Research shows that an important component to successful adjustment and improved quality of life following a laryngectomy is comprehensive preoperative counseling. However, evidence indicates that preoperative counseling in its current form is inadequate. Additionally, due to a small percentage of speech language pathologists having clinical experience working with this population, SLPs may be unsure of what to include in counseling sessions if presented with a laryngectomee. This report serves as a guide to assist SLPs in preoperative counseling sessions. It contains information regarding laryngeal cancer, treatment options, alaryngeal speech options, and additional postoperative considerations to include in preoperative counseling. Illustrations and tables are included within the report so that the practicing clinician has access to user-friendly information to provide to his or her patients. By spending extra time consulting with the patient and his or her family during the preoperative sessions, the SLP can make a vast difference in the patient’s overall quality of life after surgery. / text

MMed (Otorhinolargngology). Faculty of Health Sciences, University of the Witwatersrand / Introduction The bulk of the surgical literature about laryngeal cancer is concerned with cure rates or five-year survival rates. While this is important, the five year survival rate is only one measure of success of laryngeal cancer surgery. Whereas, postoperative morbidity and mortality are also very important. Pharyngocutaneous fistula (PCF) is the most frequent complication in the early post operative period after total laryngectomy. It creates a communication between the pharynx and the cervical skin or less frequently with the stoma of the tracheostomy. The pharyngeal contents, usually saliva, flow through the fistula emerging from the cutaneous orifice. This study aims to determine the incidence and the predisposing factors for the development of pharyngocutaneous fistula (PCF); and to review the management and outcome of such cases following total laryngectomy at Ear, Nose and Throat (ENT) department, Chris Hani Baragwanath Hospital. Patients and methods This is a retrospective study. The medical records of 30 patients who underwent total laryngectomy surgery for squamous cell carcinoma of the larynx with no local neck metastases between June 2000 and May 2008 were assessed. iii All patients had similar (standard) preoperative and post operative care. I studied a number of factors that could influence pharyngocutaneous fistula formation such as age, smoking habit, alcohol consumption, tumour stage, preoperative tracheostomy, preoperative hemoglobin and associated systemic diseases (gastroesophageal reflux, chronic obstructive pulmonary disease, systemic high blood pressure and diabetes mellitus) Results Pharyngocutaneous fistula appeared in 20% (6/30 patients). Spontaneous closure with local wound care was noted in 5 patients (83.3%), whereas a surgical closure was necessary in one patient . Conclusion The results of our study concluded that pharyngocutaneous fistula remains a troublesome complication of the early post-operative period after total laryngectomy. There are many conflicting reports in the literature concerning the pharyngoctaneuos fistula predisposing factors, but our study data (table 1 page 22) of age, smoking habit, alcohol consumption, tumor stage, preoperative tracheostomy, preoperative hemoglobin and associated systemic diseases( gastroesophageal reflux, chronic pulmonary obstructive disease, systemic high blood pressure and diabetes mellitus) did not show any significant value. Our experience confirmed that most pharyngocutaneous fistulas can be successfully treated conservatively.

Thesis (M. Phil.)--University of Hong Kong, 2005.

This dissertation is submitted as a final copy as the University’s Academic and Clinical supervisor / Background Thyroid gland involvement in advanced laryngeal malignancies is a rare entity, mostly resulting from direct contiguous spread from anterior and inferior tumours. Reported practice is to perform a hemithyroidectomy at the time of laryngectomy. However, this results in pointless excision of functional tissue and the added morbidity of hypothyroidism post operatively. Aim The aim of this study is twofold: firstly, to assess the frequency of thyroid gland involvement in laryngectomy specimens from Chris Hani Baragwanath Hospital, and secondly, to determine any association between the anatomical subsites of tumour and thyroid gland involvement. Methods This is a retrospective clinical audit of histological reports on laryngectomy specimens collected over a 10 year period from January 2005 and December 2014. The study was conducted at Chris Hani Baragwanath Hospital, affiliated to the University of the Witwatersrand, in South Africa. ENT operating registries and the laboratory database were used to access all records of total laryngectomies done over the 10 year period. Seventy-three laryngectomies were done, 9 were excluded as no thyroid tissue was included in the sample and 1 was excluded due to inadequate demographic detail. Thus a total of 63 histological reports were included in the study. Data extracted included age, race, sex, pathological stage of tumour, thyroid gland involvement and anatomical subsites involved by tumour (subglottis, anterior commissure and transglottic tumours). Data was analysed using standard statistical methods including a Fischer-exact test and an ANOVA association test. Statistica software was used. Results Four of the 63 cases had thyroid gland involvement (6.35%). The majority of the patients were black males in the age group 50 to 60 years of age. The tumours were all advanced laryngeal malignancies and only 2 of the 63 cases were found to have a diagnosis of adenosquamous carcinoma and chondrosarcoma. None of the anatomical subsites were found to be statistically significant in association with thyroid gland involvement, however, this result was thought to be skewed due to the small number of tumours involving the thyroid gland. Conclusion In accordance with South African and international studies on the same topic, thyroid gland involvement in laryngeal tumours is a rare occurrence. Due to the complications of performing a thyroidectomy and the hypothyroidism that accompanies it, a thyroidectomy should not always be performed. However, due to the recurrence rates and poor prognosis of patients with stomal recurrence (associated with thyroid gland involvement), thyroidectomy still needs to be considered. Based on known anatomical pathways of extralaryngeal spread of tumours via the anterior commissure, paraglottic spaces and those tumours involving the subglottis, selected patients require thyroidectomy at the time of laryngectomy to achieve adequate oncological margins. / MT2017

published_or_final_version / Speech and Hearing Sciences / Master / Master of Philosophy

No / Objective : To describe the common themes in the experiences and expressed information needs of patients undergoing head and neck surgery. Summary background data : Patients who suffer head and neck cancers and undergo surgery often report considerable psychological distress and impaired social functioning. To optimise survival, the decision about what treatment option to follow is often made quickly, with little support in terms of counselling or the provision of information. There is inadequate previous work exploring the content and delivery of information required by patients at this time. Patients and Methods : Participants included patients who had undergone surgery for head or neck cancer (n = 29) and their immediate relatives who were present at the initial consultation with the surgeon (n = 13). Patients were recruited from out-patient departments in two hospitals in the north of England. All interviews were conducted in participants' homes and were guided by a semistructured interview schedule devised both from literature and a pilot study. Results : Whilst most participants felt well informed about the surgical procedure they were undergoing, many reported feeling unprepared for the long-term lifestyle changes that occurred. Information, support and advice throughout the 3-6 months postoperative period was reported to be inadequate. The majority of participants did not ask any questions and did not perceive there was a choice regarding treatment. Individuals who wanted to take an active role in decisionmaking reported difficulties accessing information to enable them to do so. Conclusion : The findings of this study emphasise the need for individualised information provision defined not exclusively by the surgical procedure.

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.

No description available.

No description available.

O sucesso do tratamento cirúrgico no câncer de laringe não pode apenas dar atenção à taxa de sobrevida, está também relacionado com a rápida reabilitação da voz e da fala. Para compreender como as estruturas do trato digestivo participam da produção do som traqueoesofágico, a pressão aérea e o limiar de pressão fonatória podem ser utilizados como método de análise nos pacientes com vozes traqueoesofágica. O objetivo desse estudo foi comparar as medidas aerodinâmicas em laringectomizados totais falantes com prótese traqueoesofágica com indivíduos laríngeos. O estudo incluiu a análise de dois grupos, sendo o grupo de estudo (GE) composto por 28 indivíduos que se submeteram a laringectomia total e que optaram pela reabilitação da voz alaríngea por meio da prótese traqueoesofágica e o outro grupo, denominado grupo controle (GC), composto por 32 indivíduos laríngeos saudáveis. Ambos os grupos foram submetidos à avaliação das medidas aerodinâmicas, por meio do Sistema Aerodinâmico Fonatório (SAF) Modelo 6600 (Kaypentax®). Os resultados foram apresentados de forma descritiva e, posteriormente, foram realizadas as comparações entre os grupos (estudo e controle) com o teste t de student para amostras independentes. Foram apresentadas as diferenças estimadas da comparação entre o grupo estudo e o grupo controle com seus respectivos valores p e intervalos de confiança (95%). Para a comparação entre os grupos e as faixas etárias (40 a 59 anos e 60 a 89 anos) foi utilizado um modelo de regressão linear. Os resultados encontrados revelaram diferenças estatisticamente significantes em algumas medidas dos protocolos do Sistema Aerodinâmico Fonatório (SAF). Foi constatada a possibilidade de utilizar o Sistema Aerodinâmico Fonatório (SAF) para auxiliar e aprimorar a produção da voz traqueoesofágica. Todavia, ressalta-se a importância de realizar mais estudos utilizando o aparelho para obter conclusões mais específicas. / Abstract here. The success of surgical treatment in laryngeal cancer can not only pay attention to the survival rate, it is also related to the rapid rehabilitation of voice and speech. To understand how the structures of the digestive tract participate in the production of tracheoesophageal sound, air pressure and the phonatory pressure threshold can be used as a method of analysis in patients with tracheoesophageal voices. The aim of this study was to compare the aerodynamic measurements in total laryngectomized speakers with tracheoesophageal prosthesis with laryngeal individuals. The study included the analysis of two groups, the study group (ES) composed of 28 individuals who underwent total laryngectomy and who opted for the rehabilitation of the alaringeal voice through the tracheoesophageal prosthesis and the other group, called the control group GC), composed of 32 healthy laryngeal individuals. Both groups were submitted to aerodynamic measurements, using the Model 6600 - Spin Aerodynamic System (SAF) (Kaypentax®). The results were presented in a descriptive way and, afterwards, comparisons between the groups (study and control) were carried out with the student t test for independent samples. We presented the estimated differences between the study group and the control group, with their respective p values and confidence intervals (95%). A linear regression model was used to compare the groups and the age groups (40 to 59 years and 60 to 89 years). The results found revealed statistically significant differences for some measures of the Aerodynamic Phonatory System (SAF) protocols. It was verified the possibility of using the Fonody Aerodynamic System (SAF) to aid and improve the production of the tracheoesophageal voice. However, it is important to carry out more studies using the device to obtain more specific conclusions.