Laryngectomy and Tracheoesophageal Puncture - Research Paper Example

?Running Head: Laryngectomy Laryngectomy [Institute’s Laryngectomy Laryngeal Cancer In laryngeal cancer, malignant cells develop on the tissues of the larynx. Two bands of muscles within the middle of the larynx - known as the vocal cords - help humans in making any sound. The front portion of the larynx is defended by thyroid cartilage, which a coating of hard, flexible tissue. Laryngeal cancer can begin anywhere within the larynx, but it often starts from the middle part of the larynx, having the vocal cords. Cancers that develop beneath the vocal cords are not very common. There is “no single reason of laryngeal cancer; however, a number of factors raise the risk of having it. The majority of individuals identified with laryngeal cancer are more than 50 years of age” (Mary et al, 2010). Males are more prone to be diagnosed with this cancer as compared to females. Other causes that seem to raise the risk of laryngeal cancer include (1) smoking, (2) heavy drinking, (3) staying at a place having sulphuric acid mist for long hours, and (4) asbestos exposure. Not making an adequate amount of vegetables as well as fruits a part of regular diet and having a family account of cancer are being identifies as other likely risk factors that may raise an individual’s likelihood of having laryngeal cancer. On the other hand, a number of individuals suffer from laryngeal cancer without any of the aforementioned risk factors. Radiation therapy via external beam is the frequently used cure for laryngeal cancer. An apparatus is utilized to cautiously target a beam of radiation on the tumor. The radiation harms the cells that are present within the range of the beam - both normal cells along with cancer cells. Tumors, that are small, may be treated by using radiation only. For larger tumors, external radiation is regularly applied accompanied by chemotherapy. A person can have a custom-made mask before radiation treatment. This custom-made mask is worn during the treatment procedure as well as during every radiation session. The mask ensures that the person is in the precisely similar position for all sessions and assists in keeping the head as well as neck from moving throughout treatment. For large tumors as well as for tumors that are spread to the lymph nodes, chemotherapy is most frequently applied with radiation treatment. Chemotherapy treatments obstruct the capability of cancer cells to develop and multiply; however, they as well harm healthy cells. Even though healthy cells can recuperate after a while, a person may face some side effects from the treatment such as vomiting, nausea, loss of hunger, exhaustion, hair loss as well as an increased threat of infection. Decision of surgery relies on the size of the tumor as well as its location. During the surgery, all or part of the tumor along with a few healthy tissues in the region of the tumor are eradicated. Surgery is carried out with general anesthetic and after that person may have some hurting or lethargy. However, these side effects are momentary, and can be taken care of (Mary et al, 2010). A surgery to eradicate all or part of the larynx is known as laryngectomy. Sometimes it is also become necessary to remove the lymph nodes in the neck and / or thyroid gland. For partial laryngectomy, the doctor eradicates the portion of the larynx having the tumor. Normally, one or both of the vocal cords are left untouched in so the person can talk; however, the voice may be different as compared to what it was before the surgery. For a complete laryngectomy, the entire larynx is removed. A tracheostomy is carried out simultaneously to make a cavity within the lower portion of the neck for the patient to respire through (Evans et al, 2009). Another option, laser surgery applies a strong and thin ray of light to eradicate cancerous tissue with slight or no harm to adjacent healthy tissue. It is mostly carried out with general anesthetic and may be applied for somewhat small laryngeal tumors. Role of Speech-Language Pathologist (SLP) The SLP will see the patient as well as the family before surgical procedure. The SLP will assess issues such as vocal excellence, range of pitch, and existence or nonexistence of pronunciation or local speech distinctions. This assessment lets the SLP to recognize the patient’s speech as well as voice capabilities (Stajner-Katusic, 2006). This knowledge facilitates the SLP to arrange the cure following surgical treatment. The SLP will as well clarify the anatomy and physiology of the larynx, and the way surgical procedure will alter this, and give know-how about what will be done within the ICU soon after the surgical treatment. The patient will not be able to talk once the larynx is removed. The SLP will give a writing device for communicating essential requirements to nurses, physicians, relatives, and acquaintances soon after the surgical procedure. Following the surgery, the SLP's most important objective is to give the patient a new source of sound for speech, and for this, there are three major alternatives: 1. Artificial Larynx, 2. Esophageal Speech, and 3. Tracheoesophageal Puncture (TEP) Artificial Larynx The patient utilizes an ‘electronic’ or ‘mechanical’ device that acts as the source of sound for verbal communication. A number of such devices are placed against the neck, and others include a cylinder that the person has to put in his/her mouth. A number of patients use an artificial larynx as their primary way of alaryngeal talking. Effectual use still needs guidance as well as practice (Bohnen et al, 2010). Intraoral machines are used for those who are unable to get sufficient sound transmission on the skin. A little tube is inserted toward the posterior vocal cavity, and the created voice is then expressed. The tube has negligible consequence on articulatory precision if the person is trained correctly and known how to use it properly. Another form of electrolarynx has been created by means of an electromyograph (EMG) transducer within the strap muscles to stimulate a source of sound for hands-free usage (Goldstein et al, 2007). Its positive aspect is that voice return following the surgical treatment is instant, and the maintenance for the electrolarynx is very nominal. Its negative aspect is the mechanical sound, needs the one hand to use, and becomes the source of drawing attention to the user. Esophageal Speech Esophageal speech is a form of verbal communication in which the vocal cords are not utilized. As an alternative, gas is discharged via the esophagus - in a way that is slightly similar to burping - to generate verbal communication. The esophagus role in esophageal speech is almost similar to the vocal cords during laryngeal speech, vacillating swiftly to generate different speech sounds. The patient inhales air via the mouth, keeps it in the throat, and after that exhales it. As the air is discharged, it makes the upper portion of the throat or esophagus quiver and generates voice that is transformed into words in the similar manner as it was earlier than surgical procedure: by means of the mouth parts. This kind of alaryngeal communication is complicated to be taught and use efficiently, particularly in quick or demanding communication conditions. The two fundamental approaches to esophageal insufflations are insertion and inhalation. Both methods are supported by the pressure discrepancy standard that air flows from regions of higher pressure towards regions of lesser pressure. Insertion entails utilizing the articulators to enhance oropharyngeal air pressure, which, consecutively, dominates the sphincter pressure of the PE section, and in this ay insufflating the esophagus. Inhalation entails lessening thoracic air pressure lower than environmental air pressure via quickly inflating the thorax so air insufflates the esophagus. Expertise in esophageal communication usually needs quite extensive speech therapy. Communicating in this manner needs a lot more effort as compared to other methods, and speakers must talk at a rather slower pace than individuals speaking via their larynx. Speech rates for well-taught esophageal speakers are 80 to 120 words per minute, as contrasting to more or less 120 to 200 words per minute for laryngeal speakers. A large number of individuals that go through a laryngectomy prefer to start with esophageal vocalizations and point their way to by means of a prosthetic insertion for rather convenient communication. Esophageal speech requires a lot of time to properly master, and several patients rely on the electrolarynx straight away following a surgery to continue talking instantaneously, without having to learn to completely manage their esophageal vocalizations (Espy-Wilson et al, 1998). The positive aspect is that no device has to be bought or maintained, and no additional surgical procedure is necessary. The negative aspect is that speech attainment is postponed due to the learning curve, and problems with terminology as well as decibels are feasible. Tracheoesophageal Puncture (TEP) This operation is among the mostly used methods of alaryngeal speech generation. It can be carries out at the time of the laryngectomy surgical treatment or afterwards. The surgeon forms a link between the trachea and the esophagus by a tiny opening. A little, one-way shunt device is then placed within this opening. To talk, the patient breathes in air via the hole and into the lungs. Afterwards, he/she covers the hole with a finger. Air from the lungs is moved from the trachea, via the shunt device, and into the throat. The throat vibrates, producing a sound source for vocalizations. This sound is then changed into words within the mouth in the similar manner it was done earlier than laryngectomy. The SLP will help the person in choosing as well as fitting the prosthesis and tell about appropriate care and use. During the final assessment, a speech pathologist evaluates the extent of the deflate tract and chooses a size as well as style of prosthesis for insertion. Once inserted, the person digitally occludes the tracheostoma ‘to direct air through the prosthesis into the esophagus for phonation. Hands-free external airflow valves are also available as accessories’ (Ng & Wong, 2009). The positive aspect is that air supply for vocalizations is pulmonary, phonation seems normal, and voice return takes place in less than two weeks after surgical treatment. Negative aspect is that another surgical procedure is necessary for minor punctures, the prosthesis should be retained, and aspiration may take place if liquids seep out by a broken valve. Moreover, every person cannot do TE vocalizations. In some instances, the walls of the esophagus are very rigid to permit way of air. In these cases, when person breathes out and covers the hole, air just cannot escape. It is similar as if one is attempting to gust against a sealed pipe. There is an assessment that a speech pathologist can perform earlier than the insertion of a TE fistula to check if the esophagus can put up with TE vocalizations. Another problem is that the hole should be firmly covered at the time of breathing out in order for air to go into the esophagus. This asks for swift arm as well as hand movement, and this may become tricky following a spinal cord hurt. There are regulators that can be put on the hole that divert air within the esophagus; however, they do not function at all times. Another issue that is faced by a number of patients is that the prosthesis can come out and the opening will seal over with 24 hours. In this case, a second surgery has to be done so a new hole can be formed. References Bohnen, T. A., Stowell, T. H., Wright, S. (2010). ‘Speech breathing in speakers who use an electrolarynx.’ Journal of Communication Disorders. Volume 43, pp. 199-211. Espy-Wilson, C. Y., Chari, V. R., MacAuslan, J. M., Huang, C. B. and Walsh, M. J. (1998). ‘Enhancement of electrolaryngeal speech by adaptive filtering.’ Journal of Speech, Language, and Hearing Research. Volume 41, Issue 6, pp. 1253-1264. Evans, E., Carding, P. and Drinnan, M. (2009). ‘The Voice Handicap Index with post-laryngectomy male voices.’ International Journal of Language & Communication Disorders. Volume 44, Issue 5, pp. 575-586. Goldstein, Ehab A. H., James, T. S., Cara, E. and Hillman, R. E. (2007). ‘Training Effects on Speech Production Using a Hands-Free Electromyographically Controlled Electrolarynx,’ Journal of Speech, Language, and Hearing Research. Volume 50, Issue 2, pp. 335-351. Lee, M. T., Gibson, S. and Hilari, K. (2010). ‘Gender differences in health-related quality of life following total laryngectomy.’ International Journal of Language & Communication Disorders. Volume 45, Issue 4, pp. 287-294. Ng, M. L. and Wong, J. (2009). ‘Voice Onset Time Characteristics of Esophageal, Tracheoesophageal, and Laryngeal Speech of Cantonese.’ Journal of Speech, Language, and Hearing Research. Volume 52, Issue 3, pp. 780-789. Stajner-Katusic, S., Horga, D., Musura, M. and Globlek, D. (2006). ‘Voice and speech after laryngectomy.’ Clinical Linguistics & Phonetics. Volume 20, Issue 2/3, pp. 195-203. Read More