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Ear, Nose, and Throat Disorders

research into Vocal Reconstruction

10/04/1998

Question:

Where can I find research into Vocal Reconstruction after a Larynjectomy with Bilateral Gland Excision ?.

Answer:

Vocal Rehabilitation after total laryngectomy consists of three traditional options. The first, and probably most common method at this time, is tracheoesophageal voice. This voice is accomplished by surgically creating a hole in the back wall of the trachea (stoma) which communicates with the esophagus (swallowing passage). A plastic, one-way valve prosthesis (Blom-Singer Prosthesis or Provox Prosthesis) is then placed in this hole. The prosthesis will allow air to pass into the throat. The throat tissues will then vibrate producing a sound. As the sound passes through your mouth you then shape it into words with your tongue, teeth, and lips. This usually produces a low pitched voice. This is usually not a problem for male patients. However, occasionally, female patients may be mistaken for men on the telephone.

The second method of rehabilitating the voice after total laryngectomy is by using an electrolarynx. This is a hand held device that is applied to the neck or cheek or occasionally placed in the mouth. Since it vibrates, it produces a sound. You then speak like normal to produce words. This gives a mechanical voice that is very effective when the patient is properly trained in its use. Some don't like it simply because it is a mechanical sound.

The third method of voice rehabilitation after total laryngectomy is esophageal speech. This technique requires patients to swallow air into their esophagus (swallowing passage). Then regurgitate the air. You are essentially burping air on demand. As the air comes up it vibrates the throat tissues causing a sound to be produced. You then form words with you mouth like usual. The major drawback for this method is that only about 25% of patients who undergo a total laryngectomy will actually be fluent in this technique.

The common thread throughout these three techniques of voice rehabilitation is that you need a vibratory source. That is essentially what the vocal cords are - a sound generator.

There is another technique which is still experimental. Laryngeal transplantation is currently being studied by Dr. Marshall Strome at the Cleveland Clinic. He has successfully performed this operation on a human being. This operation is not be considered to be a good option for patients with a cancer diagnosis. The medications necessary to keep your immune system from rejecting the transplanted organ would put you at risk for developing another cancer. As technology progresses this technique may be available to cancer patients in the future.

Keith Wilson, M.D.; Assistant Professor of Otolaryngology; College of Medicine; University of Cincinnati Medical Center

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Response by:

Thomas A Tami, MD Thomas A Tami, MD
Professor of Otolaryngology
College of Medicine
University of Cincinnati