Improving hands-free speech rehabilitation in laryngectomized patients – proof-of-concept of a novel intratracheal fixation device

Permanent hands-free speech with the use of an automatic speaking valve (ASV) is regarded as the optimal voice rehabilitation after total laryngectomy. Due to fixation problems, regular ASV use in patients with a laryngectomy is limited. We have developed an intratracheal fixation device (ITFD) composed of an intratracheal button augmented by hydrophilic foam around its shaft. This study evaluates the short-term effectiveness and experienced comfort of this ITFD during hands-free speech in 7 participants with a laryngectomy. We found that 4 of 7 participants had secure ASV fixation inside the tracheostoma during hands-free speech for at least 30 minutes with the ITFD. The ITFD’s comfort was perceived positively overall. The insertion was perceived as being mildly uncomfortable but not painful. This proof-of-concept study demonstrates the feasibility of the ITFD that might improve stomal attachment of ASVs, and it provides the basis for further development toward a prototype suitable for long-term daily use

Compensation in Verbal and Nonverbal Communication after Total Laryngectomy

Total laryngectomy is a major surgical procedure with life-changing consequences. As a result of the surgery, the upper and lower airways are disconnected, the natural voice is lost, and patients breathe through a tracheostoma in the neck. Tracheoesophageal speech is the most common speech rehabilitation technique. Due to the lack of air volume, and the amount of muscle tension in the esophagus, some patients may suffer from a hyper- or hypo-tonic voice, resulting in less intelligible speech. To communicate as intelligibly as possible, patients likely adapt their verbal and nonverbal communication to their physical disabilities. The current study aimed to explore the compensation techniques in verbal and nonverbal communication after total laryngectomy focusing on the complexity of grammar and the use of co-speech gestures. We analyzed previously obtained interviews of eight laryngectomized women on the syntactic complexity in speech and the use and type of co-speech gestures. Results were compared with analyses of productions by healthy controls. We found that laryngectomized women reduce the syntactic complexity of their speech, and use nonverbal gestures in their communication. Further research is needed with systematically obtained data and more suitable match-groups

Tumor volume as a prognostic factor for local control and overall survival in advanced larynx cancer

Objectives/Hypothesis Tumor volume has been postulated to be an important prognostic factor for oncological outcome after radiotherapy or chemoradiotherapy. This postulate was retrospectively investigated in a consecutively treated cohort of T3-T4 larynx cancer patients. Study Design Retrospective cohort study. Methods For 166 patients with T3-T4 larynx cancer (1999-2008), pretreatment computed tomography and magnetic resonance imaging scans were available for tumor volume delineation. Patients were treated with radiotherapy, chemoradiotherapy, or total laryngectomy with postoperative radiotherapy. Both a dedicated head and neck radiologist and the first author determined all tumor volumes. Statistical analysis was by Kaplan-Meier plots and Cox proportional hazard models. Results Patients with T3 larynx cancer had significantly smaller tumor volumes than patients with T4 larynx cancer (median = 8.1 cm3 and 15.8 cm3, respectively; P < .0001). In the group treated with total laryngectomy and postoperative radiotherapy, no association was found between tumor volume and local or locoregional control or overall survival. In the group treated with radiotherapy, a nonsignificant trend was observed between local control and tumor volume. In the chemoradiotherapy group, however, a significant impact of tumor volume was found on local control (hazard ratio = 1.07; 95% confidence interval = 1.01-1.13; P = .028). Conclusions Tumor volume was not significantly associated with local control, locoregional control, or overall survival in the surgically treated group. In the group treated with radiotherapy, there was no statistically significant association, but a trend was observed between local control and tumor volume. Only in patients treated with concurrent chemoradiotherapy was a significant impact of tumor volume on local control found. Level of Evidence 4