Alaryngeal Final Flashcards
Describe a typical treatment program for training E speech.
Teach how to get air in and out
Practice CV and CVC words (stops/fricatives)
First voiceless obstruent, then voiced obstruent, followed by sonorants.
Low to high vowels
One syllable then two syllables
Articulation practice
Longer phrases
Pitch and loudness
Conversational skills
Optimum rate
What is the difference between insufflation by compression and insufflation by inhalation?
Compression: creates a positive pressure in the pharyngeal cavity to drive air down into the esophagus and then it comes back up to create vibration (easier to teach). The mouth and VP port are sealed.
Inhalation: Creates a negative pressure in the esophagus which then sucks air in from the pharynx (harder to teach).
How would you teach insufflation by compression and inhalation?
They are both hard to teach because everything is happening on the inside (oral cavity, pharynx, esophagus) so it makes it challenging to show visual cues.
Compression: teach them how to say /p/. think about the “ball of air” in the oral cavity, and teach them how to move from side to side or back through the PE segment. Needs a lot of practice!! Air is forced through the PE segment so they need to learn how to relax the PE segment.
-avoid using the word “swallow” but rather “compression” or “pushing air back”. Swallow would take air to stomach, we don’t want this!
Inhalation: this occurs in the diaphragm (quick contraction) where air is taken into the esophagus so it’s more difficult to teach as it cannot be visualized. Explain the process to the client. Imagine “sucking in air” into the esophagus causing more negative pressure above PE segment to relax PE segment. Needs lots of practice!!
How might you deal with stoma blast in a beginning E speaker?
When they first start to speak, they put a lot of effort into the speaking, which blows a bunch of air out of the stoma which tends to mask the artificial speech or E speech and interferes with intelligibility, so they must learn how to not let the large blast of air come out of the stoma. They are used to using a lot of breath and lung effort to speak, so they must relearn the new amount of effort. Explain to the client that they no longer need to drive that kind of air pressure of effort anymore. No audible air sound should come out.
You can use a nasal listening tube for auditory feedback- put the tube next to the stoma and the other end by their ear so they can hear when too much air is being expelled from the stoma
List 4 basic skills that are considered essential in developing functional esophageal speech.
Produce voice consistently on demand (they have to have the ability to produce voice instantly and fast to be as close to fluent and natural speech as possible)
Rapid insufflation
Adequate duration of voicing (if they insufflate and can sustain a vowel, studies say 3 seconds – their phonation will also be limited to 3 seconds of speech because the esophagus cannot hold very much air)
Maintain 1, 2, and 3 in conversation
What is “consonant injection”? Why is it important in developing esophageal speech?
How can a person who can only phonate for 3 seconds have fluent speech? Consonant injection.
From the very beginning, once they learn to insufflate, they start with voiceless consonants, and we encourage them to set the articulators to produce the consonant and as they create the pressure in the mouth, they use some of that pressure to produce that consonant and some they put in the esophagus as a reservoir. The more voiceless consonants, the easier the phrase is. So early in the therapy process we have them do whisper voice, phrases with all voiceless consonants (e.g., the horse eats grass, Susie skipped church). So, it is continually putting air back into the esophagus and only letting a little bit of air to escape for the consonant.
Is consonant injection important in developing tracheoesophageal speech? Why or why not?
No, TEP speech using a prosthesis that allows air from the esophagus to enter into trachea to allow speech.
Describe a type of alaryngeal speech that may masquerade as esophageal speech.
Buccal speech/pharyngeal speech - alaryngeal form of vocalization which uses the inner cheek to produce sound rather than the larynx.The speech is also known as Donald Duck speech.
We don’t want this because it uses the tongue against the cheeks as the sound source and we want the tongue free to articulate.
It is not commonly used and is not considered an efficient primary method of speech for alaryngeal speakers
Differentiate the 2 major types of AL.
Pneumatic artificial larynxes which are powered by stomal air – these may not be available anymore to buy new, never very popular because the SLP cannot demonstrate these because you have to have a stoma to demonstrate these
Straw/conduction tube – which conducts sound from the device into the mouth
Put the cup over the stoma to trap air, air passes over a membrane/instrument piece, as the air passes over it it vibrates and produces a sound
One advantage was that it was pretty loud
Puts air into the mouth to produce things like the voiceless consonants
He thought their speech was better than esophageal speakers
Electronic artificial larynx are powered by batteries has three types:
Neck type: most common artificial larynx
Mouth type:
Intraoral:
Choose one specific AL of each major type and describe it in detail.
Pneumatic: The tonaire (no longer in production) has a cup on one end and a vibrating membrane on the inside of the device. Place the cup over the stoma. When you exhale, the air travels through the conduction tube and vibrates that then you put in your mouth to produce voice
Electronic: SERVOX battery powered device that you place on the neck (find sweet spot), the tissues of the neck and throat vibrate, this allows for production of voice through the mouth using your articulators, strongly. Speak slowly and release power button between words. Cheek is a alternative option or an oral adaptor (straw) in the corner of the mouth. Frequency and intensity can be adjusted separately.
Describe a typical treatment program for an AL.
-Positioning (find the “sweet spot” for neck placement or place the mouthpiece back in the throat)
-Timing/coordination (start and stop at the exact time that you start and stop talking)
-Phrasing/rate (use natural breath units, pause as you would in a regular convo)
-Articulation (work on exaggerated movement and pushing harder to get voiceless consonants)
Before trying to say words and sentences, the client must learn how to produce the best possible voice, the client should experiment with different locations while practicing with a mirror, once the best spot is determined, the client should be taught single words and then sentences, the client should be taught to talk in phrases, over articulate, use high and low tones to add expressions, and intensity adjustments.
How might you improve voice/voiceless contrasts in AL speakers?
Electrolarynx speakers
Voice Amplification
Chattervox with headset microphone
Whisper practice – voiceless sounds
AL speech more intelligible than E speech? Explain
E-speech has better pitch, rate, and intelligibility than AL. AL sounds robotic and unnatural due to the usage of an artificial device.
Do you think SLPs an/or ENTs are biased toward TE/E speech? Why/why not?
They have financial interest in TE speech. Especially when it is the primary puncture during the surgery because they get to bill for two codes.
SLPs may want a lot of E speakers on the case load because they will be there a lot longer than the other types of alaryngeal speakers.
Influenced by the amount of income from the patient and what procedure to choose.
When do you think the AL should be introduced to patient?
I think the artificial larynx along TE and E speech should be introduced to the patient before surgery because it will prepare them. If SLPs counsel patients before surgery, it will put them at ease to know that they’ll be able to communicate right after surgery. Allow access in acute care as a substitution for prosthesis
How does the intelligibility of E speech compare to TE speech?
TE speakers are more intelligible than E speakers, especially during the production of monosyllabic words. E speaker has to rely on producing sound on exhaled air while TE speakers pull air from the esophagus to the trachea to produce sound.
What are some advantages of TE speech over E speech? Disadvantages?
Advantages of E speech
No equipment to purchase
Listeners consider it more natural than TE speech
E speech is “hands-free” and does not require occlusion
No additional surgeries required
TE speakers will have air source that is pulmonary which allows speech to sound more natural, acquiring speech is typically quicker.
Disadvantages of E speech
Fundamental frequency tends to be lower than TE speech (bigger problem for females to be recognized as man)
Low intensity compared to TE speech
Often described as monoloudness or monopitch
TE speakers require extensive surgery, esophageal stricture, stoma/tracheal stenosis, marked radiation fibrosis, and dysphagia.
Is a tight PE segment a pathological condition? Explain.
No, there are no predispositions or disease to cause the PE segment to be tight, if there is not good sound after laryngectomy including a strained/sporadic vocal quality, there is no reason to try a prosthesis and a myotomy may be necessary.
