食管发音对无喉患者生存质量的影响

目的探讨无喉患者术后躯体康复对生存质量（qualjty of life）的影响。方法对49例喉全切除术后进行食管发音训练成功的患者，分别在训练前和食管发音后3个月，用头颈肿瘤行为状态量表（performance status scale for head and neck cancer patients，PSS—HN），癌症治疗功能评估调查问卷（functional assessment of cancer therapy-head and neck，FACT—H＆N）进行生存质量评估。结果喉全切除严重影响患者的生存质量，在食管发音训练前PSS—HN量表和FACT—H＆N问卷的评分为131．4和90．6分，均低于标准（分别300分和144分），差异有统计学意义（t值分别为53．673、67．44，P值均〈0．001）。在运用食管发音后PSS—HN量表、FACT—H＆N问卷的评分均比训练前提高，分别为240．4和103．7分，与训练前比较差异有统计学意义（t值分别为18．209、21．389，P值均〈0．001）。结论无喉患者可以通过术后躯体的康复及食管发音训练来提高其生存质量。     

Factors influencing pharynx' and pharyngoesophageal sphincter's morphology and their function after total laryngectomy

The usefulness of the videolaryngoscopy in patients after total laryngectomy/laryngopharyngectomy was discussed. They serve for: a) evaluation of the pharynx and of the pharyngoesophageal sphincter (pes) morphology, b) prognosis of the esophageal speech developing. In the study videolaryngoscopy was done in 82 patients (7 female and 75 male). In 62 of them total laryngectomy was done (among them in 50/62--with standard pharynx suture, in 9/62--with the pes plasty, and 3/62--with simple pes myotomy). In 20 case of laryngopharyngectomies--4/20 standard pharynx suture was done, 12/20 were reconstructed with tongue flap, 3/20--with pes plasty, and in 1/20 simple myotomy was performed. The investigations were carried out between 1 to 36 months after total laryngectomy and 24 month after laryngopharyngectomy. The analysis of the videolaryngoscopy imagings revealed that the pharynx and pes morphology after laryngectomy/laryngopharyngectomy (shape, thickness of the mucose, weakened wall peristalsis, secretion retention, lack or presence of the pes relaxation at the time of examination) correlates with the rest pressure in the pes area, measured by Seeman's method and with the occurrence of the esophageal speech mastering. The most significant changes in morphology and function of the pharynx (irregular shape, weakened wall peristalsis, retention of secretion) as well as the highest pressure in the area (5.1 +/- 3.33 kPa-38 +/- 25 mm Hg) was found after pharyngolaryngectomy. The shape of the pharynx in all the patients after laryngectomy with plasty or simple myotomy of the pes was regular, with thin and smooth mucosa while the rest pressure was low (3.0 +/- 1.18 kPa(-)+/- 22.5 +/- 8.8 mm Hg). In the analyzed material at the rest pressure in the sphincter area from 0.7 to 4kPa (from 5 to 30 mm Hg), 93% (41/44) of the patients have mastered the esophageal speech. It was stressed that videolaryngoscopy is entirely sufficient for the approximate assessment of the rest pressure in the pes area and prognosis of the esophageal speech development process.     

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.     

Functional organ preservation after chemoradiotherapy in elderly patients with loco-regionally advanced head and neck squamous cell carcinoma

The aim of the present investigation is to evaluate the outcome after induction chemotherapy and concurrent multi-drug chemoradiotherapy (IC/CCRT) with or without post-chemoradiation neck dissection in medically fit elderly patients with loco-regionally advanced head and neck squamous cell carcinoma (HNSCC). Retrospective study including 44 elderly patients (median age 71 years; range 66–77 years) with previously untreated, inoperable, histologically proven non-metastatic stage III or IV HNSCC. Following one cycle of IC, two cycles of cis-platinum and 5-fluorouracil CCRT with conventional fractionated radiotherapy up to a dose of 66–70 Gy were administrated. A neck dissection was recommended for patients with node metastasis larger than 3 cm regardless of the response to therapy and for patients who had suspected persistent neck disease 8–12 weeks after completing treatment. Salvage surgery was considered for histologically proven persistent or recurrent tumor in the primary site. Time-to-event data were described using Kaplan–Meier actuarial curves. Overall, 37 patients (84.1%) completed the planned treatment. There were no cases of treatment-related deaths. Twenty-nine patients (65.9%) developed severe toxicities with grade 4 toxicity accounting for 22.7%. The median follow-up time in survivors was 41 months. Three-year overall survival, progression-free survival, and functional progression-free survival estimates were 70.9, 67.0, and 57.3%, respectively. In selected medically fit elderly patients with loco-regionally advanced HNSCC, cis-platinum-based chemoradiotherapy can be successfully applied, with moderate adverse events, in attempt to preserve a functional upper aerodigestive tract.     

全喉切除Ⅰ期气管食管端-侧吻合发音重建术远期疗效分析

目的 :探讨一种有别于其他全喉切除术后发音重建术的手术方法。方法 :施行全喉切除术后行Ⅰ期气管膜样部食管前壁造孔端 侧吻合气管食管分流发音重建术 36例。结果 :随访 5～ 10年 ,1例失访 (按死亡计算 )。36例中 ,近期发音成功率为 6 9.4 % ,远期为 83.3% ;3年存活率为 72 % ,5、10年存活率为 6 9%。结论 :该发音重建术不影响全喉切除的彻底性 ,Ⅰ期完成 ,操作简单、误吸率较低、发音成功率高、远期效果稳定 ,是一种让全喉切除术后患者开口讲话的较好的手术方法     

Predictive value of objective esophageal insufflation testing for acquisition of tracheoesophageal speech.

This prospective study was undertaken to assess the predictive value of esophageal insufflation on the acquisition of tracheoesophageal (TE) speech. Fourteen total laryngectomy patients were evaluated prior to tracheoesophageal puncture (TEP) using objective esophageal pressure measurements. These patients then were followed prospectively for 6 to 13 months. Speech was assessed at the time of prosthesis fitting, at 1 month, at less than 6 months, and at greater than 6 months post-TEP. No patient underwent pharyngeal myotomy. Pre-TEP esophageal insufflation pressure was associated (P = .065) with successful TE speech at the time of prosthesis fitting, but was not associated with successful TE speech acquisition after 6 months. This study's results suggest that patients with poor pre-TEP esophageal insufflation test results will usually obtain successful TE speech given adequate time and training, even without pharyngeal myotomy.     

Voice and speech outcomes of chemoradiation for advanced head and neck cancer: a systematic review

Purpose of this review is to systematically assess the effects on voice and speech of advanced head and neck cancer and its treatment by means of chemoradiotherapy (CRT). The databases Medline, Embase and Cochrane were searched (1991–2009) for terms head and neck cancer, chemoradiation, voice and speech rehabilitation. Twenty articles met the inclusion criteria, whereof 14 reported on voice outcomes and 10 on speech. Within the selected 20 studies, 18 different tools were used for speech or voice evaluation. Most studies assessed their data by means of patient questionnaires. Four studies presented outcome measures in more than one dimension. Most studies summarised the outcomes of posttreatment data that were assessed at various points in time after treatment. Except for four studies, pre-treatment measurements were lacking. This and the fact that most studies combined the outcomes of patients with radiated laryngeal cancers with outcome data of non-laryngeal cancer patients impedes an interpretation in terms of the effects of radiation versus the effects of the disease itself on voice or speech. Overall, the studies indicated that voice and speech degenerated during CRT, improved again 1–2 months after treatment and exceeded pre-treatment levels after 1 year or longer. However, voice and speech measures do not show normal values before or after treatment. Given the large-ranged posttreatment data, missing baseline assessment and the lacking separation of tumour/radiation sites, there is an urgent need for structured standardised multi-dimensional speech and voice assessment protocols in patients with advanced head and neck cancer treated with CRT.     

Malignancy of the larynx

Summary  Squamous cell carcinoma is by far the commonest malignancy of the larynx and I would confine my present paper mainly to this along with the management and post-operative rehabilitation after total laryngectomy. High survival rate in majority of the cases, if diagnosed and treated early and adequately, provokes and encourages the interested laryngologist to consider not only about performing effective surgery, including on those cases where radiotherapy is inadequate or has failed, but also resorting to rehabilitative surgical procedures after total laryngectomy with or without neck dissection, offering to the laryngectomee a ‘Biologic’ Neo-Larynx, created from the patients own tissues, for tracheo-oesopharyngeal phonation. I am of the opinion that if a Neo-Larynx is constructed from the upper parts of the patient’s own trachea and oesophagus without using any extraneous synthetic material, the patient would be happy to learn that the new voice box has been created out of his own tissues and no extraneous foreign material has been implanted and left in his body and he can effortlessly phonate ‘tracheo-oesophageally’ instaneously after removal of the silastic sheet from the Neoglottis five weeks after the operation without any rigorous training and the voice is better than the conventional alaryngeal ‘pharyngo-oesophageal’ one after total laryngectomy. Moreover, the complications associated with the prostheses viz. fungal and bacterial invasion with subsequent leakage around it and its displacement, and the tedious maintenance and replacement problems can be obviated by providing the patient with a ‘biologic’ Neo-Larynx of viable tissues. Therefore, my present paper will deal with the construction of Neo-Larynx after conducting experiments on animals. In the Neo-Larynx, a Neo-Epiglottis (hitherto not reported in the literature to my knowledge) and a Neo-Glottis are ingeniously constructed in order to enable the laryngectomee to phonate tracheooesophageally (c.f. pharyngoesophageally). The Neo-Glottis is transversely disposed since it offers better protection against aspiration than the vertically disposed one. The Neo-Epiglottis is constructed from the posterior tracheal wall, inferiorly based, or from the superiorly based tongue-shaped flap, raised from the full-thickness membranous posterior tracheal wall, or from the anterior tracheal wall, folded posteriorly (as in ‘Duck-Bill’ Neo-Larynx), for preventing aspiration through the Neo-Glottis into the tracheaobronchial tree during deglutition. In addition, a statico-dynamic sphincter or sling, reminiscent of the original primitive one, has been constructed around the Neo-Larynx, utilizing the strap muscles of the neck, in order to bring about competency of the Neo-Larynx for preventing aspiration through the Neo-Glottis. By this operation the problems of aspiration and stenosis of the Neo-Glottis have been largely solved. The Neo-Glottis is constructed in a transverse slit in the anterior oesophageal wall in a protective gutter in the anterior wall of the oesophageal lumen and the inferior lip of the slit is reinforced with a small cartilage bar in order to make it a stiff neo-vocal cord for producing stronger and better voice than pharyngo-oesophageal one which (i.e. tracheo-oesophageal one) is akin to normal voice. Presumably, the sphincter influences the voice quality by its continuously changing tension. The upper end of the trachea is closed to form a cul-de-sac and the phonetic stream is stopped here and channelised through the only available outlet i.e. the tracheooesophageal fistula (Neo-Glottis) into the oesophagus and pharynx for articulation. The latest proposed procedure is easier than the previous ones in which a biologic ‘Duck-Bill’ Neo-larynx is constructed from the upper parts of the trachea and oesophagus. Neo-Epiglottis and Neo-Vocal cords are incorporated in this. The Neo-Glottis is situated in the trachea anterior to the tracheo-oesophageal fistula. In this there are two additional phonatory mechanisms through which the phonetic stream passes :

In vitro measurements of aerodynamic characteristics of an improved tracheostoma valve for laryngectomees

Tracheostoma valves are often required in the rehabilitation process of speech after total laryngectomy. Patients are thus able to speak without using their hands to close the tracheostoma. The improved Groningen tracheostoma valve consists of a “cough” valve with an integrated (“speech”) valve, which closes for phonation. The cough valve opens as the result of pressure produced by the lungs during a cough. The speech valve closes by the airflow produced by the lungs, thus directing air from the lungs into the esophagus at a deliberately chosen moment. An experimental setup with a computer-based acquisition program was developed to measure the pressure at which the cough valve opened and the flow at which the speech valve closed. In addition, the airflow resistance coefficient of the tracheostoma valve was defined and measured with an open speech valve. Both dry air from a cylinder and humid expired air were used. Results showed a pressure range of 1–7 kPa to open the cough valve and a flow range of 1.2–2.7 l/s to close the speech valve. These values were readily attained during speech, while the flow range occurred above values reached in quiet breathing. The device appeared to function well in physiological ranges and was optimally adjustable to an individual setting. No significant differences were measured between air from a cylinder and humid expired air. Findings showed that methods used to obtain results could be employed as a reference method for comparing aerodynamic characteristics of tracheostoma valves. Received: 13 February 1997 / Accepted: 16 September 1997     

The influence of early speech rehabilitation with voice prostheses on the psychological state of laryngectomized patients

This survey assessed how early speech rehabilitation influences the emotional state and psychological adjustment of 43 male laryngectomy patients, at three different chronological stages. The first assessment occurred 2–3 days before the operation. The patients filled out a stress questionnaire (SVF) which assessed coping strategies. Exactly 2 weeks after the operation the patients were given a list of adjectives (EWL) which measured their actual emotional state. One day before leaving the hospital the patients were given the Post-laryngectomy Telephone Test (PLTT) which ascertained the quality of speech intelligibility. In addition, patients filled out a questionnaire on postoperative stress and anticipated stigmatisation with regard to their changed voice. Results demonstrated that patients who had early speech rehabilitation felt significantly more active and, in general, felt considerably better than patients who had not received speech rehabilitation training. Patients assessed voice loss as extremely distressing. The postoperative stress and the anticipated stigmatisation on the basis of the changed voice was significantly higher in those patients with good speech intelligibility than in patients with poor speech articulation at hospital discharge. The coping strategies “Giving up and resignation” and “Need for social support” correlated positively with postoperative stress and anticipated stigmatisation. Results show that early speech rehabilitation with voice prostheses had a positive effect on the emotional state of laryngectomy patients. However, the early speech rehabilitation leads to distress in the initial phase in laryngectomy patients. Moreover, patients who habitually tend towards resignation, or need lots of social support should receive psychological support during the early phase of speech rehabilitation training. Received: 27 April 2001 / Accepted: 5 July 2001     

The incidence of adenoidal regrowth after adenoidectomy and its effect on persistent nasal symptoms

Objective of the study is to evaluate the effectiveness of adenoidectomy for children, to asses the rates of adenoidal regrowth and find out if the regrowth of adenoidal tissue affects persistent nasal symptoms post-surgery. A prospective study was carried out in the period of 2005–2007. The inclusion criteria for patients in the study were hypertrophic adenoid tissue and moderate or severe persistent nasal obstruction. One hundred and fifty children had undergone an adenoidectomy using consistent technique and visual control. Medium-term follow-up results were conducted 12–24 months (the mean follow-up period was 17.1 months) post-surgery, performing transnasal fibroscopy and completing the questionnaire. A total of 104 (69.3%) out of 150 patients polled. Children’s parents answered the questions that were used for the subjective assessment of symptoms and to ascertain the history of the patient’s nasal obstruction and upper respiratory tract infection prior to surgery. The age range was from 3 to 15, of which, 68 (65.3%) of them had undergone a transnasal fibroscopy. There was a significant reduction in symptoms that were displayed by children prior to the operation: there were 5.8% patients with nasal obstruction after the surgery, while incidences of upper airway infections dropped from 79.8 to 7.7% after surgery (P < 0.001). Eighty-six (82.7%) parents considered their child’s well-being as “having improved” and they were “satisfied” with the results. Transnasal fibroscopy examinations identified some regrowth of adenoidal tissue in 13 cases (19.1%), with only 3 cases demonstrating adenoidal regrowth to grade 1. Adenoidal regrowth was correlative with the age of the patients (P = 0.048) and to numerous postoperative treatment with antibiotics (P = 0.032). Adenoids rarely regrow after surgery and where there were traces of adenoidal tissue, it did not manifest clinically. Nasal obstruction after the adenoidectomy is rhinogenic origin, not the cause of enlarged adenoids. Adenoidal regrowth more often occurs in children younger than five years old and in those patients who were treated postoperatively with antibiotics on numerous occasions.     

喉全切除术食管发音机制研究

目的　探讨喉全切除术后食管言语的特点。方法　对北京同仁医院 40例训练食管发音患者的嗓音声学、言语、形态特征及发音时食管压力变化进行分析 ,以 5 0例健康男性作为对照。结果　食管发音不良 8例 ,发音良好 32例。发音不良者黏膜痉挛 ,气流无法送出 ;发音基频小于 6 0Hz无法评估。发音良好者食管入口黏膜松弛 ,振动明显 ;其嗓音声学特征与健康对照差异有显著性(P值 <0 0 5或 <0 0 1)。食管发音不良者训练发音年龄、言语清晰度、速度、呼吸发音协调程度与发音良好者差异有显著性 (P值 <0 0 5或 <0 0 1)。食管发音时食管上、中段压力明显高于健康对照组(P值 <0 0 5或 <0 0 1) ,其中发音不良者压力增加更为明显 ,特别是食管中段压力。结论　食管发音声道振动及动力器官均与正常发音存在本质区别 ,通过代偿机制瞬间发音可达良好效果 ,但在自然、持续言语交流中存在明显障碍     

Induction chemotherapy with paclitaxel and cisplatin followed by radiotherapy for larynx organ preservation in advanced laryngeal and hypopharyngeal cancer offers moderate late toxicity outcome (DeLOS-I-trial)

A prospective multicenter phase-II trial (12 centers) was performed by the German larynx organ preservation group (DeLOS) to evaluate the effect of induction chemotherapy (ICHT) with paclitaxel/cisplatin (TP), followed by accelerated-hyperfractionated (concomitant boost) radiotherapy (RT) in responders. The trial was focused on larynx preservation, tumor control, survival, salvage surgery and late toxicity in patients with advanced larynx/hypopharynx carcinoma eligible for total laryngectomy (LE). Seventy-one patients (40 larynx, 87.5% St. III, IV; 31 hypopharynx, 93.4% St. III, IV) were enrolled into the study and treated with ICHT (200 mg/m² paclitaxel, 100 mg/m² cisplatin; day 1, 22) according to the DeLOS protocol. Patients with complete or partial tumor response proceeded to RT (69.9 Gy in 5.5 weeks). Non-responders received a LE followed by postoperative RT (56–70 Gy in 5.5–7 weeks). The response rate to ICHT for larynx cancer was 69.6% (7.1% complete, 62.5% partial response) and for hypopharyngeal cancer was 84.3% (6.9% complete, 77.4% partial response). Overall survival after 36 months was 60.3% (95% CI, 48.4–72.2%), after 42 months was 56.5% (95% CI, 44.2–68.8%). Laryngectomy-free survival was as follows: after 36 months, 43.0% (95% CI, 30.9–55.0%); after 42 months, 41.3% (95% CI, 29.3–53.3%). Both parameters did not show different outcomes after distinguishing larynx from hypopharynx. LE was indicated in 15 non-responders after ICHT. Five of the 15 non-responders refused the laryngectomy. Two of the five received RT instead and had no evidence of disease 42 months after RT. Late toxicity (dysphagia III, IV LENT SOMA score in laryngectomy-free survivors: after 6 months, 1.8%; 12 months, 11.4%; 18 months, 14.5%; 24 months, 8.1%; 36 months, 16%) and salvage surgery (4 pharyngocutaneous fistulas in 27 operations) were tolerable. In a large portion of patients eligible for LE, the larynx could be preserved with satisfying functional outcome. Good responders after ICHT had also a good general outcome with relatively rare severe late toxicities. Due to a slight increase of relevant late dysphagia, functional outcome regarding swallowing and tracheotomy free breathing should be more focused in future larynx organ preservation trials. This trial was initiated and conducted by the German Larynx Organ Preservation Study Group (DeLOS) which was founded as collaboration between head and neck surgeons and radiation oncologists to focus on the role of multimodality treatment in advanced laryngeal and hypopharyngeal cancer in Germany.     

Mechanism of esophageal speech after total laryngectomy]

OBJECTIVE: To evaluate the characteristics of esophageal speech after total laryngectomy. METHODS: Esophageal speech evaluation of 40 cases of esophageal phonation included acoustic parameters, intraesophageal pressures during phonation, speech intelligibility, fluency, communication, respiratory sound and cognate distinctions between voiced and voiceless sounds. RESULTS: In 8 poor speakers, the neoglottis was spasmodic and difficult to vibrate during phonation. In 32 good speakers, the neoglottis was relaxed and easy to vibrate during phonation. The training age, speech intelligibility, fluency, communication, respiratory sound, cognate distinctions between voiced and voiceless sounds and intraesophageal pressures during phonation were significantly different between good and poor esophageal speakers. Vocal characteristics of good speakers differed significantly from those in the normal (P < 0.05 or P < 0.01). The upper intraesphageal pressure during esophageal phonation was higher than that of the normal, especially for poor esophageal phonation. The middle to lower intraesphageal pressures was highest during poor esophageal phonation. CONCLUSIONS: Esophageal phonation was completely alaryngeal, and its activators also differ completely, so phonation could not maintain much longer. Patients with poor esophageal phonation could not drive the air through the neoglottis freely.     

Clinical aspects of esophageal speech (author's transl)

The quality of esophageal voice and speech after laryngectomy depends on several factors. Negative influences are produced by irradiation, resection of the hyoid bone and radical neck dissection. The factors important in esophageal speech were analyzed, with consideration given to the functional morphology of the pseudoglottis and the reconstructed hypopharynx. Phoniatric, laryngologic and radiologic aspects are considered.     

食管发音患者的语音学分析

目的 观察喉全切除食管发音患者的语音声学特征。方法对16例喉全切除食管发音患者进行语音声学分析及最大发声时程的测定，并以健康男性作对照。同时比较食管发音者和健康人的声波周期性。结果同健康男性比较，食管发音患者的语音声学参数除振幅外，基频、基频微扰、振幅微扰、谐噪比、标准化噪声能量均有统计学差异，且声波周期性差。结论食管发音的声学特性与正常男性相比有显著差别，声音稳定性差、声时短、音调低钝，但食管发音仍是喉全切除术后患者获得发音的一种重要途径。     

两种无喉言语的比较研究

目的：比较无假体气管食管分流音与食道音在最大发声时间，可懂度和阅读时间等方面的差异，方法，研究对象包括年龄，性别和术后发声时间相当的两组无喉言语者，其中，食管音组21名，无假体气管食管音组30名，采集了两组的最大发声时间，可懂度和阅读时间的数据，用t检验分析最大发音时间和阅读时间（P＜0．05），H检验分析言语可懂度（P＜0．05），结果：食管音在这三个项目上均较气管食管分流音差；言语可懂度略差于气管食管分流音；言语流利度和最大发声时间均明显差于气管食管分流音。结论：无假体管食管音的言语效果优于食管音，而且其手术方法简单，容易训练，利于推广。     

Relationships between esophageal speech proficiency and surgical, biographical, and social factors

The relationship between judged esophageal speech proficiency and detailed medical/surgical, biographical, and social factors was investigated among a large sample of alaryngeal speakers. The data suggested that more extensive surgery such as radical neck dissection did not lessen the subjects' ability to learn esophageal speech. Surprisingly, subjects who had undergone radical neck surgery had better voices in many cases than those who had undergone only a simple laryngectomy. Educational level, socioeconomic status, length of time spent in speech therapy, and the number of years since surgery did not statistically influence speech results. However, those subjects still gainfully employed did achieve esophageal speech more often than those who were unemployed, particularly with reference to female subjects.     

喉全切除术后食管语音康复训练

目的 帮助喉全切除术后患者恢复言语功能，提高生活质量，回归社会。方法 自1990年以来，采取术前个别指导，术后以集中办学习班的形式，利用“吸气法”或“注气法”对276名学员进行了3周的食管发声训练。结果 成功率为89．80%(248／276)，发声良好占69．7％(173／248)。结论 食管发声训练后食管语音基本接近正常人的声音，不用任何器械，经济简便，同时又避免了外科手术的麻烦和痛苦。因此食管发声是无喉者言语康复较理想的方法。