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.     

Relationship between nasal obstruction and pulmonary ventilation in laryngectomized patients.

Respiratory gases (Po2 and Pco2) in arterial blood were determined in 19 laryngectomized patients (47 to 77 years of age) following nasal obstruction. Po2 values were somewhat elevated, but the difference was statistically insignificant, while Pco2 value remained the same. These results to a certain extent correlate with the findings of Cave et al. on dogs, but with a minor correction which we explain by the effect of the second reflex arch of the trigeminal--phrenic and intercostal nerves. Respiration (rate, tidal volume and minute volume) was also tested and the results agreed with the findings of respiratory gases.     

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.     

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.     

Automatic speaking valve in speech rehabilitation for laryngectomized patients

For speech rehabilitation after total laryngectomy, the Provox FreeHands Heat and Moisture Exchanger (FreeHands HME; Atos Medical AB, Hörby, Sweden) was compared with the Provox Heat and Moisture Exchanger (HME), and the patients Health-Related Quality of Life (HRQoL) was assessed. A review of the English literature was performed considering automatic speaking valves. The study design was a cohort study. Fourteen laryngectomized male patients who had used the HME successfully before receiving the FreeHands HME entered the study. An ENT specialist and a speech pathologist examined these patients. Data concerning voicing, breathing, skin adhesion, voice and speech quality, and HRQoL were collected by a structured questionnaire. Voice recordings were performed for evaluation of the quality of the voice. A computer-aided search of the MED-LINE database was conducted, supplemented by hand searches of key journals. Twelve patients had used the FreeHands HME on special social occasions and reported three main reasons why FreeHands HME was unsuitable for continuous use: heavier breathing, more difficult speaking, and worse subjective quality of voice. With HME, phonation time tended to be longer and the softest phonation softer ( P =0.034). The loudest phonation was louder with FreeHands HME ( P =0.015). Patients HRQoL assessed by the 15D profile was similar to that of the age- and sex-matched male Finnish general population (patients 0.877, population 0.884). A review of the literature showed few works dealing with automatic speaking valves. The FreeHands HME is a useful additional device in a selected group of laryngectomized patients. Total laryngectomy did not lower patients HRQoL notably.Some of these data were presented at the 16th Annual Meeting of the Scandinavian Society for Head and Neck Oncology, 24 April 2004, in Oulu, Finland.     

Experience with the HME-Provox Stomafilter in laryngectomized patients

Respiratory symptoms after total laryngectomy are both frequent and troublesome. Previous studies have demonstrated the positive effect of a heat and moisture exchanger (MHE) on the respiratory system in patients after total laryngectomy. In the present study we analyze the opinion of 40 total laryngectomized patients regarding the use of the MHE-Provox Stomafilter kit. Focus has been directed to speech function parameters and pulmonary symptoms. Benefits in phonatory parameters--intelligibility, fluency, pressure and telephone intelligibility, have been over 70%. Reduction in pulmonary symptoms--coughing, sputum production, forced expectoration, stoma cleaning--have also been significant. Our results support the use of MHE Provox Stomafilter for minimizing and preventing respiratory problems and increasing the quality of the voice through the tracheoesophageal puncture system.     

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.     

Jejunal grafts for reconstructing a phonatory neoglottis in laryngectomized patients

Summary After laryngopharyngectomy and reconstruction of the upper digestive tract, a free jejunal graft can be anastomosed in an isoperistaltic direction end-to-end to the trachea and the hypopharynx in order to form a shunt for vocal rehabilitation. Following placement of the shunt, no special care is required nor does any patient show any aspiration. Because of a low-flow resistance of the shunt, patients so treated possess long-lasting phonation with loud and modulated voices.     

Jejunal grafts for reconstructing a phonatory neoglottis in laryngectomized patients

After laryngopharyngectomy and reconstruction of the upper digestive tract, a free jejunal graft can be anastomosed in an isoperistaltic direction end-to-end to the trachea and the hypopharynx in order to form a shunt for vocal rehabilitation. Following placement of the shunt, no special care is required nor does any patient show any aspiration. Because of a low-flow resistance of the shunt, patients so treated possess long-lasting phonation with loud and modulated voices.