Alaryngeal Speech Flashcards
What are the 2 types of Alaryngeal speech?
Electronic: artificial larynx (external vibratory source)
Esophageal: includes TEP speech
What is the cure rate of laryngeal cancer?
75-80% unless the cancer has metastasized
What are important things to tell patient pre-op
- great survival rate
- hard to tell how spread/severe until surgery and biopsy
- provide printed material (they are in shock, won’t “hear” a lot of what you say
- don’t use technical terms
- tell them they have a great doctor (even if they don’t)
- describe basics of the surgery
- let them know they will be in the ICU for a few days, will not have a voice and will need to write
- will have more discomfort than pain
- fed through NG tube for a while
- average 5-6 day stay post-surgery
- cover stoma when they cough (increased mucus production in lungs post surgery)
- explain why they cant just remove part (larynx wont work anyway, better chance of getting all the cancer)
- explain simple tube/valve mechanism to patient
- explain why they can’t speak (no air flow to mouth, they will speak again, lots of options that will be explained later)
How soon post surgery can the patient begin learning to speak again
6 weeks (due to swelling)
How long will it take to become an efficient speaker with an electronic vibratory source?
8 weeks
- with electronic, most everyone will be successful
- contact usually pressed against neck
- in mouth usually speech breaks
How long does it take to learn Esophageal speech?
3 months to learn
- not everyone can do it because UES is sensitive to air and radiation may have stiffened neck tissue and left scarring
- requires vibration of pharyngeal esophageal segment
- hardest part is to get air in
- most difficult sounds are plosives, fricatives, affricates
- TEP faster to learn
Insufflation Testing
No longer done
-was a way to see if PE segment would vibrate for TEP speech
Indwelling Prosthesis
- placed by SLP
- has 2 collars one on tracheal side, one on esophageal side
- possible for collar to open between trachea and esophagus in the wall which can cause swelling and growth of a granuloma
- intended to be long-term
- tale can be cut
Low Pressure Prosthesis (duck bill)
- one way valve, quacking side is esophageal side
- tape tale down
- can be changed by the patient
- softer and smaller than indwelling
TEP Prosthesis
- In-Dwelling or Low-Pressure
- can develop Candida (yeast in prosthesis and mouth)
- flush with Nystatin
What is different about breathing through a stoma?
- no filter, moisture, heating
- no resistance, inhale/exhale (respiratory) muscles get weaker/shrink (atrophy) and decrease lung capacity
- put valve/filter on stoma
- HME filter (heat/moisture exchange) recommended
Why would a tracheal tube be place in a stoma?
to keep it open
-stomas can grow, shrink or stay the same
What are Esophageal Strictures?
- narrowing of esophagus
- from radiation
- esophagus is always open and food can get stuck
Electronic Speech/Artificial Larynx
- handheld electronic device
- provides vibration to air molecules in oral cavity
- Electrolarynx needs to be in contact with face/head/neck (find the “sweet spot”)
- articulate as if you were speaking normally
What is a vibrating retainer?
Individually fit electronic device
- in a wet environment (breaks a lot)
- expensive
