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Organic & Neurogenic Comm Disorders > Alaryngeal Speech > Flashcards

Flashcards in Alaryngeal Speech Deck (19)
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1

Laryngectomy

Surgical removal of the larynx
-Disease
-Trauma

2

Alaryngeal Speech

Oral communication without a larynx
-Role of speech-language pathologist

3

Laryngeal Cancer

Supraglottic malignant tumors
Subglottic malignant tumors
Glottic malignant tumors

Causes:
Smoking
Smoking and drinking

4

Cancer

Immortal cells

-Benign – not cancerous and don’t spread to other parts of the body
-Malignant – cancerous and can spread to other parts of the body
-Metastasis – spread of malignant cells to other parts of the body
-Well-differentiated
-Less differentiated

5

Laryngeal Cancer Diagnosis

Auditory perceptual changes

Imaging:
-Indirect laryngoscopy
-Visible lesions
-Direct laryngoscopy
-Vocal fold vibration
-Tumor size, location, and type
-MRI or CT
-Tumor size and location

6

Laryngeal Cancer Treatment

Early identification

Radiation – targets cancerous cells


7

Near Total Laryngectomy

Entire larynx is removed except a strip of tissue on the contralateral/opposite side of the tumor
-Tracheostomy
-Strip of tissue is reconstructed into a shunt

8

Total Laryngectomy

Removal of the larynx
Permanent tracheostomy
Neck breathing

9

Cordectomy

Diseased vocal fold is removed

Postsurgical voice is breathy, weak, and hoarse

10

Partial Laryngectomy

Half of the thyroid cartilage, arytenoid cartilage, membranous tissues, and vocal fold on the affected side are removed

Voice is hoarse and breathy
Dysphagia – typically resolves with therapy

11

Supraglottal Laryngectomy

Partial removal of the hyoid bone & thyroid cartilage, removal of the ventricular folds and the epiglottis

12

Laryngeal Cancer Rehabilitation

Interdisciplinary Team:
Otolaryngologist (ENT)
Oncologist
Physician
Nurse
Social worker

Role of SLP:
-Improve pharyngeal function for eating and voice
-Collaborate with other healthcare professionals, patient, and family
-Counseling
-Adjustment and acceptance of new voice

13

Post-Laryngectomy Changes

Increased production of mucous
-Phlegm is removed from the stoma/blowing nose is difficult

Cover stoma with clothing

Reduced sense of taste and smell

No heavy lifting

No swimming/bathing precautions

Loss of laugh, cry, and other emotional vocalizations

Support groups

14

Preoperative Consultation

Counseling and preparing patient/family
Review medical information
Assess patient and needs

15

Postoperative Consultation

Counseling
Alaryngeal speech techniques reviewed/demonstrated
Educate patient and family

16

Electrolarynx

Vibration passes through muscles and tissue of neck creating sound

Patient moves articulators to produce speech

Used early after surgery

Gives patient an acceptable source of speech

Con- sounds artificial
Con- one hand has to be free to use the device

17

Esophageal Speech

Pharyngoesophageal (P-E) sphincter is constructed during surgery
-P-E sphincter functions like “new” vocal folds

Air is forced down and then back up through the P-E sphincter

Each person’s “voice” is different, but typically present with:
Lower fundamental frequency
Lower intensity/loudness
Slower rate of speech
3-5 words compared to 12 on a single breath of air

Cons:
It can be difficult to produce
Small air reserve
Stoma blast
Voice sounds different

Pros:
Produces a more natural sounding voice
No devises or instruments are needed – just air

18

Tracheo-Esophageal Speech

One-way prosthetic valve placed between the trachea and esophagus (air goes from trachea to esophagus, but nothing from the esophagus can enter the trachea)

Stoma is occluded to divert air into the esophagus below the P-E sphincter

Esophageal speech is produced

Acoustics:
Low pitch
Louder than esophageal speech
More natural rate of speech

19

One-Way Valve:

A prosthetic that is inserted into the trachea and esophagus postoperatively

Esophageal edge has a flange to secure the placement

Prosthetic vary and should be selected based on the patient’s needs

Easy flow of air into the esophagus and doesn’t take up too much room in the tracheostomy

Patient is taught how to insert, remove, and clean the prosthetic

Air pressure valve can be added to allow a person to speak without covering the stoma

Pro: most natural-sounding voice, especially for males
Con: Maintenance and may require second surgery for fistula