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    Rehabilitation Esophageal Speech & Artificial Larynx

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    KUNNAMPALLIL GEJO JOHN
    This document discusses rehabilitation options for individuals who have undergone a laryngectomy, including esophageal speech and artificial larynx devices. It provides details on: 1) How esophageal speech works by vibrating the pharyngoesophageal segment using compressed air injected into the esophagus. 2) Different types of artificial larynx devices, including pneumatic and electronic options, and how they generate sound externally to restore speech. 3) Advantages and disadvantages of esophageal speech and different artificial larynx devices.

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    Rehabilitation Esophageal Speech & Artificial Larynx

    Uploaded by

    KUNNAMPALLIL GEJO JOHN
    685 views50 pages
    This document discusses rehabilitation options for individuals who have undergone a laryngectomy, including esophageal speech and artificial larynx devices. It provides details on: 1) How esophageal speech works by vibrating the pharyngoesophageal segment using compressed air injected into the esophagus. 2) Different types of artificial larynx devices, including pneumatic and electronic options, and how they generate sound externally to restore speech. 3) Advantages and disadvantages of esophageal speech and different artificial larynx devices.

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    Rehabilitation Esophageal Speech & Artificial Larynx

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    This document discusses rehabilitation options for individuals who have undergone a laryngectomy, including esophageal speech and artificial larynx devices. It provides details on: 1) How esophageal speech works by vibrating the pharyngoesophageal segment using compressed air injected into the esophagus. 2) Different types of artificial larynx devices, including pneumatic and electronic options, and how they generate sound externally to restore speech. 3) Advantages and disadvantages of esophageal speech and different artificial larynx devices.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    685 views50 pages

    Rehabilitation Esophageal Speech & Artificial Larynx

    Uploaded by

    KUNNAMPALLIL GEJO JOHN
    This document discusses rehabilitation options for individuals who have undergone a laryngectomy, including esophageal speech and artificial larynx devices. It provides details on: 1) How esophageal speech works by vibrating the pharyngoesophageal segment using compressed air injected into the esophagus. 2) Different types of artificial larynx devices, including pneumatic and electronic options, and how they generate sound externally to restore speech. 3) Advantages and disadvantages of esophageal speech and different artificial larynx devices.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    The document discusses different techniques for voice rehabilitation after laryngectomy including esophageal speech and artificial larynx devices.

    The techniques discussed are esophageal speech, which involves injecting air into the esophagus to produce vibrations, and artificial larynx devices which produce a mechanical sound that is transmitted through the neck.

    The advantages of esophageal speech are that it is hands free but it takes practice to learn. The disadvantages include difficulty producing consonant sounds which can make speech unclear.

    Rehabilitation : Esophageal speech & Artificial larynx

    KUNNAMPALLIL GEJO JOHN BASLP,MASLP AUDIOLOGIST

    KUNNAMPALLIL GEJO JOHN

    KUNNAMPALLIL GEJO JOHN

    ESOPHAGEAL SPEECH
    Air is compressed within the oropharynx This dense air is injected into the esophagus Denser air moves in towards more rarefied bodies of air This sets up a vibration of the pharyngo-esophageal segment These vibrations act as voice
    KUNNAMPALLIL GEJO JOHN

    PHARYNGO-ESOPHAGEAL SEGMENT
    Portion of the pharynx and esophagus where muscle fibres from esophagus, inferior constrictor and cricopharyngeus blend together These fibres are under voluntary control of the individual Anterior fibres of cricopharyngeus are sutured, creating a complete muscle sphincter around the esophagus

    KUNNAMPALLIL GEJO JOHN

    Normal tonicity of PE segment is essential for the acquisition of esophageal speech or TEP speech Candidacy for esophageal or TEP speech can be determined by administering the Air Insufflation Test

    KUNNAMPALLIL GEJO JOHN

    Esophageal speech is based on the technique in which the patient transports a small amount (75 ml) of air into the esophagus. Probably due to an increased thoracic pressure, the air is forced back past the pharyngoesophageal (PE) segment to induce resonance. This resonance is the sound source that allows speech. Rapid repetition of the aforementioned air transport can produce understandable speec
    KUNNAMPALLIL GEJO JOHN

    Esophageal speech
    Goals of esophageal speech( A. E. Aronson 85) Reliable phonation on demand Rapid air intake Short latency between air intake and phonation 4-9 syllables per air charge 2-3 secs of voice duration per air intake Good intelligibility

    KUNNAMPALLIL GEJO JOHN

    KUNNAMPALLIL GEJO JOHN

    KUNNAMPALLIL GEJO JOHN

    Air at atmosphere continues to circulate with in the nasal , oral and pharyngeal cavities. The PE segment is tonically contracted and registered positive pressure while the oesophagus is closed down and registered negative air pressure

    KUNNAMPALLIL GEJO JOHN

    Air must pass through PE segment and enter into the esophagus which will then register a positive presdsure relative to that in the oral and pharyngeal cavities

    KUNNAMPALLIL GEJO JOHN

    The tonicity of the PE segment may be overcome by voluntary relaxation ( Inhalation technique is based on this ) or by applying pressure by forcing the air into the esophagus ( Injection technique )

    KUNNAMPALLIL GEJO JOHN

    AIR INSUFFLATION TEST


    The oral and nasal cavities are anaesthetized using a local anesthetic. A catheter is inserted through the nostril till the PE segment The person is asked to phonate The clinician blows in through the open end of the catheter and the individual has to phonate again, keeping the stoma closed Strained, effortful voice: Hypertonic Breathy voice: Hypotonic Esophageal speech is not advised in either of the KUNNAMPALLIL GEJO JOHN above cases

    METHODS OF AIR INTAKE

    INHALATION

    INJECTION

    CONSONANT INJECTION
    KUNNAMPALLIL GEJO JOHN

    GLOSSAL PRESS

    INHALATION
    The patient is told to close his mouth and imagine he is sniffing through his nose (Diedrich and Youngstrom, 1966) The sniffing is often accompanied by esophageal dilation Air rushes into the esophagus

    This air is expelled by belching it out, vibrating the PE segment as it is expelled


    KUNNAMPALLIL GEJO JOHN

    CONSONANT INJECTION
    A plosive or affricate is used to inject air into the esophagus /p/, /t/, /k/, /s/, // and /t/ are the recommended phonemes (Diedrich & Youngstrom, 1966; Moolenaar-Bijl, 1953; Stetson, 1937) Production of the consonants facilitates the transfer of air into the esophagus

    KUNNAMPALLIL GEJO JOHN

    GLOSSAL PRESS( Gateley 71)


    Tongue is elevated against the hard palate Tongue body is swept backwards towards the pharynx, loading air into the esophagus till a klunk is heard Carbonated beverages and water may assist in creating a pocket of air in the esophagus

    Thoracic compression forces the air out

    KUNNAMPALLIL GEJO JOHN

    GLOSSAL PRESS
    Tongue is elevated against the hard palate Tongue body is swept backwards towards the pharynx, loading air into the esophagus till a klunk is heard Carbonated beverages and water may assist in creating a pocket of air in the esophagus

    Thoracic compression forces the air out

    KUNNAMPALLIL GEJO JOHN

    ADVANTAGES OF ESOPHAGEAL SPEECH


    No external devices necessary More natural voice compared to that produced using an artificial larynx To some extent, pitch and intensity can be varied No dependence on batteries, chargers, etc No costs involved Hands free speech
    KUNNAMPALLIL GEJO JOHN

    DISADVANTAGES OF ESOPHAGEAL SPEECH


    Takes long to learn and master Must have good articulatory abilities, or else speech will be extremely unintelligible Listeners reportedly find esophageal speech least preferable compared to other types of alternate sound production (Carpenter, 1991)

    Voice may be too soft to be heard above


    background noise
    KUNNAMPALLIL GEJO JOHN

    Artificial larynx

    KUNNAMPALLIL GEJO JOHN

    Artificial Larynx
    Is a device which is placed externally for the purpose of sound production in those cases from which the real larynx is removed As a device that replaces the laryngeal source with an external sound producing mechanism

    KUNNAMPALLIL GEJO JOHN

    The essential components

    Power supply Oscilltor which vibrates Diaphragm

    KUNNAMPALLIL GEJO JOHN

    Control
    On / off Volume control Tone control Pitch control

    KUNNAMPALLIL GEJO JOHN

    Types
    Pneumatic type Electronic type

    KUNNAMPALLIL GEJO JOHN

    Pneumatic type Utilizes pulmonary air as its power source A cuff that contains reed or a membrane fits over the stoma As the patient expels the air from stoma for speech , the vibrations from the membrane arte transmitted by a flexible rubber or plastic tube into the patients mouth The patient articulates as the sound is produced

    KUNNAMPALLIL GEJO JOHN

    F0 is determined by the width and the tension of the membrane Pitch and loudness can be achieved by varying the force of air expelled from the lungs

    KUNNAMPALLIL GEJO JOHN

    Components
    Neck tube Stoma tube Stoma cover fits into the stoma Mouth Tube placed in the mouth between lips and cheek Vibrating structure made up of rubber strings- kept in the pocket
    KUNNAMPALLIL GEJO JOHN

    Types
    Tokyo Van Humen OSAKA Western type Memacan

    KUNNAMPALLIL GEJO JOHN

    Tokyo Type

    KUNNAMPALLIL GEJO JOHN

    Advantages
    Sound quality from the pneumatic larynx is more pleasing than the electro mechanical devics No electronic noise or buzzing sound Less expensive

    KUNNAMPALLIL GEJO JOHN

    Disadvantage
    Presence of the tube in the mouth Which interferes with articulation and collect saliva Cuff may clogged with mucous Does require the use of one hand for placement of the cuff

    KUNNAMPALLIL GEJO JOHN

    Electronic type
    Is a battery powered sound generator These devices may differ in size and shape, quality of sound, ability to control pitch ,volume, type of batteries

    KUNNAMPALLIL GEJO JOHN

    Types
    Intra oral devices Neck type

    KUNNAMPALLIL GEJO JOHN

    KUNNAMPALLIL GEJO JOHN

    Components of intra oral devices


    Battery compartment Pulse generator Mouth tube to vibrator Vibrator

    KUNNAMPALLIL GEJO JOHN

    Models of Intra oral devices


    Cooper rand 15 volt electronic speech aid Cooper rand 9 volt electronic speech aid Aurex neovox M -550

    KUNNAMPALLIL GEJO JOHN

    Advantage
    Is ideal for patients who has scar tissue or edema of the neck Can use immediately after following surgery

    KUNNAMPALLIL GEJO JOHN

    Disadvantage
    Presence of the tube in the mouth Which interferes with articulation and collect saliva Cuff may clogged with mucous Does require the use of one hand for placement of the cuff

    KUNNAMPALLIL GEJO JOHN

    KUNNAMPALLIL GEJO JOHN

    KUNNAMPALLIL GEJO JOHN

    NU-VOIS III Digital Artificial Larynx

    KUNNAMPALLIL GEJO JOHN

    Neck Type
    Are popular devices Relatively easy to learn to use Provides immediate speech Restoration Placing the head of the device firmly against the neck allowing for the sound to be transmitted to through the tissue of the neck and into the oral cavity It allows variation in volume and pitch

    KUNNAMPALLIL GEJO JOHN

    types
    Western electronic 5 A AT & T 5e electronic artificial larynx Denrick DR-1 speech aid Aurex nevox electronic artificial larynx Servox electronic artificial larynx Servox Inton Romet electronic speech aid
    KUNNAMPALLIL GEJO JOHN

    KUNNAMPALLIL GEJO JOHN

    How to teach
    Acceptance Orientation Selection Placement On-off timing Articulation Rate Phrasing Modification of Pitch & loudness
    KUNNAMPALLIL GEJO JOHN

    Advantages
    Immediate restoration & easy to learn Early return to the work is possible Can be used as a initial method for the restoration of esophageal speech Free from stoma noise

    KUNNAMPALLIL GEJO JOHN

    Disadvantage
    Produces unexpectable sounds because of which sound becomes unintelligeble Causes attention& bulky Acts as a crutch and not hands free speech Costly & maintenance is a problem

    KUNNAMPALLIL GEJO JOHN

    The major disadvantages of these electromechanical devices is the distinct voice quality. The voice production sounds mechanical and even robot like, distracting the listeners attention. The electrolarynx requires the use of a hand and has a conspicuous appearance

    KUNNAMPALLIL GEJO JOHN

    Electromechanical devices can be a useful treatment option in the early postoperative phase when the patient can not use other voice rehabilitation techniques, thereby limiting the frustration of speechlessness. Electrolarynx devices can also be of value in addition to other voice rehabilitation methods
    KUNNAMPALLIL GEJO JOHN

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