The Role of Esophagus in Voice Rehabilitation of Laryngectomees

The total laryngectomy is a standard procedure of laryngeal carcinoma treatment which leaves multiple persistent consequences on a laryngectomized person. After laryngectomy, all of patients cannot speak loudly, and 10–58% patients have a dysphagia. In such changed anatomical condition, the esophagus has a key function in two of three primary approaches to voice—speech rehabilitation of laryngectomized patients: esophageal and tracheoesophageal speech therapy method because one of these is the only acceptable solution of substitute alaryngeal speech. In esophageal speech, the esophagus has the role of speech air reservoirs since the respiratory and digestive pathways are permanently separated after the procedure. In the production of tracheoesophageal speech, the tracheoesophageal fistula and the esophagus allow the recommunication of these pathways and the use of air from the lungs for speech. There are several prerequisites for successful esophageal and tracheoesophageal speech. After tracheoesophageal puncture and insertion, the tracheoesophageal prosthesis may occur different complications in the early or late postoperative period in 10–60% of patients. The quality of alaryngeal voice is very different from the quality of laryngeal voice, but allows communication to laryngectomees

Vocal rehabilitation after total laryngectomy.

Vocal rehabilitation after total laryngectomy

The development of a new rating scale for the perceptual assessment of tracheoesophageal voice quality outcome following total laryngectomy

PhD ThesisPerceptual assessment of voice in people with surgical voice restoration (SVR) is essential to evaluate surgical and other interventions aimed at delivering optimal voice quality. Currently there are no tools to measure this that do not have issues of validity and reliability. This work describes the development and trialling of investigatory versions of three scales to address this situation: a) the Sunderland Tracheoesophageal Perceptual Scale (SToPS) for professional raters, b) the Naïve Rater Scale for non-specialist raters and c) the Patient and Carer Scale. In the final testing of the pilot version 55 speakers using tracheoesophageal voice were evaluated by twelve Speech and Language Therapists (SLT’s) and ten Ear, Nose and Throat (ENT) surgeons, divided into experienced or not at assessing voice. Ten naïve raters assessed the voice stimuli within a test-retest design. Forty tracheoesophageal speakers and thirty-seven carers attended an interview to rate their own or their relative’s voice. Inter rater agreement was then calculated between SLT, ENT, naïve, patient and carer groups with weighted kappa co-efficients Strength of agreement values (Landis and Koch 1977) were compared to profession and expertise. Expert SLT’s achieved “good” agreement for nine of fourteen parameters. Naïve judges attained “good” levels of inter and intra-rater agreement for the parameters Overall Grade and Social Acceptability. The greatest inter group consensus was for patients and carers, with “good” agreement for Intelligibility, Volume and Wetness. The only other “good” agreement was between naïve/ENT and naïve/ SLT groups for Overall Grade. The scales are ready for clinical use with the proviso that future work will determine whether it is possible to enhance agreement so less experienced judges can achieve “good” levels of agreement for more parameters and examine which perceptual parameters might be more prominent or vital for outcomes for different groups.City Hospitals Sunderland NHS Foundation Trust