Ventilatory function in laryngectomized patients

It is established that maximum expiratory flow-volume curve coupled with closing volume curve may give important information on obstructive impairment in the laryngectomized patients. In the patients after laryngectomy, the pattern of the flow-volume curve was similar to that found in patients with chronic bronchitis. These abnormalities of the flow-volume curve which became convexity to the volume axis can be reversed at least partially by bronchodilator drug inhalation. It is concluded that the patients after laryngectomy have abnormalities of ventilation distribution despite relatively normal results of routine pulmonary function tests and respiratory resistance.     

Early oral feeds in laryngectomized patients

OBJECTIVES: It is a common practice to start oral feeding after 7 to 10 days in patients who have undergone laryngeal surgeries. It was our observation that when oral feeds were initiated earlier than this period, there was no increase in the incidence of pharyngocutaneous fistulas. This prospective study is about our experience in initiating early oral feeds in the postoperative period (on the 2nd day) in laryngectomized patients. METHODS: Seventy-eight patients underwent laryngectomy with or without partial pharyngectomy over a period of 38 months between October 2001 and December 2004. The oral feeds were initiated on the 2nd postoperative day in 40 patients. Thirty-eight patients served as controls in whom feeds were initiated after the 10th postoperative day. RESULTS: Only 1 patient in the study group and 2 patients in the control group developed pharyngocutaneous fistulas. Most patients in the control group wished to avoid nasogastric intubation in the recovery period because of discomfort, gastric symptoms, and the need to taste food. CONCLUSIONS: With this study we can assume that in a select group of patients, it is possible to initiate oral feeding much earlier in the postoperative period than was formerly thought.     

Arytenoid vocal shunt in laryngectomized patients.

A method is presented for forming short, mucosa-lined vocal shunt in cases of supracricoid laryngectomy with preservation of one or two arytenoids, or the interarytenoid fold alone. On the basis of radiologic and particularly radiocinematographic examinationion of the anterior pharyngeal wall is of paramount importance. In cases of complete absence of leakage, said wall lies in the plane of the arytenoids or somewhat posteriorly. After simple supracricoid laryngectomy it is possible to prevent aspiration also by translocation of the anterior pharyngeal wall into the plane of the cricoid cartilage plate. The clinical experience with this supracricoid shunt is still scanty. Of 25 cases with the arytenoid vocal shunt, phonation was possible in 22 cases under the expiratory pressure of 20-45 cm H2O; in one under the more elevated pressure, and in the last two the result is still not known. Loudness of speech was 70-100 db and its comprehensibility 73-90 percent. Complete absence of leakage was observed in 17 cases, "practical" prevention of aspiration (some drops of thin fluids, no saliva) in seven cases, profuse leakage in one case (ceased after correction), In the last 10 consecutive cases the problem of aspiration was completely eliminated. Advantages and disadvantages of our own method in comparison with Asai's method have been presented.     

Nasal mucociliary clearance in total laryngectomized patients

We measured the nasal mucociliary activity in total laryngectomy patients, and to compare among themselves, smokers, diabetics and normal population besides that to investigate the short and long term effects of total laryngectomy on nasal mucosa. The study includes 39 patients who had total laryngectomy between the January 1998–August 2005 and 36 volunteer healthy individuals. To examine the early and late changes on nasal mucosa the patients that had total laryngectomy separated into two groups as operated before August 2003 (> 2 years), as operated after August 2003 (< 2 years). Moreover diabetic patients and smokers are differently grouped. This study is performed in Haydarpasa Numune Hospital for Research and Education, Department of Otorhinolaryngology, between May 2005–September 2005. Mucociliary clearance measurement is performed by saccharin test for all patients and control group. The mucociliary clearance of the patients (diabetics–nondiabetics, smokers–non smokers) are measured and examined if they show any difference among themselves. For the patients operated between the dates August 2003–2005 (< 2 years group) the nasal mucociliary clearance time average is found 8,15 ± 2.06 min., for the patients operated before August 2003 (> 2 years group) the mean time is found 23.79 ± 5.58 min., for the control group the mean time is found 14.5 ± 3.55 min In operated group the patients who are diabetics has longer mucociliary clearance time than nondiabetics, and the difference is statistically significant. Similarly in control group diabetics has longer mucociliary clearance time than nondiabetics. As another parameter smoking, comparing the groups among themselves, smokers have longer mucocilliary clearance time than nonsmokers. In total laryngectomy patients hypersecratory phase is produced in early period and nasal mucosal clearance is increased. On the other hand, dependent on chronic infections nasal mucosa is atrophied and nasal mucosal clearance is disrupted. However smoking and diabetes mellitus also damage the mucocilliary clearance.     

Gustatory and olfactory dysfunction in laryngectomized patients

After total laryngectomy surgery, nasal airflow is moved permanently to the tracheostomy opening, compromising the contact of odorant molecules with the nasal cavity, which may reflect changes in the olfactory and gustatory perception in these individuals.ObjectiveTo evaluate the functions of smell and taste in total laryngectomized patients. Study design: a study of series.MethodThe sample included a group of 25 patients submitted to total laryngectomy and another group of 25 patients who did not underwent the procedure. The taste function was evaluated by gustatory strips of filter paper. To assess the olfactory function we employed the Brief Smell Identification Test.ResultsAmong the laryngectomized patients there was more hypogeusia (80%, p < 0.05), as well as hyposmia (88%, p < 0.001), alone and concomitant (72%, p < 0.001). Concerning flavor discrimination, the bitter taste did not differ between the groups - which was different from the other flavors. In the olfactory aspect, laryngectomized patients performed worse in detecting warning and food-related odors. We found that a history of smoking and alcohol consumption were significantly more frequent among laryngectomized patients.ConclusionWe found a decrease of gustatory and olfactory functions in total laryngectomized patients in this study.     

Ultrasonic diagnosis of the pseudoglottis in laryngectomized patients

The validity of ultrasonic imaging as a tool for the investigation of pseudoglottal movements was studied in five good to excellent esophageal speakers. The length of pseudoglottis and vibration rate during phonation of vowels was evaluated by means of B-mode and M-mode sonography respectively. The pseudoglottal vibration rate as seen in M-mode sonography was in high agreement with the fundamental frequency of the simultaneously recorded sound as assessed by speech analysis. Ultrasound imaging is a promising diagnostic and therapeutic tool for the control and development of esophageal speech.     

Factors influencing quality of life in laryngectomized patients

The aim of this study is to estimate the quality of life postlaryngectomy. A questionnaire was used. Fifty-six patients were enrolled answering 26 questions. The mean age was 60.2 (40–76) years and median post-treatment time 43 (7–120) months. The most frequent complaints of the patients were increased bronchial discharge (66%) and reduced olfactory function (63%). Communication problems with strangers was mentioned by 57% and with their family by 29%. With regard to the psychological status, 30% were ashamed of their voice, 32% were ashamed of their appearance, 42% stated that they were rather depressed, and 30% were feeling lonely. More than 3 out of 4 patients believed that their everyday life had been altered. Half of the patients experienced financial difficulties and 37% were not participating in social meetings outside their house. Statistical analysis was used in order to calculate the severity of each category of problems which the patient faced using the scale from 0 to 1. The average grade for functional disorders was 0.31, for communication problems 0.47, for psychological problems 0.29, for social problems 0.27, and for financial problems 0.51. Received: 6 August 2000 / Accepted: 25 May 2001