Characteristics of tracheoesophageal voice and speech in laryngectomized patients after primary and secondary application of vocal prosthesis

Abstract

Total laryngectomy is a radical procedure that leads to permanent loss of the voice generator and a part of the voice resonator, the larynx, where the basic laryngeal tone is created. One method of voice and speech rehabilitation is implantation of tracheoesophageal prosthesis. The aim of this study was to determine the characteristics of tracheoesophageal speech in patients with primary and secondary vocal prosthesis, to analyze the influence of gender and age on characteristics of the tracheoesophageal speech and self-assessment by patients themselves. This paper presents the results of voice and speech rehabilitation in 48 laryngectomized patients aged 44 to 77 years, with implanted vocal prosthesis during the period from 2008 to 2010 at the Clinic for Ear, Nose and Throat of the Clinical Centre of Vojvodina. The assessment of voice and speech characteristics included: maximum phonation time for the sound /a/, the length of phrases, reading of phonetically balanced word lists, intelligibility of words, reading phonetically balanced text and self-assessment of speech quality of patients referred to their communicative needs. Characteristics of voice and speech in patients who underwent primary vocal prosthesis in relation to secondary placement show no statistically significant difference. In patients under the age of 60, statistically significant better result in terms of speech intelligibility was found. There were no statistically significant differences depending on the patients' gender. Only one patient (1/48) assessed his speech as unsatisfactory. As developing countries cannot provide adequate number of prostheses and their continuous supply for all laryngectomy patients, the installation of a secondary vocal prosthesis could be an adequate method of rehabilitation. A large percentage of success in education of tracheoesophageal speech recommends the placement of vocal prosthesis.

Totalna laringektomija predstavlja radikalni zahvat koji dovodi do trajnog gubitka generatora i dela rezonatora glasa, larinksa u kom se stvara osnovni laringealni ton. Jedna od metoda rehabilitacije glasa i govora je ugradnja traheoezofagusnih proteza. Cilj rada je da se utvrde karakteristike traheoezofagusnog govora kod pacijenata sa primarno i sekundarno ugrađenim vokalnim protezama, analizira uticaj pola i starosti na karakteristike traheoezofagusnog govora, kao i samoprocena glasa i govora od strane samih pacijenata. Uzorak se sastojao od 48 laringektomisanih pacijenata starosti od 44 do 77 godina, kod kojih su ugrađene vokalne proteze u periodu od 2008. do 2010. godine na Klinici za bolesti uva, grla i nosa Kliničkog centra Vojvodine. Procena karakteristika glasa i govora obuhvatala je: maksimalno fonacijsko vreme za glas /a/, dužinu fraze, čitanje fonetski izbalansirane liste reči, razumljivost pročitanih reči, čitanje fonetski izbalansiranog teksta i samoprocenu kvaliteta govora pacijenata u odnosu na individualne komunikativne potrebe svakog pacijenta. Karakteristike glasa i govora kod pacijenata kod kojih je rađena primarna ugradnja vokalne proteze u odnosu na sekundarnu ugradnju ne pokazuje statistički značajnu razliku. Kod pacijenata mlađih od 60 godina postoji statistički značajno bolji rezultat u pogledu razumljivosti govora. Nisu nađene statistički značajne razlike u zavisnosti od pola pacijenata. Samo jedan pacijent (1/48) je svoj govor procenio kao nezadovoljavajući. Kako zemlje u razvoju ne mogu obezbediti adekvatan broj proteza i njihovu kontinuiranu nabavku za sve svoje laringektomisane pacijente, sekundarna ugradnja vokalne proteze bi mogla biti adekvatna metoda rehabilitacije. Veliki procenat uspešnosti u edukaciji traheoezofagusnog govora i preporučuje ugradnju vokalne proteze.