laryngectomy – surgical and slt perspectives
DESCRIPTION
Mr Hartley SRH Mr O’Hara SRH Mr Ragbir RVI. Lynn Bolden SRH/FH Sarah Owen FH. Laryngectomy – surgical and SLT perspectives. Programme. Options and selection Swallowing problems Valve complications Quiz. History of speech rehabilitation in laryngectomy. Oesophageal voice - PowerPoint PPT PresentationTRANSCRIPT
Laryngectomy – surgical and SLT perspectives
• Mr Hartley SRH• Mr O’Hara SRH• Mr Ragbir RVI
• Lynn Bolden SRH/FH• Sarah Owen FH
Programme
• Options and selection
• Swallowing problems
• Valve complications
• Quiz
History of speech rehabilitation in laryngectomy
• Oesophageal voice
• 1932: Ice pick
• Electro-larynx
• 1980 Secondary SVR
• 1985 Primary SVR
• 2011…..
Surgical and SLT perspectives:
• Communication options – Characteristics, advantages and
disadvantages
• Selection– Surgical/medical/non-surgical/outcome/
evidence
• Measuring outcomes
Electrolarynx Oesophageal voice
Surgical voice restoration (SVR)
Production of voice
Requirement Laryngeal voice SVR OV
Initiator
power
Lungs Lungs Oesophageal air from oro-phayrnx
Vibrator
Sound
Vocal cords PE segment PE segment
Resonator
Quality
Vocal tract Vocal tract Vocal tract
Articulators
Speech
Tongue, teeth
palate
Tongue, teeth
palate
Tongue, teeth
palate
Impact of altered speech
• Verbal – Basic or complex information, telephone, social
exchanges• Non verbal expression
– Power, superiority, trust, seduction, vulnerable, encouragement etc
• Emotional expression– Joy, fear, sadness, anger
• Physical changes– Effort, fatigue, breathing, volume, pitch, intonation– Inconsistent and unreliable (E.L. ex)
Cont.
• Vocal Image– Gender, culture, intelligence, class, personality: kind, warm..
• Reactions from others– Deaf, low intelligence– Left out, avoided – Adverse attention or comments – misunderstandings
• Environmental/situational limitations– Noisy or smoky environments– Telephone– Meal times– Group situations
Communication options and voice characteristics. Exercise 1
• Use exercise 1 sheet to rate/describe voices
• Recordings
• E1, M Scar, OV, MDay
• Next slide valve
• DVD TW
• Then… WLvs D Wil, JMc, N Murph, Len
Communication options - selection
• Exercise 2
• Divide into 3 groups
• Mixture of Senior and junior SpRs
Summary of surgical and SLT considerations/literature
“Primary SVR should be offered to all patients undergoing laryngectomy” (H & N guidelines ‘11)
• Discuss…
Swallowing in laryngectomy
• Swallowing problems and outcomes
• ENT and plastic’s perspectives
• Assessment and management
Exercise 3
• Swallowing is the main concern for your patient. He is making the decision about whether to have treatment, or which treatment option to have, based on the information you give.
• Describe the short and long term swallowing outcomes for your patient. Explain the sorts of problems he may encounter and any future assessments or treatments that may be required.
Clinical presentation
• Increased effort & time to eat• Sticking• Limited consistencies• Weight loss• Regurgitation – nasal/oral• Bloating/belching• Voice and valve problems• Other – upper/lower GI…
ENT perspective
Plastic’s perspective
Assessments
• Which assessment when?– Comprehensive history - may have been
assessed extensively!– EUA– TNO– Ba Swallow/Videofluoroscopy/combined– Other imaging – Valve assessment– Other
Case recordings/images
• Normal swallow, Jej, ALT, pseudo-epiglottis, stricture, multiple problems
• Surgical management
• Other: SLT, lymphoedema, nutrition, psychology/support groups
Which outcomes should we measure?
• Discuss
Outcome measurements
• Multi-perspective– Patient: voice/swallow
related QOL– Voice: quality– Intelligibility – Valve complications– Cost– Dietary intake– WST
• Longitudinal
• Comparison with other methods – Do patients adapt what ever their communication method?
• Primary Vs secondary
What outcomes should we measure?
Multi-perspectivePrimary Vs Secondary SVR???Validated/ratings of voice and swallow function• SRH rating scale• Intelligibility? % use by patient? • Normalcy of diet, WST
Validated questionnaires of patient’s perceptionValve complicationsValve costEnteral feeding