• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.19 no.1
• /
• pp.21-27
• /
• 2008

Total laryngectomy is the most useful procedure tor advanced laryngopharyngeal cancer, but it remains the major problem such as loss of voice. Voice restoration is essential for every patients who undergo a total laryngectomy. Ideal voice rehabilitation methods can resolve three factors. First, every laryngectomee can produce voice sufficient for communication, second every patient should be allowed to use both hands freely during phonation, and last, the voice restoration methods should be easy and safe without complication during and after treatment. Among various voice rehabilitation procedures during or after total laryngectomy, it can be divided electronic and pneumatic methods. In pneumatic methods, there are also divided both pulmonary air and non-pulmonary air methods. The non-pulmonary air methods include esophageal speech, buccal speech, and pharyngeal speech. Pulmonary air methods are divided into surgical and non-surgical such as pneumatic speech aid. In the surgical methods, there are neoglottic operation, tracheopharyngeal shunt, and tracheopharyngeal shunt operations. Recently, tracheoesophageal shunt with or without prosthesis are being recognized the most effective method. Blom-Singer low pressure prosthesis, Panje button, and Provox are well known types of prosthesis in the tracheoesophageal shunt operation. Amatsu method is a kind of famous tracheoesophageal shunt method without using prosthesis. Authors tried to review the published articles for evaluation of effectiveness and problems of tracheoesophageal shunt operation with or without prosthesis. In conclusion, indwelling type of prosthesis and pharyngeal myotomy and plexus neurectomy are recommended for higher success rate during tracheoesophageal puncture procedure. More over, Amatsu method is also one of the recommended voice rehabilitation procedure during total laryngectomy. In this situation, pharyngeal myotomy and plexus neurectomy may be helpful for better fluent communication.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.27 no.1
• /
• pp.18-20
• /
• 2016

Total laryngectomy remains as an important treatment option in selected patients with laryngopharyngeal cancers, which inevitably sacrifices naturally produced voice. Much effort has been devoted to voice restoration for these laryngectomized patients. Several ways of voice rehabilitation after total laryngectomy have been developed and utilized thus far, including tracheoesophageal shunt speech, esophageal speech, pneumatic speech aid, and electrolarynx. Of these, tracheoesophageal shunt speech appears to be the most effective voice restoration method, while other trials might also be useful in special situations. Nevertheless, each method has its own unique mechanisms of voice production, thus has its advantages and drawbacks in clinical setting. In this review, we discuss the currently available management options for the rehabilitation of laryngectomized voice.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.4 no.1
• /
• pp.19-23
• /
• 1991

Selected characteristics were compared in the speech of three tracheoesophageal, five tracheopharyngeal and ten normal laryngeal adult speakers. Tracheoesophageal speakers use Blom-Singer voice prosthesis after total laryngectomy and tracheopharyngeal speakers use tracheopharyngeal myomucosal shunt after near-total laryngectomy. Intelligibility judgement was based on standard Korean monosyllabic and bisyllabic word lists of 50 items. Aerodynamic study was composed of maximum phonation time, phonaton quotient. phonation pressure and mean air flow rate. Results indicate that intelligibility of tracheopharygeal speech is more similar to normal laryngeal speech than tracheoesophageal speech using Blom-Singer voice prosthesis.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.12 no.2
• /
• pp.152-157
• /
• 2001

Background : Electrolarynx, Esophageal voice, and Silicone voice prosthesis with tracheoesophageal(T-E) fistula have been used as vocal rehabilitating methods for the post-laryngectomized patients. Prosthetic rehabilitation of voice after total laryngectomy has gained wide acceptance and has become a common practice in many clinics since the pioneering works of Singer and Blom In 1979. Since the introduction of tracheo-esophageal puncture and application of Blom Singer$\circledR$ voice prosthesis in 1980, several reliable voice prostheses have been developed and are successfully being used. Objectives : Even though quality of voice produced by Silicone voice prosthesis with T-E fistula is superior to other modalities, it still has some disadvantages. We devised a new cannulatyped silicone voice prosthesis. Methods : 1) Devising a new prototype of cannula-typed silicone voice prosthesis. 2) Application of the prototype using canine animal model(laryngectormized dog) and fitting trial on human patient whose previously inserted Silicone voice prosthesis is not functioning due to presumed fungal infection. Discussion : Final form of prototype was made after several times of major and minor modifications. Insertion of the newly developed Cannula-typed Silicone voice prosthesis on canine animal model and human trial were done without any difficulty. There were no serious leakage of saliva or food during swallowing. Conclusion : The newly developed Cannula-typed Silicone voice prosthesis(So-Mang$\circledR$) and the modified replacement method will further improve the results of post-laryngectomized prosthetic voice rehabilitation. Long-term animal study and human trial are planned in the near future.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.10 no.1
• /
• pp.58-62
• /
• 1999

Previously, laryngectomized patients can achieve speech with tracheoesophageal device. Tracheoesophageal speech is currently one of the best methods of postlaryngectomy voice rehabilitation. But, tracheoesophageal speakers have some troublesome with digital occlusion of tracheostoma in every speaking time. Therefore, the tracheostoma valve has been introduced since 1982, and this valve could eliminate the need of tracheostoma digital occlusion. Currently, couple of tracheostoma valves has been introduced and developed. In this article, we introduced the 3 representative tracheostoma valves. Also, we discussed their use and characteristics. Traditionally the tracheostoma valve is used in total laryngectomized patients. We introduced one case using a tracheostoma valve after near total laryngectomy. Advantage and disadvantage of Blom-Singer valve and BIVONA II valve during using in this patients are discussed.

• Phonetics and Speech Sciences
• /
• v.5 no.4
• /
• pp.25-32
• /
• 2013

This research is aimed at finding the acoustic characteristics of different voice rehabilitation techniques, the electrolaryx (EL), standard esophageal (SE), and tracheoesophageal (TE), used on 17 patients with laryngectomees. The analysis of the voice qualities was achieved using MDVP. In order to compare the acoustic characteristics, patients were asked to produce the vowel /a/ sound. The acoustic analysis included fundamental frequency (f0), jitter, shimmer, and noise-to-harmonic ratio (NHR). The main acoustic results showed no significant statistical differences between the average measurements of SE and TE speakers. It was found that the current study showed the same tendency found in previous studies. There was also a significant difference between SE and EL speakers. On the other hand, there were no significant statistical differences between the average measurements of TE and EL speakers on all acoustic measurements. This research will contribute to establishing a baseline related to speech characteristics in voice rehabilitation for patients with laryngectomees. In future, the present findings and issues should be considered in the context of gender. Specifically, the number of women who are diagnosed with laryngeal cancer continues to rise and their acoustic characteristics may indeed differ from those of men.

• Proceedings of the KOR-BRONCHOESO Conference
• /
• 1991.06a
• /
• pp.27-27
• /
• 1991

저자들은 후두전적출술을 시행한 환자의 음성재활을 위해 식도의 근육과 점막을 이용한 shunt를 만들고 이상적인 shunt의 기능을 위해 shunt의 길이, 직경, 적절한 괄약효과 보강, 음성훈련 요령등에 대해 개 5마리를 이용한 동물실험 및 5례의 임상 적용을 통해 다음과 같은 지식을 얻었기에 문헌 고찰과 아울러 보고하는 바이다. 1. shunt의 협착에 대한 문제는 없었다. 2. 식도측의 입구를 좁혀 줌으로서 기관으로의 흡인을 방지할 수 있었다. 3. Nelaton catheter는 72시간 삽입이 적당했다. 4. 음성훈련은 3주부터 시작함이 적당했다. 5. shunt의 길이는 3 cm가 적당했다.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.15 no.2
• /
• pp.141-144
• /
• 2004

Background and Objectives : To compare acoustic, aerodynamic analysis of voice and intelligibility score in patients with near-total laryngectomy and implantation of Provox prothesis. Material and Methods : In order to evaluate the voice characteristics, acoustic, aerodynamic parameter and speech intelligibility were measured in 5 patients after near-total laryngectomy, 5 patients after implantation of Provox prosthesis with total bility were measured in 5 patients after near-total laryngectomy, 5 patients after implantation of Provox prosthesis with total laryngectomy and 10 adults normal speaker. Acoustic analysis was carried out using CSL and aerodynamic analysis was carried out using Aerophon II. Speech sample was recorded and 10 listener was scored for speech intelligibility using a percentage of words correctly identified. Results. Fundamental frequency($F_0$), intensity, jitter, shimmer, maximal phonation time(MPT), subglottic air pressure were used for parameters for voice analysis. There were no significant difference between two group except on fundamental frequency and shimmer. The fundamental frequency was higher in patients with near-total laryngectomy and shimmer was higher in patients after implantation of Provox prosthesis with total laryngectomy. In addition, speech intelligibility was no significant difference between two groups. Conclusion : This results confirm that near-total laryngectomy and implantation of Provox prosthesis provides good voice rehabilitation.

• Phonetics and Speech Sciences
• /
• v.5 no.4
• /
• pp.17-24
• /
• 2013

This study is aimed at finding out different types of speech characteristics categorized based on voice rehabilitation techniques used on twenty-six patients (all-male) with total or partial laryngectomees. The speech intelligibility of standard esophageal (SE), tracheoesophageal speech (TE), and electriclarynx (EL) was measured by using the CSL and eleven listeners were instructed to rate the speech on a 5-point scale. The vowel space parameters such as vowel space, VAI, FCR, and F2 ratio were measured by averaging 5 repeats of each vowel (/a/, /e/, /i/, /u/) and the results were put into the parameter formula. The results showed significant statistical differences in speech intelligibility and vowel space between SE and TE. The speech intelligibility and vowel space of TE were higher than those of SE or EL and there was a high correlation between speech intelligibility and some parameters (vowel space, VAI, F2 ratio). The results also showed that TE's speech characteristics were most similar to normal groups comparing with SE and EL, but still very deviant in laryngeal speech. This was due to insufficient airflow intake into the esophagus when producing sounds, and because articulation movement was carried out differently among groups. Therefore, these findings will contribute to establishing a baseline related to speech characteristics in voice rehabilitation for patients with alaryngeal speech.

• Proceedings of the KSLP Conference
• /
• 1999.11a
• /
• pp.186-186
• /
• 1999

Tracheoesophageal fistulation following total laryngectomy has widely been used for voice restoration, This technique make exhaled air to divert to hypopharynx where phayngoesophageal segment forms the neoglottis. Even through layngectomized patients loss the normal laryngeal adjustment for speaking, it has been known that voiced and voiceless sounds are prodused in TE phonation. Nine TE speakeres were subjected to present study designed to clarity the mechanism of neoglottic adjustment in TE phonation, Fiberoptic examination and radiologic studies were performed at all patients and EMG study was performed at 3 patients during I phonation. Fiberoptic ＆ radiologic studies revealed the location of neoglottis, so called pharyngoesophargeal segment which was vibrated well. EMG activity increased for sound production at retropharyngeal prominence. These results indicated that neoglottic adjustment in TE phonation.