Voice Resonance Week 6: Carcinoma of the Larynx and Voice After Laryngectomy

What are the causes of a carcinoma of the larynx?

1. Heavy smoking/drinking 

2. Poor eating habits

3. Weakened immune system 

4. Acid reflux 

5. Exposure to chemicals 

What are the mass signs of a carcinoma?

Hoarseness, dysphagia, neck mass, difficulty breathing (compromised airway), aspiration.

What does throat and ear pain indicate?

Suggests advanced stage carcinoma (CN X)

Supraglottic Carcinoma

Tends to present later 

What are the classifications of a carcinoma?

TNM: Tumor, (Lympth) Node, Metastasis (size/sight of tumor) 

Where can a carcinoma appear?

Supraglottic, Glottic, Subglottic

What are the treatment options for a carcinoma? 

Chemo, radiation, surgical removal of larynx or parts of larynx (risk of spread would be smaller). 

What is the role of an SLP in carcinoma treatment?

1. Pre-operative counseling

2. Explain what will happen (use images)

3. Explain effects on voice/swallowing

4. Possible complications with respect to speech/swallowing

What are the different voice options after a laryngectomy?

1. Esophageal Speech

2. Tracheo-Esophageal Speech

3. Electrolarynx

Esophageal Speech 

The pharyngo-esophageal segment (PES) vibrates instead of the VF (uncommon method). 

What does the PES correspond to?

The upper esophageal sphincter (UES) - the person manually swallows air then forces it back up from the stomach to vibrate the UES. 

Tracheo-Esophageal Puncture Speech

A surgical passageway is created in the wall separating the trachea and esophagus. Then, a one-way prosthesis is placed that lets air from the lungs pass through it and vibrates the PES/UES.

Why does the TEP have to be one-way? 

To prevent the bolus from entering the trachea. 

What does it mean if you see food/leakage on the outer surface of the prosthesis? 

It means it is leaking and needs to be changed immediately. 

Electrolarynx

An external mechanical sound source is substituted for the larynx, but anatomic structures for articulation/resonance are unaltered.

What are advantages of the electrolarynx?

Voice is restored immediately after surgery and the maintenance for the electrolarynx is minimal.

What are the disadvantages of the electrolarynx?

The voice quality sounds mechanical.