Speech rehabilitation after near total laryngectomy
KUNNAMPALLIL GEJO JOHN, BASLP,MASLP AUDIOLOGIST
KUNNAMPALLIL GEJO JOHN,
First duty of a man is to speak that is his chief business in this world
KUNNAMPALLIL GEJO JOHN,
Role of speech therapist
-
Important member of the team in head and neck cancer rehabilitation
- Not just speech rehabilitation but involved in total rehabilitation
KUNNAMPALLIL GEJO JOHN,
Speech restorative surgery-goal
Speech
and swallowing sans aspiration Swallowing sans dysphagia
KUNNAMPALLIL GEJO JOHN,
What is near total laryngectomy? (NTL)
Is a surgical procedure where in part of the larynx preserved
Total laryngectomy Near total laryngectomy
Partial laryngectomy
KUNNAMPALLIL GEJO JOHN,
Near total laryngectomy
Surgical intervention to preserve the part of the function of the larynx Between the partial laryngectomy and total laryngectomy Like total laryngectomy-speech is preserved Like partial laryngectomy-nasal breathing is sacrificed
KUNNAMPALLIL GEJO JOHN,
Total laryngectomy
Nasal
breathing sacrificed Permanent stoma Verbal communication is lost
KUNNAMPALLIL GEJO JOHN,
Partial laryngectomy
Nasal
breathing is preserved Verbal communication is present Temporary tracheostoma Stoma will be in situ for only few days
KUNNAMPALLIL GEJO JOHN,
Near total laryngectomy
Nasal breathing is sacrificed Verbal communication is preserved Permanent stoma Patient can speak with preserved larynx
KUNNAMPALLIL GEJO JOHN,
How does speech produced after NTL?
Myomucosal
shunt At the tine of surgery part of the larynx is preserved Preserved larynx - one vocal cord, one arytenoid, one false vocal cord,
KUNNAMPALLIL GEJO JOHN,
NTL(Tracheo pharyngeal shunt speech)
Lung powered speech Left over larynx serves as vibrator Temporal and acoustic parameters are far superior to esophageal speech
KUNNAMPALLIL GEJO JOHN,
Diagrammatic representation of NTL speech
KUNNAMPALLIL GEJO JOHN,
Shunt from trachea to pharynx
KUNNAMPALLIL GEJO JOHN,
Speech therapy after NTL
when?
days after removal of NG tube After medical line of treatment completes
KUNNAMPALLIL GEJO JOHN,
3-4
Speech rehabilitation technique
Start Rx after swallowing tolerated Breathing and relaxation exercises Occlusion of stoma with clean hand and finger Visual feed back for proper occlusion of stoma
KUNNAMPALLIL GEJO JOHN,
Speech therapy schedule-NTL How ?
30-40
min/session Individual therapy Group therapy Resume sentence level before initiation of post operative RT
KUNNAMPALLIL GEJO JOHN,
How do we proceed?
Good posture Relaxing exercises for head and neck area Normal inhalation Closing of the stoma Phonation Words beginning with a vowel and sentences Refinement of speech
KUNNAMPALLIL GEJO JOHN,
Inhalation --occlusion of stoma+ exhalation and production of voice
KUNNAMPALLIL GEJO JOHN,
Patient in conversation
KUNNAMPALLIL GEJO JOHN,
Near total laryngectomy speech
KUNNAMPALLIL GEJO JOHN,
KUNNAMPALLIL GEJO JOHN,
NTL Therapy procedure
Counseling
Therapist make an attempt
Finger to stoma coordination
Proper valving
Inhalation-occlusion of stomaexhalation & articulation
KUNNAMPALLIL GEJO JOHN,
Factors to keep in mind
Patient should be motivated Pulmonary reservoir should be sufficient Stoma should not be narrow
KUNNAMPALLIL GEJO JOHN,
Finger to stoma coordination
Not
too much pressure -Strained voice Not too little - Air escape from the stoma Not closing the mouth of the shunt at the tracheal level - air will not pass through shunt
KUNNAMPALLIL GEJO JOHN,
Digital occulusion of stoma
KUNNAMPALLIL GEJO JOHN,
Problem one can face -NTL
Severe
cough Short neck Improper closure of stoma Lack of motivation Vaso vagal irritation Inability to understand instruction Short of breath
KUNNAMPALLIL GEJO JOHN,
Aspiration in NTL cases
Pulmonary complication Total laryngectomy Moderate ------Aspiration of liquid frequently Manageable with antiaspiration methods Minimal----Detected occasionally Transient
KUNNAMPALLIL GEJO JOHN,
Severe ------
How to prevent aspiration
Cuffed tracheostomy tube Use of digital pressure over the tip of the shunt Use of Dan Kelly pressure band Sensory and motor innervations of one of the arytenoid should be intact Shunt should not be too wide
KUNNAMPALLIL GEJO JOHN,
NTL Speech Achievement Kidwai Study
Laryngeal lesion n= 70 Hypopharyngeal lesion n=112
KUNNAMPALLIL GEJO JOHN,
NTL speakers speech proficiency
Larynx n=70 Excellent=13 Good =25 Satisfactory =9 Poor = 23 Hypopharynx n=112 Excellent = 22 Good = 30 Satisfactory =26 Poor =35
KUNNAMPALLIL GEJO JOHN,
If all my possessions were taken away from me, I would like to keep the power of speech, so that I would soon regain the rest Daniel Webster
KUNNAMPALLIL GEJO JOHN,
Thank you
KUNNAMPALLIL GEJO JOHN,
