Možnosti rehabilitacije pri bolnikih z rakom glave in vratu

Rak glave in vratu je osmi najpogostejši rak v Sloveniji. Zdravimo ga kirurško, z radioterapijo in kemoterapijo, pogosto s kombinacijo teh načinov zdravljenja. Ker pa rak glave in vratu prizadene nos, ustno votlino, žrelo in grlo, so kot posledica bolezni same in nato zdravljenja okvarjene številne pomembne funkcije, ki vključujejo: dihanje, požiranje, govor, kašelj in vohanje. Za čim boljšo rehabilitacijo prizadetih funkcij je treba najprej natančno ugotoviti, kateri organi so prizadeti in kako okvarjeni so ter kakšne so preostale zmožnosti za izvedbo opisanih funkcij. Na podlagi ustreznih preiskav izberemo način rehabilitacije za vsakega bolnika posebej. V diagnostiko okvarjenih funkcij in rehabilitacijo je vključena vrsta različnih strokovnjakov, v rehabilitaciji pa je vodilni ustrezno usposobljen specialist klinične logopedije. Dobra rehabilitacija okvarjenih funkcij omogoča bolniku večjo kakovost življenja

Voice quality after radiation therapy of early glottic cancer

Radiation therapy is generally accepted as a successful treatment modality forearly glottic cancer offering an acceptable voice quality after the treatment. In order to evaluate objectively the voice quality in irradiated patients and to eliminate the influence of decreasing voice quality as a result of normal aging, the results of the acoustic analysis of voice in 20 patients with early glottic cancer treated with radiation therapy were compared to the results of 20 age-matched volunteers. The results established worse voice quality in the irradiated group but the difference was not significant except in amplitude perturbation quotient which expresses the instability of loudness. In order to identity the factors which could influence the quality of voice after irradiation of the laryngeal carcinoma, the results of laryngoscopy and the biopsy extension, were correlated with theresults of the perceptive voice evaluation and the results of acoustic voice analysis. No significant influence of the stated factors on the voice quality of the patients was established. Only the irregular glottic gap duringphonation indicated to be connected with very hoarse voice. In conclusion, radiation therapy of early glottic cancer results in an abnormal, but still satisfactory voice quality when compared to the voice quality of normal age-matched speakers. The hoarseness is the results of instability of pitch and specifically the instability of amplitude (loudness). The voice quality after the treatment can be influenced by the tumor extension and localization, the sequels of excisional biopsy, and the radiation therapy or functional disorder. All the stated factors are very intermingled and are probably acting together

Fiziologija in patologija glasu ter izbrana poglavja iz patologije govora

Učbenik je namenjen študentom logopedije za spoznavanje delovanja vokalnega aparata in patologije glasu. Dodana so tudi nekatera poglavja iz patologije govora, opisana predvsem s stališča zdravnika otorinolaringologa

LARYNGEAL PAPILLOMATOSIS

Background. Laryngeal papillomatosis is a rare disease of the upper respiratory tract, which may have a dramatic course. The results of many studies have proved a viral etiology, but the precise mode of the virus transmission remains indistinct. Surgery is the most successful mode of treatment. Adjuvant therapy is indicated only in an aggressive form of the disease.Patients. In the last 23 years, 136 patients have been treated for laryngeal papillomatosis at the Department of Otorhinolaryngology and Cervicofacial Surgery in Ljubljana. All patients were treated surgically; since 1995, CO2 laser has been used. Eighteen patients with aggressive disease received adjuvant therapy. Only in 2.2% of patients was tracheotomy necessary. In 9.6% of patients, laryngeal scarring occurred as a result of repeated surgical procedures. In 2.2%, malignant alteration of laryngeal papillomatosis developed.Conclusions. The outcome of treatment of laryngeal papillomatosis in Ljubljana is comparable to the results of other centres. As carcinoma may develop, although very rarely, more than 10 years after the onset of laryngeal papillomatosis, all patients must be followed carefully.</p

The impact of communication mode on quality of life in laryngectomees

Background: Laryngectomy is the most successful mode of treating an advanced laryngeal and hypopharyngeal cancer. It results in the loss of ability of speech communication. In Slovenia the two most common ways of voice rehabilitation after laryngectomy are esophageal speech (ES) and tracheoesophageal speech (TES). The aim of the study was to compare the influence of these two communication modes on patients’ quality of life and to determine the factors influencing the choice of communication mode after laryngectomy.Patients and methods: There were 22 patients communicating with TES and 31 communicating with ES included in the study. A standardized questionnaire about quality of life (Voice-Related Quality of Life) was used to compare both groups. The patients also assessed their new way of communication on visual analogue scale, and how it affects their lives in general. The data on patients’ characteristics, their place of living, mode of treatment, treatment complications, and possible swallowing problems were obtained from the medical documentation.Results: The two groups did not differ with regard to the factors possibly influencing the choice of communication mode. The results of the questionnaire did not show any significant differences between the patients with ES and the patients with TES. The patients with TES stated significantly smaller deterioration of the quality of their lives after laryngectomy than the patients with ES. The patients with TES had fewer problems with the communication in the noise and with social life than the patients with ES but the differences were not significant.Conclusions: The best way of speech rehabilitation after laryngectomy would be the insertion of tracheoesophageal prosthesis and simultaneous teaching of ES. Thus the patient gets the possibility for verbal communication soon after the operation and also learns the mode of communication without any devices. Both modes of speech rehabilitation enable good quality of life after laryngectomy.</p

Razcepi v orofacialnem področju in drugi razlogi za artikulacijske motnje: študijsko gradivo

Mišice ustnic in jezika so bistvene pri artikulaciji, s spreminjanjem položaja in oblike jezika, nastajajo soglasniki, samoglasniki. Ustna votlina skupaj z žrelom, nosom in obnosnimi votli-nami tvori supraglotisni del vokalnega trakta in sodeluje pri oblikovanju posameznih glasov

Razcepi v orofacialnem področju in drugi razlogi za artikulacijske motnje: študijsko gradivo

Mišice ustnic in jezika so bistvene pri artikulaciji, s spreminjanjem položaja in oblike jezika, nastajajo soglasniki, samoglasniki. Ustna votlina skupaj z žrelom, nosom in obnosnimi votli-nami tvori supraglotisni del vokalnega trakta in sodeluje pri oblikovanju posameznih glasov