窄1例，行造口扩大术得以解决；发音管食管端鸭嘴部真菌生长1例，制霉菌素清洗，后更换发音管；误吸1例，封闭造口后患吸入性肺炎。15例并发症中成功治疗12例，余3例发音失败。结论 气管食管穿刺安放Blom-Singer发音管帮助喉全切除患者恢复语言功能，并发症少，成功率高，发声质量好，目前已成为一种最常用的手术方法。     

咽食管括约肌切开术在喉全切除术后发音重建中的作用

目的　探讨咽食管括约肌切开术对减少咽食管括约肌失弛缓对喉全切除术后安装Blom Singer发音管发音重建的影响。方法　喉全切除术后 ,咽食管括约肌收缩或是痉挛都会不同程度地影响食管的气流并阻碍发音。咽食管括约肌的解剖位置是环咽肌以及其上的下咽缩肌的一部分和颈段食管上段的一部分。手术操作是在喉全切除术中、术后于气管造瘘口外上方切除长 5cm ,宽 1cm的咽食管括约肌。结果　 3 3例喉全切除术的患者进行咽食管括约肌切开术后有 3 2例发音成功 ,发音重建的成功率是 97%。其中包括 12例喉全切除术中I期进行环咽肌切开术 ,2 1例是Ⅱ期进行咽食管括约肌切开术的 ,后者又有 9例是安装Blom Singer发音管后发音不能再行咽食管括约肌切开术的。患者 3年存活 2 5例 ,5年存活 18例。同期行喉全切除术和咽食管括约肌切开术的 12例患者 ,Kaplan Meier法统计 3年生存率 81 82 % ,5年生存率 42 86%。结论　咽食管括约肌切开术能提高Blom Singer发音管发音重建的成功率。     

Amatsu法发音重建术60例评价

目的 评价Amatsu法发音蕈建术的临床效果.方法 60例喉全切除、双颈淋巴清扫术患者一期行Amatsu法发音重建术,其中喉癌49例,下咽癌11例;1例术前放疗80 Gy,20例术后放疗60～70 Gy.术后随访3～6年,评价言语、吞咽功能.结果 52例(86.7%)术后均获得良好的言语功能,其中吞咽功能正常51例,另1例进食流食时可见气管内少量滴漏.8例(11.3%)发音重建失败,吞咽功能均正常:4例因并发咽瘘(其中术前放疗1例),经换药、抗感染处理后咽瘘均痊愈,吞咽功能正常,但已敛发音管坏死,发音失败;2例因气管食管造口粘连致发音管闭锁,未再行补救性手术,改用人工喉发音;1例不明原因呼吸困难;1例无发音意愿.20例术后放疗者言语功能有暂时性影响,均恢复良好.结论 Amatsu法发音重建术可一期重建喉全切除患者的言语和吞咽功能,可获得良好的发音效果,术后放疗不影响患者的远期发音效果.     

喉近全切除发音管重建术

目的进一步探讨喉近全切除术在晚期喉癌、喉咽癌中的应用。方法参照唐平章Pearson改良法,1995年5月～2003年3月共治疗39例,其中喉癌30例(T3N0～T3N2 17例,T4N0～T4N2 13例),喉咽癌9例(T3N0～T3N1 6例,T4N0～T4N1 3例)。同期颈清扫16例。结果39例中36例(92.3％)获得较好发音。除1例饮水和进流体食物偶有轻微呛咳外,其余38例(97.4％)均可顺利进食。喉癌的3年生存率73.3％(22/30),5年生存率61.1％(11／18);喉咽癌3年生存率55.6％(5/9)。局部复发率2.56％(1/39)。结论喉近全切除术的应用可使部分晚期喉癌、喉咽癌患者免于喉全切除,并可获得良好的发音和吞咽功能。