Dynamic behavior of the Provox and Staffieri prostheses for voice rehabilitation following total laryngectomy

Abstract

The present study evaluated the differences in aerodynamic behavior between the 1990 Provox and 1986 Staffieri voice prostheses for total laryngectomy patients. Both prostheses were submitted to in vitro laboratory testing to assess their aerodynamic behavior under different conditions of air flow through the valve and tracheal side pressure. In addition, six patients using the Provox and another six using the Staffieri prostheses were submitted to a dynamic study of phonation. This latter study evaluated the intratracheal pressure corresponding to the different intensities at which the vowel sound /a/ was pronounced. In vitro measurements revealed significant differences between the two prostheses, with the best results achieved with Provox. In contrast, the in vivo measurements did not reveal any significant differences between the two groups of patients in the 50-79 dBSPL range, although there was some difference at intensities equal to or greater than 80 dBSPL. Again, in this latter case the best results were achieved with the Provox. However, the ideal prosthesis has yet to be found. In some patients, the so-called low-resistance prostheses fail to maintain their aerodynamic performances, most likely because anatomic resistors interfere with the effort (i.e., pressure) required to produce a voice. At present the choice of prosthesis is best determined on an individual patient-to-patient basis.

Correlation of intraluminal esophageal pressure with the dynamic extension of tracheoesophageal voice in total laryngectomees

“…What has been observed is that different types of prostheses [2][3][4][5][6][7] and the manner of stoma occlusion 3,5,7 influence dynamic extension. In this group of laryngectomees, all subjects performed digital occlusion of the stoma and wore the same prosthesis.…”

“…Characteristics of tracheoesophageal voice and speech such as vocal intensity and dynamic extension have been studied in association with overall voice analysis, with different aerodynamic characteristics being tested for the various models of prostheses available [2][3][4][5][6][7] . However, there still is a lack of studies regarding the physiology of sound intensity and of dynamic extension for total laryngectomees since a lot remains to be determined about the production of tracheoesophageal voice, such as rhythm, modulation and characteristics of phonation intensity.…”

Velopharyngeal aerodynamics of /m/ and /p/ in tracheoesophageal speech

“…However, neoglottal aerodynamics are altered such that an air conservation strategy might still be employed, at least by some TE speakers. Neoglottal resistance in TE speakers is higher than glottal resistance in laryngeal speakers, 11,24,25 and at least for some TE speakers, trans-source airflow rates are lower. 26 Additionally, some TE speakers experience intermittent tightness/spasticity of the PE segment during voicing attempts resulting in significant reduction or transient cessation of air flow.…”

Magnitude and Variability of Oral Pressure in Tracheoesophageal Speech

“…Speech rate, pause time, consonant duration, vowel duration, and voice onset time, among others, have been reported to differ between TE and laryngeal speakers [4,5,15,16]. Aerodynamically, changes in air pressures, flows, and resistances at the level of the TE prosthesis and the pharyngoesophageal segment [11,13,17], along with articulatory adjustments that speakers may implement to maximize speech intelligibility, could alter oral aerodynamics relative to laryngeal speakers.…”

“…Endoscopic [6][7][8][9], fluoroscopic [9,10], and electromyographic [9] investigations of the neoglottis have also been reported in an attempt to better understand the nature of TE voice production and control. Aerodynamic characteristics of TE speech have been reported, again with a focus almost exclusively on the voice source or the various prosthetic valves [e.g., [11][12][13][14]. Very little has been reported regarding the aerodynamics of speech behaviors involving the oropharynx, velopharynx, and oral cavity (i.e.…”