speech rehabilitation after near total laryngectomy
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Speech Rehabilitation After Near Total LaryngectomyTRANSCRIPT
Speech rehabilitation after
near total laryngectomy
KUNNAMPALLIL GEJO JOHN,
BASLP,MASLP
AUDIOLOGIST
KUNNAMPALLIL GEJO JOHN,
““First duty of a man is to First duty of a man is to
speak that is his chief speak that is his chief
business in this world”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,
Speech therapy after NTL
when?
3-4 days after removal of NG
tube
After medical line of treatment
completes
KUNNAMPALLIL GEJO JOHN,
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,
NTL Therapy procedure
Counseling
Therapist make an attempt
Finger to stoma coordination
Proper valving
Inhalation-occlusion of stoma-
exhalation & 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,
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
Severe ------ Pulmonary complication
Total laryngectomy
Moderate ------Aspiration of liquid
frequently
Manageable with anti-
aspiration methods
Minimal----- Detected occasionally
Transient
KUNNAMPALLIL GEJO JOHN,
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,