XLII Rehabilitation of the Postlaryngectomized Patient

Abstract

Since the voice following laryngectomy is dependent upon a chamber for the storing of air and a vibrating mechanism by which sound is produced on expulsion of the trapped air, failure to develop a voice may be due in a limited number of cases to extensive technical procedures which encroach upon both these factors. Pharyngeal or upper esophageal stenosis is a complication in future speech training, far more than lower esophageal disturbances. The inferior con strictor muscle has been thought to be a factor in voice production but when the cricoid cartilage is removed in laryngectomy it takes away the lower attachment so that there is no fixed point upon which the muscle can act, although it may have some importance in estab lishing a vibrating mechanism. This upper esophageal sphincter with its striated muscle fibers is partly under voluntary control and can be trained to both inspire and expire air, at the same time establishing enough contact with the surrounding mucosal tissue to cause vibra tion. While failure of the membrane in the pharynx to vibrate either due to extensive scar tissue or fixation may hinder the creation of a buccal voice there is little evidence to incriminate anatomical factors as the primary cause for lack of voice. Many patients have adequate reservoirs and resonating mechanisms, yet will only say one or two indistinct words. Some contend that they cannot learn to swallow air while others are unable to use the swallowed air for more than several syllables. A few inspire deeply and sharply through the tracheal stoma at each attempt to speak so that their voice is clouded by the inspiratory noise in the trachea. Still other patients have complained of severe heartburn at OAKLAND UNIV on June 12, 2015 aor.sagepub.com Downloaded from REHABILITATION AFTER LARYNGECTOMY

Prognostic indicators of esophageal speech

“…Three of the four were good esophageal speakers, indicating equal or better performance than that of the male subjects. This finding differs from that reported by Putney (1958), who found that men were more adept at developing esophageal speech than women. The female subjects in our sample responded similarly to the males on all tests and questions, including that of attitude toward esophageal speech.…”

Chapter IX: The Speech Handicapped

“…In a survey of 440 cases, Putney (72) reported that 38 percent failed to develop useful buccal voice. Males were more successful than females.…”

Psychological considerations in the attainment of esophageal speech

“…Investigators (Putney, 1958 ;Horn, 1962) have shown that approximately two thirds of all laryngectomees who have been adjudged medically able t o use esophageal speech are, in fact, unable t o satisfactorily learn this method of communication.…”

“…Unfortunately, the improved rate of cure has not been met with a corresponding increase in the ratio of esophageal speakers to nonspeakers, or to those using artificial larynxes. Investigators (Putney, 1958 ;Horn, 1962) have shown that approximately two thirds of all laryngectomees who have been adjudged medically able t o use esophageal speech are, in fact, unable t o satisfactorily learn this method of communication.…”

“…It is widely agreed (Diedrich and Youngstrom, 1966;Damste et al, 1956;Putney, 1958;Levin, 1940;Greene, 1947;Shands, 1966; and others) t h a t the psychological trauma concomitant with laryngectomy may cause more interference with the learning of esophageal speech than either anatomical or physiological changes resulting from the surgery. The most forceful view supporting this position is t h a t of Diedrich and Youngstrom (1966), who conducted an exhaustive survey of the physiological movements involved in esophageal speech.…”