Loss of speech is one important factor which contributes to a decrease of life quality for patients who undergo larynx removal following for example advanced laryngeal cancer. Several devices such as the electrolarynx and the tracheo-esophageal valve prosthesis (without oscillation) have been commercialized in order to restore speech. However, such voice restoration prosthesis are still limited for certain patients. The development of a new device using a valve of variable resistance entrained by a linear electromechanical transducer was investigated as a way to produce speech for patients with total laryngectomy (ablation of vocal folds). The concept was to undertake the design of a varying air flow resistance valve, built around existing Blom-Singer valves. The oscillating valve features a spherical head making it possible to block the opening in the wall between the trachea and the esophagus in a sinusoidal periodic fashion. A physical model of the vocal tract was built and used for preliminary in-vitro verification studies. The relationship between pressure and flow rate through the valve was determined from pressure measurements. The orifice discharge coefficient of the orifice was then calculated and the parameters of a variable resistor model were identified. Radiated sound pressure produced from the change in flow rate at the valve orifice was then compared to the original voice output to assess the accuracy of the design prototype. Results showed that the forced oscillating valve prosthesis model has lower power efficiency but can produce better sound quality than the electrolarynx.

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A total laryngectomy (TL) affects the quality of life (QoL) of individuals who have undergone this surgical procedure, as changes are seen in respiration, swallowing and communication. The aim of this study was to gather perspectives of the hallmarks of successful alaryngeal voice rehabilitation by tracheo-esophageal puncture (TEP) with voice prosthesis of laryngectomy patients from key role players based at a public hospital in Gauteng Province, South Africa. A qualitative method of inquiry was used, namely a single-program, collective case study. A focus group, comprising of four individuals who had undergone a total laryngectomy, was held to identify the participants‟ views about successful voice rehabilitation. From this focus group, one successful communicator was identified to be interviewed individually. Five semi-structured, face-to-face individual interviews using open-ended questions were conducted with five key role players in alaryngeal voice rehabilitation. The interviewees comprised of the successfully rehabilitated person with total laryngectomy (PWTL), his caregiver, an ear, nose and throat surgeon, speech-language pathologist and specialist nurse, to gather their perspectives on the factors that contributed to successful alaryngeal voice rehabilitation using TES. The Thematic Framework Approach was used to qualitatively analyze the data. Factors identified as contributing to success included patient selection for tracheo-esophageal puncture, information provision, support in the form of support groups, spiritual as well as family support, stomal care, the skill of the team and key management issues. Issues related to finance adversely affect the provision of voice prostheses and/or the provision of correctly sized prostheses and accessories. Systems have been implemented at the hospital to provide the option of TEP with voice prosthesis without much consideration to the other two alaryngeal options; namely esophageal speech and electrolarynx speech. Implications for clinical practice have been identified especially the need to provide more social support services to persons with TL. / Thesis (M.Sc.)-University of KwaZulu-Natal, Westville, 2012.

Made available in DSpace on 2016-04-27T18:11:59Z (GMT). No. of bitstreams: 1 Priscila Rodrigues Prado Prado Zagari.pdf: 1492484 bytes, checksum: 2b44c673b0beaa58cf017f67ea182c25 (MD5) Previous issue date: 2013-02-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: changes in vocal quality can bring impact on quality of life of an individual undergoing the treatment of advanced larynx cancer. Objective: Analyze the impact of rehabilitation methods of oral communication in laryngectomized, regarding the impact of voice on the quality of life and vocal handicap. Methods: cross-sectional study-exploratory carried out in patients with malignant neoplasms of the larynx, in advanced stages III and IV, and submitted to the major surgeries in the period of six months, after surgical treatment. The selection was performed between the months of May and September 2011, and the final 40 male subjects, which comprised the sample, answered two protocols: Quality of Life in Voice (V-RQOL) and Voice Handicap Index (VHI). The descriptive statistical analysis revealed the absolute and relative frequencies of socio-demographic aspects, and to check adherence to the normal curve of the indices was used the test Kolmogov-Smirnov, for the difference in rates between the different groups of rehabilitation (tracheoesophageal prostheses, electronic larynx and esophageal voice), the Kruskal-Wallis test and for the difference between these groups, post hoc Dum test. For all analyzes was assumed a descriptive level of 5% (p<0.05) for statistical significance. Results: recorded total values higher in answers to the QVV (82.9) and lower in IDV (24.8) of the patients rehabilitated with tracheoesophageal prostheses when compared to those who make use of electronic larynx (V-RQOL= 73.6 and IDV = 32.1) or esophageal voice (V-RQOL= 55.4 and IDV = 46.4). In the comparison between the groups for the indices of the QVV total score and the Socioemotional Domain registered a significant difference (p=0.027 and p=0.006) as well as the total score and the functional of the IDV (respectively, p=0.049 and p=0.012). Conclusion: the rehabilitation of laryngectomees totals with tracheoesophageal prostheses, according to the patients themselves had more positively on the quality of life with smaller vocal disadvantage, when compared to rehabilitation with electronic larynx and finally with esophageal voice / Introdução: mudanças na qualidade vocal podem trazer impacto na qualidade de vida de um indivíduo submetido a tratamento de câncer avançado de laringe. Objetivo: Analisar a repercussão dos métodos de reabilitação de comunicação oral em laringectomizados totais, quanto ao impacto da voz na qualidade de vida e desvantagem vocal. Métodos: estudo transversal-exploratório realizado com pacientes com neoplasias malignas de laringe, em estádios avançados III e IV, submetidos às cirurgias de grande porte no período de seis meses, após tratamento cirúrgico. A seleção foi realizada entre os meses de maio e setembro de 2011, e ao final 40 sujeitos do sexo masculino, que compuseram a amostra, responderam dois questionários: Questionário de Qualidade de Vida em Voz (QVV) e Índice de desvantagem Vocal (IDV). A análise estatística descritiva evidenciou as freqüências absolutas e relativas dos aspectos sócio-demográficos, e para verificar a aderência a curva normal dos índices foi utilizado o teste Kolmogov- Smirnov, para a diferença dos índices entre os diferentes grupos de reabilitação (prótese traqueoesofágica, laringe eletrônica e voz esofágica), o teste Kruskal-Wallis e para diferença entre esses grupos, teste post hoc Dum. Para todas as análises foi assumido um nível descritivo de 5% (p<0,05) para a significância estatística. Resultados: foram registrados valores totais maiores nas respostas ao QVV (82,9) e menores no IDV (24,8) dos pacientes reabilitados com prótese traqueoesofágica, quando comparados aos que fazem uso de laringe eletrônica (QVV= 73,6 e IDV = 32,1) ou voz esofágica (QVV= 55,4 e IDV = 46,4). Na comparação entre os grupos para os índices de QVV o escore Total e o Sócio-Emocional registraram diferença significativa (respectivamente p=0,027 e p=0,006) assim como o escore Total e o Funcional do IDV (respectivamente p=0,049 e p=0,012). Conclusão: a reabilitação do laringectomizados totais com prótese traqueoesofágica, segundo autorreferência dos pacientes repercutiu de forma mais positiva na qualidade de vida, com menor desvantagem vocal quando comparada a reabilitação com laringe eletrônica e por último com voz esofágica