Flashcards in O12 Types of Alaryngeal Speech, Exam 3 Deck (35):
What is the purpose of insufflation testing?
To determine whether or not a patient will be able to voice well with a prosthesis after undergoing a laryngectomy.
How does insufflation testing take place?
A tube is placed down the nose, and then the patient or SLP blows into it to see whether the upper esophageal sphincter vibrates.
What are the two passing criteria for a patient to be eligible for a prosthesis?
1. Continuous phonation: about 8 seconds on ‘ah’ and/or the patient being able to count from 1-15 on one breath
2. Consistent phonation: being able to phonate repeatedly
What are PE (pharyngo-esophageal) segment relaxing procedures?
What is the purpose of PE (pharyngo-esophageal) segment relaxing procedures?
Helps the upper esophageal sphincter relax to be able to vibrate
What will hypertonicity in the PE segment result in? Will therapy be helpful?
An intermittent voice/interrupted phonation ; therapy will potentially be helpful.
T/F: if you have a tonic PE segment, the voice will work.
If you have hypotonicity, what will it result in?
Consistent speech, but weak and breathy
How can you tell whether the patient is hypotonic?
If voicing works when you press your thumb on the patient's neck to mechanically tighten the PE segment in the esophagus
What is a neurectomy?
Nerve surgery - cuts CN X vagus nerve which innervates cricopharyngeus
What is a myotemy?
Surgery to cut cricopharyngeus muscle
T/F: Hypotonic PE segment should never have a relaxing procedure done on it!!! No myotemies or neuroectomies! They won’t be able to hold down food.
What is Blanton's opinion of myotemies and neuroectomeies?
Not a good plan to cut a muscle that has already been radiated, and cutting a nerve will damage it – this will set up the patient for having acid reflux...
...BUT the other option is the patient may not be able to voice the way they want to, device free -- is the price worth it?
What will injecting botox into the PE segment accomplish?
Will relax the muscle enough to voice.
Often, even when the botox wears off, the patient will still be able to voice because the patient is used to the sensation and sound of their voices. For some people, this will not happen, however.
What will happen if a patient with a hypotonic PE segment gets a relaxing procedure done on their PE segment?
They will not be able to hold down food or liquid anymore
What are the three relaxing procedures?
a. neurectomy: cuts CN X
b. myotemy: cuts cricopharyngeus muscle
c. botox the PE segment
T/F: If PE spasms are bad, speech therapy won’t help.
What is an esophageal stricture?
The esophagus will no longer work the way it should because of...
a. Scarring of the esophagus from repair of the phraynx
b. Tissue changes in the esophagus from radiation
c. Small PE segment
What is the length of the tracheal-esophageal (TE) prothesis measured in?
millimeters - mm
What is the diameter of the tracheal-esophageal (TE) prothesis measured in?
French - Fr.
Why is it important that the TE prosthesis fits tightly?
To prevent leakage from entering the trachea --> aspiration
Test if its tight enough by giving your patient a glass of water.
Talk about creating a TE puncture.
• It’s an office procedure
• Punch a hole through the trachea and esophagus, and then quickly insert a catheter to prevent the hole from closing while its healing.
What is one tip for taking the catheter out?
Instead of having the patient sit upright, have them lie on their backs to help prevent saliva and boogers from coming up and out with the catheter.
What do you need to remember to put in when you take the catheter out?
Why is it important that the collar on a prosthesis is not too long?
to avoid pistoning in the trachea (move front and back in the trachea)
If the collar doesn't turn, what is this a sign of?
That the prosthesis has inflated inside the puncture between the trachea and esophagus. This is an infection risk.
How do you clean a prosthesis?
With a tiny brush or flush with water, or can be taken out and soaked in vinegar, hydrogen peroxide, or nystatin
What is often a problem with prostheses?
If liquid leaks THROUGH the prosthesis, what is this a sign of?
If liquid leaks AROUND the prosthesis, what is this a sign of?
What are some issues with voiced-voiceless consonants with esophageal and TE speakers? What should you teach TEP speakers to do to help this?
Listeners aren’t able to perceive the contrast very well.
Teach to push harder - take a breath and then push the air.
What is the biggest cue for the difference between voiced and voiceless consonants?
Voice onset time
What are the four types of air injection that can be used for esophageal speech?
1. compression system - swallow air
2. Pressure systems
3. Inhalation - inhale air
4. Consonant injection - inhale air while speaking (best to do on stops)
Talk about alaryngeal speech therapy.
a. Get air in, get air out
b. CV and CVC syllables are best to start practicing with, with stops/affricates 1st, then liquids and glides
c. Bisyllabic words
d. Move to Phrases
e. Articulation practice
f. Longer phrases
g. Pitch and loudness are minimal but possible and needed all the same.
h. Eventually, Conversation
i. Maximum rate: 60-70 wpm is adequate, 100-125 is excellent. Normal is about 150 wpm.