This investigation attempted to determine the relationship of the site of contact ulcers and subject’s handedness. Literature concerned with contact ulcers has indicated that cerebral dominance tends to determine the site of the lesion. Four research questions were posed, two questions were presented in the form of the null hypothesis. The questions were: (1) Is the proportion of right-handed subjects with left-sided ulcers equal to the proportion of left-handed subjects with left-sided ulcers? (2) Is the proportion of right-handed subjects with right-sided ulcers equal to the proportion of left-handed subjects with right-sided ulcers? (3) Will the site of contact ulcers be able to be predicted from subject’s handedness? And (4) Is there a significant relationship between the factors of age, sex and occupation of the sample studied and the occurrence of contact ulcers?

The current functional model of the anuran larynx includes four pairs of laryngeal muscles. Their contractions do not account, however, for the behavioral control of call complexity observed in male túngara frogs (Engystomops pustulosus), which optionally add a secondary note with distinct harmonic structure to their advertisement call. Examination of the túngara frog's laryngeal morphology through dissection, microtomography, and resin histology has revealed that the m. dilatator laryngis is divided into two separate bundles (superficial and deep). The superficial bundle closely matches the typical description of the m. dilatator laryngis and is well positioned to open the glottis. The deep bundle is exclusively innervated by the short laryngeal nerve and has an attachment to the fibrous mass, an internal laryngeal structure necessary for complex call production. This attachment indicates a separate role for the deep bundle in controlling the complexity of the call. Based on physical separation, exclusive attachments, distinct fiber orientation, exclusive innervation, and potential action, this study recognizes the deep bundle of the m. dilatator laryngis as a separate muscle. It also revalidates the name m. arylabialis which had been previously used to describe it. The split of the m. dilatator laryngis into two muscles results in a laryngeal innervation pattern that closely matches that of mammals. This study identified a novel laryngeal muscle in túngara frogs, a potential mechanism for the control of call complexity, and revealed new evidence of homologies between the laryngeal structures of amphibians and mammals.

Voice is an important tool for communication. Consequently, voice disorders tend to severely diminish quality of life. Voice research seeks to understand the physics that govern voice production to improve treatment of voice disorders. This thesis develops a method for creating complex synthetic laryngeal models and obtaining flow data within these complex models. The method uses Computed Tomography (CT) scan data to create silicone models of the larynx. Index of refraction matching allows flow field data to be collected within a synthetic complex larynx, which had previously been impossible. A short proof-of-concept of the method is set forth. Details on the development of a mechanically-driven synthetic model are presented. Particle image velocimetry was used to collect flow field data in a complex and a simplified supraglottal model to study the effect of complex geometry on the supraglottal jet. Axis switching and starting and closing vortices were observed. The thesis results are anticipated to aid in better understanding flow structures present during voice production.

The purpose of this study was to examine external laryngeal oscillation and its potential effects on phonation threshold pressure (PTP; cm H2O) and phonation threshold flow (PTF; L/sec). Measures of PTP and PTF have inherent limitations due to the nonlinear nature of phonation, influencing their clinical and experimental utility. This is true particularly for tracking relatively small changes in voice function because variability in the measure itself can be larger than that resulting from voice change. Elevated PTP and PTF are associated with a variety of voice disorders and correlate with self-reported vocal effort and fatigue. Prior studies involving silicone and excised animal larynges have demonstrated PTP reduction in response to external oscillation. In an extension of this work, this thesis examined external laryngeal oscillation and aerodynamic voice measures in two experiments including a translational benchtop to human approach. Experiment 1 used a within-subjects counterbalanced design to examine PTF in 12 porcine larynges. Larynges were fitted with a custom oscillation device and 30 phonation trials were conducted for each larynx, 15 with external oscillation and 15 without. Although summary statistics indicated that PTF was lower with external oscillation, differences were not significant. Experiment 2 applied a within-subjects counterbalanced design to examine PTP in four healthy adult females and one healthy adult male. Individuals produced repeated syllable strings of /pi/ productions at comfortable pitch with and without external oscillation using an electrolarynx and the second and third syllables were averaged. Descriptive analysis indicated that PTP was lowered for female participants but not the male participant. Taken together, the results of these studies offer preliminary evidence that external oscillation influences voice onset aerodynamic measures. The effects of external oscillation seem to be more evident in PTP. These findings have important clinical and research applications for PTP measurement and the potential positive influence on voice function. These preliminary results indicate the need for further research in this area.

Subglottic stenosis (SGS) is an abnormal narrowing of the airway at the level of the cricoid cartilage, above the first tracheal ring and immediately beneath the vocal folds. Individuals with SGS experience a reduction in their ability to breathe as well as adverse effects on voice function. SGS can result from a variety of causes with the type of treatment depending on stenosis severity. Surgical techniques such as laryngotracheal and cricotracheal reconstruction are beneficial for airway maintenance; however, these procedures have resulted in negative effects on voice production. On the other hand, there are patients with SGS who do not require surgery and still experience voice problems. The purpose of this study was to quantify the effects of SGS on vocal fold vibration using an excised larynx benchtop mechanical model. Using a within-subjects repeated measures design, nine porcine larynges underwent experimental conditions including 0% (i.e., normal airway), 50% and 75% stenosed. The primary outcome measure was phonation threshold flow (PTF), which is the rate of flow observed at the onset of phonation. For all larynges, the normal and stenosed conditions were sampled three times each and averaged. Analysis of the results revealed no statistically significant differences in PTF; however, descriptive data showed decreases in PTF and increased variability in PTF values as percent stenosis increased. These findings lay important groundwork for future research in SGS, specifically those that employ ex vivo methodologies. PTF has emerged as a promising means of quantifying voice function in addition to the traditional onset pressure measures. Future studies should examine a broader range of stenosis conditions with a larger sample size to promote generalization to clinical populations including individuals with SGS.

Subglottic stenosis (SGS) is a narrowing of the airway below the vocal folds and above the trachea. This narrowing may be idiopathic or caused by scarring in the airway due to prolonged endotracheal intubation, radiation therapy, trauma, or gastroesophageal reflux disease. People who present with SGS often experience respiratory difficulty both at rest and during exertion. Breathing difficulty increases with stenosis severity. SGS is also associated with voice problems. Research has identified relationships among stenosis severity, voice function and certain types of surgical management; however, many aspects of these relationships are not fully understood due to the complexities of studying human phonation in this population. The purpose of the present study was to examine the effects of SGS on aerodynamic features of voice function using an excised larynx benchtop mechanical model. Specifically, this research involved the comparison of excised porcine vocal fold vibration at baseline and under experimental conditions of 50% and 75% stenosed. The dependent variable was phonation threshold pressure (PTP), the minimum pressure needed to initiate and maintain vocal fold vibration. PTP was analyzed for nine excised porcine larynges, sampled three times each, at baseline and the two stenosis conditions. The results of this study revealed no differences in PTP based on within-subjects comparisons. Because airflow changes with airway narrowing, this finding might indicate that other factors are responsible for the voice problems associated with SGS that were not accounted for in the current mechanical model. Vocal fold tone is not easily simulated in a benchtop setup and might be an important consideration for future studies. The quantification and manipulation of vocal fold adduction, as well as the study of high-speed imaging, could be useful in future work involving excised larynx mechanical models for the study of SGS. The results from this pilot work represent an important step toward optimizing the experimental setup for studying aerodynamic features of SGS.

No description available.

Le chémoréflexe laryngé (CRL), un ensemble de réponses physiologiques servant à protéger les voies respiratoires inférieures, est provoqué par la présence de liquide, consiste en une toux accompagnée de déglutition, de la fermeture du larynx, de l’éveil et de l’augmentation de la pression artérielle systémique. Chez un nouveau-né prématuré ou un raton, le CRL est immature et la stimulation de celui-ci provoque une apnée accompagnée de désaturation en O2, de bradycardie, d’un laryngospasme et d’une redistribution du débit sanguin aux organes vitaux. L’apnée du prématuré, le malaise grave du nourrisson et le syndrome de la mort subite du nourrisson sont des exemples de pathologies qui sont très probablement reliées à des évènements cardiorespiratoires observés chez les nouveau-nés prématurés. Le syndrome de la mort subite du nourrisson atteint principalement les garçons et un CRL immature est fortement soupçonné d’y être impliqué dans certains cas. La séparation maternelle néonatale (SMN) est connue pour provoquer un retard de développement du circuit neuronal contrôlant la respiration, mais quel est son effet sur le développement du CRL? Des études montrent que les n-3 PUFA favoriseraient le développement du poumon et du système nerveux central, mais est-ce que ceux-ci ont un effet au niveau du développement de la respiration au sens plus large? L’hypothèse de cette thèse est que l’environnement est capable d’avoir un impact sur le chémoréflexe laryngé chez le jeune raton. La SMN consiste en la séparation des ratons de leur mère et du reste de la portée dans un incubateur à température (35 °C) et humidité (45 %) contrôlés 3 h par jour du 3e jour de vie au 12e. Les expériences ont eu lieu au 14e et 15e jour. La SMN augmente les effets délétères de la stimulation du CRL, surtout chez les mâles. Nous avons réalisé 3 stimulations du CRL (injections de 10µL d’eau à proximité du larynx) séparées par 5 minutes de récupération. L’inhibition cardio-respiratoire due au CRL augmentait avec le nombre de stimulations. Nous avons étudié les courants des neurones des régions impliquées dans le CRL : le noyau du tractus solitaire (NTS, qui est le centre d’intégration des données provenant entre autres du larynx) et le noyau moteur dorsal du nerf vague (DMNV, impliqué dans la bradycardie). Au niveau du DMNV, nous avons observé une augmentation de la fréquence et de l’amplitude des courants postsynaptiques excitateurs (EPSCs) chez les animaux stressés. La tétrodotoxine (TTX) a un effet plus important chez les animaux stressés vs contrôles. Cela nous permet de déduire qu’au niveau du DMNV les afférences arrivant sur ces neurones sont plus nombreuses chez les animaux stressés vs contrôles. Une explication serait que l’élagage synaptique réalisé par la microglie est perturbé par la SMN. L’analyse de la microglie au niveau du NTS et du DMNV montre que le stress modifie le phénotype de la microglie, ce qui perturberait la fonction d’élagage synaptique. Mais l’étude ne démontre pas d’effet du stress au niveau de la communication neurones-microglie. Le stress provoqué par la SMN a des effets délétères sur le CRL, surtout chez les mâles, en provoquant une augmentation de l’inhibition cardio-respiratoire due au CRL. Cet effet serait dû à un défaut de l’élagage synaptique dans les régions impliquées dans le CRL, notamment au niveau des neurones responsables de la bradycardie. Le système respiratoire étant immature chez le nouveau-né prématuré, nous avons testé l’hypothèse que la supplémentation maternelle en acide gras polyinsaturé n-3 (AGPI n-3) pouvait accélérer la maturation de celui-ci. Les expériences ont eu lieu aux 10e et 11e jours de vie chez les ratons. La supplémentation maternelle en AGPI n-3 réduit l’apnée due au CRL et favorise le développement de la réponse ventilatoire à l’hypoxie et des poumons. Cependant, le traitement augmente le nombre d’instabilités respiratoires et provoque un retard de développement de la microglie dont l’impact est inconnu. Les AGPI n-3 seraient un bon traitement pour favoriser le développement du système nerveux contrôlant la respiration; cependant, il faudrait approfondir l’étude afin de s’assurer que certains effets des AGPI n-3 n’aient pas de conséquences indésirables. Le stress favorise les effets délétères dus à la stimulation du CRL chez le raton en augmentant le signal arrivant sur les neurones impliqués dans la réponse cardio-respiratoire au CRL, ce qui pourrait s’expliquer par un défaut d’élagage synaptique. Si l’on doit favoriser le développement du système respiratoire chez l’animal immature, les AGPI n-3 seraient une bonne option. / Laryngeal chemoreflex (LCR) is a set of physiological responses to protect lower airways from liquids and include coughing and swallowing, larynx closure, arousal, and systemic arterial pressure increase. In preterm infants or young rats, LCR is immature and elicits apnea, O2 desaturation, bradycardia, laryngospasm and redistribution of blood flow to vital organs. Apnea of prematurity, apparent life threatening events and sudden infant death syndrome (SIDS) are examples of pathology strongly suspected to be linked to cardiorespiratory events observed in preterm infants. SIDS is more prevalent in males and immature LCR is suspected to be involved in a few SIDS cases. Neonatal maternal separation (NMS) is known to delay development of control of breathing neuronal networks but what is its effect on LCR development? Studies have shown that n-3 PUFA promote lung and central nervous system development but could they have an effect on respiratory development? The thesis hypothesis is that environment could influence LCR in rat pups. NMS consists in the separation of pups from their mother and the rest of the litter in an incubator at a controlled temperature (35°C) and humidity (45%), 3h per day from post-natal day 3 (P3) to P12. Experiments were performed at P14-15. SMN increases deleterious effect of LCR stimulation especially in males. We have performed 3 LCR stimulations (with 10µl of water injected close to the larynx) separated by 5 minutes of recovery for each. We have observed that LCR cardiorespiratory inhibition increased with the number of stimulations. We have studied excitatory currents in neurons in regions involved in LCR: nucleus tractus solitarius (NTS, integration center of information coming from the larynx) and dorsal motor nucleus of the vagus nerve (DMNV, involved in bradycardia). In the DMNV we have seen an increase in excitatory post-synaptic currents (EPSCs) frequency and amplitude in stressed animals. Tetrodotoxin (TTX) has a more important effect on stressed animals vs controls. These findings allow us to hypothesize that afferents arriving on neurons in the DMNV are more numerous in stressed animals than in controls. One explanation of these results could be that synaptic pruning made by microglia is disrupted by NMS. Microglial analysis in the NTS and DMNV shows that NMS changes microglia phenotype which could disrupt synaptic pruning. However, this study did not demonstrate any disturbance from stress in neurons/microglia communication. Stress issuing from NMS delays LCR development, especially in males, by causing an increase in cardio-respiratory inhibition following LCR stimulation. This effect would be due to a synaptic pruning abnormality in neuronal regions involved in LCR, especially those involved in bradycardia. The respiratory system is immature in preterm infants. To accelerate maturation of this system, we have tested the effect of n-3 PUFA maternal supplementation. Experiments were performed in P10-11 rat pups. Maternal supplementation of n-3 PUFA reduced apnea duration caused by LCR stimulation, promoted hypoxic ventilatory response development and lungs development. However, the treatment increases the number of respiratory instabilities and induces a delay of microglial development whose impacts we do not know. N-3 PUFA maternal supplementation could be an interesting treatment to promote control of breathing development. That said, we should further the study to be sure that the unexpected effects of this treatment have no undesirable consequences. Stress increases the deleterious effects of LCR stimulation in rat pups by increasing the signal arriving on neurons involved in LCR cardiorespiratory response. This phenomenon could be explained by a disruption of synaptic pruning. If we look at a treatment to enhance respiratory system development in immature animals, n-3 PUFA is an option which should be considered.

La progestérone stimule le chémoréflexe ventilatoire et réduit l’occurrence des apnées. En revanche, ses mécanismes d’actions sont peu élucidés. Les récepteurs nucléaires (nPR) et les récepteurs membranaires (mPRs) de la progestérone de type α et β sont exprimés dans les centres respiratoires au niveau du tronc cérébral. En premier, nous avons postulé que la délétion des nPR chez la souris femelle (PRKO) affecte le chémoréflexe ventilatoire et augmente la fréquence des apnées durant le sommeil. Nos résultats ont montré que les nPR stimulent la réponse ventilatoire à l’hypercapnie et réduisent la fréquence des apnées postsoupirs durant le sommeil calme. Ensuite, nous avons postulé que le mPRα et le mPRβ modulent le chémoréflexe et la stabilité ventilatoire chez la souris adulte. La réduction de l’expression des récepteurs mPRβ ou le mPRα exprimés au niveau des centres de contrôle ventilatoire de la médulla oglongata a mis en évidence que ces récepteurs contribuent à la régulation du chémoréflexe ventilatoire. De plus, le mPRβ contribue à la stabilité respiratoire chez la souris adulte mâle et femelle. Enfin, nous avons postulé que la réduction de l’expression des nPR, mPRα ou le mPRβ dans le système nerveux central affecte le chémoréflexe et la stabilité ventilatoire chez des rats de 10 jours de vie. Nos résultats ont indiqué que le nPR et le mPRβ contribuent à la stabilité du patron ventilatoire chez le nouveau-né. Nous concluons que la progestérone signale par les récepteurs nPR, mPRα et le mPRβ pour réguler le chémoréflexe ventilatoire chez l’adulte. En outre, le nPR et le mPRb contribuent à la stabilité ventilatoire à la fois chez la souris adulte et le rat nouveau-né. Ces deux récepteurs pourraient être de nouvelles cibles thérapeutiques pour le traitement de l’apnée du sommeil chez l’adulte et l’apnée du nouveau-né. / Progesterone stimulates the ventilatory chemorefelx and reduces the occurrence of apnea, but the mechanisms are not well understood. The nuclear (nPR) and membrane progesterone receptors (mPRs) sutypes α and β are expressed in the respiratory centers of the brainstem. First, we postulated that the nPR deletion in female mice (PRKO) affects ventilatory chemoreflex and increases the frequency of apnea during the quiet sleep. Our results showed that the nPR stimulate the ventilatory response to hypercapnia and reduce the frequency of post-sigh apneas during the quiet sleep. Next, we postulated that the mPRα and mPRβ modulate chemoreflex and ventilatory stability in adult mice. The reduction of the expression of the mPRβ or the mPRα, expressed at the level of the ventilatory control centers at the level of the medulla oblongata, has demonstrated that these receptors contribute to the regulation of the ventilatory chemoreflex. In addition, mPRβ contributes to respiratory stability in male and female adult mice. Finally, we have postulated that reduced expression of the nPR, mPRα, or mPRβ in the central nervous system affects chemoreflex and ventilatory stability in 10-day-old rats. Our results indicated that the nPR and mPRβ contribute to the stability of the ventilatory pattern in neonates. We conclude that progesterone signals via nPR receptors, mPRα and mPRβ to regulate ventilatory chemorefelx in adults. In addition, nPR and mPR contribute to ventilatory stability in both adult mice and neonatal rats. These two receptors could be new therapeutic targets for the treatment of sleep apnea in adults and apnea of the newborn.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Post-operative laryngectomy patients face various physical, psychological and social challenges. The comprehensive effects of a total laryngectomy can have an adverse impact on the patient and his or her family. Because improved medical treatment can increase the life expectancy of cancer sufferers, psychosocial guidance is required over an extended period. Unfortunately, limited information on the coping strategies of such patients is available. The social work profession could benefit from greater insight into the strengths and coping mechanisms of post-operative cancer patients in order to guide them through their survivorship journey with insight and compassion. The researcher therefore aimed to explore and describe the experience of a patient and his/her close family while coping with the long-term challenges of a laryngectomy. The objectives were: (1) to discuss the nature of cancer survivorship, (2) to describe the medical aspects of and physical re-adjustments to a laryngectomy, (3) to discuss principles and strategies for coping and surviving a laryngectomy, (4) to describe the comprehensive psychosocial effects during the permanent survival phase and re-entry into society; (5) to explore the survivorship journey of laryngectomy patients and their families, and (6) to analyse and interpret data obtained from the study. Each of the survivorship phases as contextualised by Miller et al. (2008:369-374)* is discussed in the literature review. Both the ecological and the strengths perspective were utilised as the theoretical framework for this study. Principles of the strengths perspective focus on the inherent strengths that help patients cope with this traumatic life event, while the ecological perspective focuses on the utilisation of community resources in order to survive the laryngectomy experience. A combination of exploratory and descriptive designs was applied throughout the study to gain insight into the survival experience of post-operative laryngectomy patients and their families. The research question was: “What are patients’ and families’ experiences of surviving a laryngectomy with the assistance of internal and external resources within the family system and environment?” This question was addressed by combining the quantitative and qualitative research approaches. Forty-five post laryngectomy patients and fifteen family members, representing one-third of these patients, were included in the study through purposive sampling. The study period was from June 2012 to July 2013. The inclusion criteria required: (1) Patients from the service area of the selected hospital who received a total laryngectomy as surgical treatment for an advanced stage of cancer of the larynx or hypopharynx; (2) patients who were operated on not less than three months previously; (3) patients who had already completed their initial treatment and who were attending the follow-up clinic; and (4) patients who had successfully acquired trachea-oesophageal speech. Data obtained from the interviews were organised into themes. Four themes were identified: (1) the need for pre-operative information; (2) experience of physical adjustment; (3) coping and strengths used; and (4) experience of psychosocial effects of surgery and re-entry into society. These themes were divided into sub-themes and categories. The main outcome of the study was that both patients and families mobilise a combination of inner strengths and external resources to adapt to the inevitable physical changes resulting from a laryngectomy. It is therefore recommended that social workers dealing with survivorship cases utilise a combination of the ecological and strengths perspectives to create an environment in which patients can explore their own inner strengths, or to help them link to community resources whilst coping with their survivorship journey. Future research should focus on the long-term psychosocial survival of laryngectomy patients and their families, as it is likely that survivorship will increase in future; the implementation of survivorship programmes for health care professionals to equip them with skills to guide cancer survivors to full utilisation of their own strengths and available community resources; the role of pre- and primary school children/grandchildren in the rehabilitation of laryngectomy patients deserves further investigation. / AFRIKAANSE OPSOMMING: Laringektomie-pasiënte word ná hul operasie met verskeie liggaamlike, psigiese en sosiale uitdagings gekonfronteer. Die omvattende gevolge van ‘n totale laringektomie kan die pasiënt en sy of haar gesin nadelig affekteer. Aangesien verbeterde mediese behandeling die lewensverwagting van kankerpasiënte kan verleng, word psigososiale ondersteuning oor ‘n langer tydperk benodig. Ongelukkig bestaan daar baie min inligting oor hoe pasiënte kanker hanteer. Die maatskaplike werk beroep kan dus voordeel trek uit beter insig in die hanteringsmeganismes van post-operatiewe kankerpasiënte om hulle met insig en empatie deur hul oorlewingsreis te kan begelei. Die navorser het ten doel gehad om die ondervindings van die kankerpasiënt en sy/haar naby familie tydens hul langtermynhantering van ‘n laringektomie te ondersoek en te beskrywe. Verdere oogmerke van die studie was: (1) om die aard van kankeroorlewing te bespreek; (2) om die mediese aspekte van en liggaamlike aanpassing ná ‘n laringektomie te beskrywe; (3) om die beginsels en strategieë vir ‘n oorwinning oor ‘n laringektomie te bespreek; (4) om die omvattende psigososiale gevolge van die finale oorlewingsfase en hertoetrede tot die gemeenskap te beskrywe; (5) om die oorlewingsreis van die laringektomiepasiënt en sy/haar gesin te ondersoek; en (6) om die resultate van die studie te ontleed en te interpreteer. Elk van die oorlewingsfases soos deur Miller et al. (2008:369-374)* beskrywe, is in die literatuuroorsig bespreek. Die ekologiese en die sterkte-perspektiewe is tesame as teoretiese raamwerk vir die studie gebruik. Die beginsels van die sterkte-perspektief is op die inherente krag van pasiënte gemik, om te bepaal hoe hulle hierdie traumatiese lewensgebeurtenis hanteer, terwyl die ekologiese perspektief op hul aanwending van gemeenskapsbronne om die laringektomie te oorleef, fokus. ‘n Kombinasie van ondersoekende en beskrywende navorsings ontwerpe is deurgaans gebruik om insig in die oorlewingstryd van laringektomiepasiënte en hul gesinne te verkry. Die navorsingsvraag was: “Wat is pasiënte en hul gesinne se ervarings van oorlewing na ‘n laringektomie met die hulp van interne en eksterne hulpbronne in die gesinstruktuur en omgewing?” Kwantitatiewe en kwalitatiewe navorsingsmetodes is gekombineer om hierdie vraag te ondersoek. Vyf-en-veertig laringektomiepasiënte en vyftien gesinslede, wat verteenwoordigend van twee-derdes van die pasiënte was, is met behulp van ‘n doelbewuste steekproef by die studie betrek. Die studie is tussen Junie 2012 en Julie 2013 onderneem. Die insluitingskriteria was: Pasiënte uit die diensgebied van die spesifieke hospitaal wat 'n totale laringektomie as chirurgiese behandeling vir 'n gevorderde stadium van kanker van die larinks of hipofarinks ontvang het; (2) pasiënte wat hul operasie nie meer as drie maande vantevore ondergaan het nie, (3) pasiënte wat reeds hul aanvanklike behandeling voltooi het en wat die opvolgkliniek bywoon, (4) pasiënte wat tragea-esofageale spraak suksesvol bemeester het. Die data, wat deur middel van onderhoude ingesamel is, is in temas gegroepeer. Vier temas is geïdentifiseer: (1) die behoefte aan inligting voor die operasie; (2) ervaring van liggaamlike aanpassing; (3) die hantering van omstandighede en innerlike krag; en (4) ervaring van die psigososiale uitwerking van die operasie en hertoetrede tot die gemeenskap. Hierdie temas is verder in subtemas en kategorieë verdeel. Die belangrikste uitkoms van hierdie studie is dat beide pasiënte en gesinne ‘n kombinasie van hul innerlike krag en eksterne bronne aangewend het om ná die laringektomie by die onafwendbare liggaamlike veranderinge aan te pas. Daar word dus aanbeveel dat maatskaplike werkers wat kankeroorlewendes hanteer, van ‘n kombinasie van die ekologiese en die sterkte-perspektief gebruik maak om ‘n omgewing te skep waarin die pasiënt sy of haar eie innerlike krag kan ontgin, of om pasiënte te help om kontak met gemeenskapsbronne te maak terwyl hulle die oorlewingsreis baasraak. Toekomstige navorsing behoort te fokus op langtermyn psigososiale oorlewing van laringektomie pasiënte en familie met inagneming van die tendens dat kanker pasiënte se oorlewing toeneem; die implementering van opleidingsprogramme vir gesondheidswerkers te fokus om hulle met die nodige kennis toe te rus om kankeroorlewendes te begelei om hul volle krag en alle beskikbare gemeenskapsbronne te gebruik. Daarby verdien die rol van voorskoolse- en laerskoolkinders in die rehabilitasie van laringektomiepasiënte verdere ondersoek.