Letteratura scientifica selezionata sul tema "Laryngectomie – Psychologie"

In this investigation the coping, adjustment, self-esteem, general well-being, perceived communication abilities, and preferred communication modes of 41 patients with laryngectomies were evaluated. Specifically, we wanted to determine how well patients with laryngectomies adjust to and cope with their cancer, whether differences in coping and adjustment vary as a function either of the type of alaryngeal voice used or the amount of time since the laryngectomy, and whether relationships exist between the speech of patients with laryngectomies and their adjustment. Standardized interview protocols and tests were employed during face-to-face interviews. Results revealed that 73% of the sample showed good adjustment and used predominantly problem-focused and seeking-social-support strategies to cope with their cancer. The 27% who were classified as poor copers also performed poorly on self-esteem and general well-being measures and used more self-blame and avoidance strategies. There were no significant differences among different types of preferred communication modes. Significant differences existed between patients with recent and distant laryngectomies; the latter showed better overall adjustment. The subjects who were well adjusted also tended to view their voice rehabilitation as more beneficial and rated themselves as more easily understood by listeners than did those subjects demonstrating psychological distress and poor adjustment. Implications for advanced voice therapy, the need for counseling and referrals, and the relationship among voice, self-esteem, and therapy are discussed.

The purpose of the study was to assess the quality of life of patients after surgical treatment for cancer of the larynx. Three groups of patients were identified according to surgical treatment: total laryngectomy, 111 patients; near-total laryngectomy, 38 patients; and partial laryngectomy, 23 patients. The impact of successful surgical treatment on their life roles was analyzed in terms of work, activities, familial and spousal relationships, sexuality, and psychologic features such as stress and anxiety. Two questionnaires were used: the Psychosocial Adjustment to Illness Scale (PAIS) and the Mayo Clinic Postlaryngectomy Questionnaire. With the PAIS questionnaire, no difference was found in role adjustment between the total laryngectomy and near-total laryngectomy groups, with one exception. In the work domain, the total laryngectomy patients who were working had better adjustment than the near-total laryngectomy patients. The overall adjustment of both groups was less favorable than that of a comparison group of patients with nonlaryngeal cancer. The patients who had the classic conservation operations adjusted in all domains more favorably than the patients with permanent tracheostomas. The partial operation patients adjusted better than the nonlaryngeal cancer patients. We conclude that the stoma has a negative impact on adjustment postoperatively and that it may have a more serious impact on life adjustment than voice alteration. Further investigation and standardization of measurement tools are needed.

Purpose The construct validity of the Voice-Related Quality of Life (V-RQOL; Hogikyan & Sethuraman, 1999) measure was evaluated in a sample of 109 individuals who have undergone total laryngectomy. Method A principal components factor analysis was performed on participant responses to the 10-question V-RQOL measure. Results Factor analysis of the V-RQOL in our alaryngeal sample confirmed the presence of two factors (physical and social–emotional), which is consistent with the identified domains in the current V-RQOL. However, the current data indicate that some of the questions proposed by the original authors of the V-RQOL (Questions 7 and 9) do not align with their proposed domains in this postlaryngectomy sample. Conclusion The results indicate that some V-RQOL questions do not align with their proposed domains. Consequently, an alternative scoring algorithm may be warranted for alaryngeal populations, and the authors make suggestions for this change that are simple and efficient. Based on the findings of the present factor analysis, use of this modified scoring procedure may serve to increase the sensitivity of the V-RQOL for those who are laryngectomized and use alaryngeal methods of voice and speech. Consequently, the value and application of the V-RQOL may be expanded in the clinical setting.

The properties of drinking in normal and laryngectomized groups were examined. Drinking associated with meals was more frequent in the 76 young and 37 older normal subjects than the 25 laryngectomized persons. The laryngectomized group preferred tea and coffee to water to alleviate thirst sensation, while such a preference was hardly seen in either normal group. Results suggest that the larynx may contribute not only to thirst sensation but may be associated with preference in drinking.

Dysphagia concerns 10–89% patients after total laryngectomy; to a greater extent, it concerns patients receiving complementary radiotherapy. The disease mechanism is associated with anatomical changes after surgery (scope of surgery) or complications of adjuvant therapy (xerostomia, neuropathy, swelling of tissue, etc.). The above changes lead to: decreased mobility of the lateral walls of the pharynx and tongue retraction, the occurrence of lingual pumping, decreased swallowing reflex, weakening of the upper esophageal sphincter opening, contraction of the cricopharyngeal muscle, tissue fibrosis, formation of pharyngeal pseudodiverticulum, etc. As a result: regurgitation of food through the nose and oral cavity, food sticking in middle and lower pharynx, prolongation of bolus transit time. Upon the formation of tracheoesophageal fistula, there may be aspiration of gastric contents. The above changes considerably reduce patients’ quality of life after surgery. The diagnostic protocol includes: medical interview (questionnaires can be helpful such as: EAT 10, SSQ, MDADI, DHI), clinical swallowing assessment and instrumental examinations: primarily videofluoroscopy but also endoscopic evaluation of swallowing. In selected cases, multifrequency manometry is necessary. The treatment options include: surgical methods (e.g. balloon dilatation of the upper esophageal sphincter, cricopharyngeal myotomy, pharyngeal plexus neurectomy, removal of the pharyngeal pseudodiverticulum), conservative methods (e.g. botulinum toxin injection of the upper esophageal sphincter, speech therapy, nutritional treatment) and supportive methods such as consultation with a psychologis physiotherapist, clinical dietitian. The selection of a specific treatment method should be preceded by a diagnostic process in which the mechanism of functional disorders related to voice formation and swallowing will be established.

The purpose of this study was to evaluate the role of the larynx in sensation of thirst and to identify precise areas responsible for the sensation in normal and laryngectomized groups. The present analysis showed that the laryngectomized group was less aware of the sensation and less able to localize it than the normal group. Both groups localized the sensation from the base of the tongue to the larynx as well as in the pharynx.

Patients who had laryngectomies were grouped according to adjustment scales into "good copers" and "poorer copers." More than 70% of the laryngeal cancer survivors were well adjusted and classified as "good copers." Three social support scales were administered and revealed that "good copers" perceived themselves as having better quality networks and more functional support. A subjective self-evaluation of the subjects’ voices revealed a relationship between perceived voice quality, adjustment, and perceived social support. Rehabilitation for some patients with laryngectomies may need to include more direct nurturing; speech-language pathologists may want to suggest self-help groups or professional support counseling.

Les cancers de la « gorge » représentent en France un peu plus de 6 000 nouveaux cas par an. Lorsque la maladie est évoluée, le traitement repose principalement sur la laryngectomie totale. Cette intervention chirurgicale consiste à enlever la tumeur avec le larynx et ses cordes vocales. Cet acte technique prive l’individu de sa voix traditionnelle et laisse un orifice au milieu du cou (trachéostome) qui lui permet de respirer. L’objectif de ce travail est de porter un regard sur le quotidien de ceux et celles que la médecine a mutilés pour leur donner une chance de survivre et de « donner à voir », au-delà de la réponse médicale, ce qui constitue le vécu de ces « stigmatisés pour survivre », qui sont désormais privés de leur voix naturelle et marqués du sceau du cancer. Cette maladie est une sociopathie au sens où il existe une inégalité dans sa survenue. Après l’opération, les patients sont « guéris médicalement » du cancer, mais leur trajectoire de vie reste descendante. La chirurgie les a métamorphosés. Leur identité individuelle et sociale s’est transformée. L’atteinte au corps, le regard des autres engendrent stigmatisation et marginalisation. In fine, ce travail a permis de forger le concept de découration pour caractériser la vie de ces opérés du cancer de la gorge. Ce néologisme, élaboré par analogie aux termes “ découragement ”, “ défiguration ” et “ décoration ”, a été avancé pour spécifier le processus qu’inaugure le plus souvent la laryngectomie totale, même quand le risque de survenue d’une récidive s’éloigne : une séquence de vie faite de désespérance liée aux handicaps d’apparence qui mène à une « mort sociale » et à un repli sur soi.

Cette thèse s'élabore autour d'une recherche questionnant le rapport de l'individu à la voix sous le prisme de son absence. Dans le cadre d'interventions au sein d'un service d'Oto-Rhino-Laryngologie, nous avons été confrontés à l'impossibilité de parler des patients lors de nos rencontres qui succédaient une opération chirurgicale à visée curative : la laryngectomie totale (l'ablation du larynx). Le dispositif de l'entretien clinique « classique », oralisé, s'y trouve malmené. C'est à partir de cette constatation que se déploie ce travail de recherche, avec comme questions centrales : quels sont les enjeux d'une telle opération pour le sujet ? Comment entendre le sujet au-delà de sa voix physique ? C'est à partir de la notion d'objet a que développent Jacques LACAN et ses contemporains, et de la pulsion invocante associée, que s'ouvre une possibilité d'entendre le sujet de l'inconscient au travers de nouveaux dispositifs accessibles lors de l'hospitalisation : l'écrit et le geste. Nous posons l'hypothèse que la pulsion invocante, par la perte de la voix que la laryngectomie totale engendre, amène à une rencontre avec cet objet a-voix par le silence vocal postopératoire imposé - rencontre que nous nommons la désirectomie partielle. Nous postulons également que pour sortir de cet état de jouissance nirvanesque, il va y avoir un réinvestissement nécessaire de la pulsion invocante sur des dispositifs tels que l'écrit ou le geste pour que le sujet de l'inconscient puisse se faire entendre et éviter la mort au travers de la jouissance de la retrouvaille. Pour comprendre ces enjeux psychiques, nous allons, au travers de ce travail, confronter la théorie à la clinique de ces sujets dits « laryngectomisés » et tenter d'en faire émerger une analyse de la pulsion invocante au travers de cette clinique silencieuse. Une démarche pathoanalytique dans laquelle nous prendrons également en compte la question du cancer et de son impact sur le sujet
This thesis is developed around a research questioning the relationship of the individual to the voice under the prism of its absence. In the context of interventions within an Oto-Rhino-Laryngology department, we were faced with the impossibility of talking about patients during our meetings following a surgical operation with curative intent: total laryngectomy (larynx removal). The tool of the “classic” clinical interview, oralized, is mistreated there. This research stems from this observation, with the core questions: what are the stakes of such a surgery for the subject? How to hear the subject beyond his physical voice? Using the notion of a object developed by Jacques LACAN and his contemporaries, and the associated invocative drive, leads to the opportunity to hear the subject of the unconscious through new tools available during hospitalization: writing and gesture. We hypothesize that the invocative drive, through the loss of voice consequence of total laryngectomy, leads to an encounter with this a-voice object through the imposed postoperative vocal silence - meeting that we call the partial desireectomy. We also postulate that to get out of this state of nirvanesque jouissance, there will be a necessary reinvestment of the invocative drive on tools such as writing or gesture so that the subject of the unconscious can make himself heard and avoid the death through the enjoyment of the reunion. To understand these psychic issues, we will, through this work, confront the theory with the clinic of these so-called “laryngectomized” subjects and try to bring out an analysis of the invocative drive through this silent clinic. A pathoanalytical approach in which we will also take into account the question of cancer and its impact on the subject

O tratamento de pacientes com câncer de laringe que realizam a cirurgia de Laringectomia Total (LT), freqüentemente implica a necessidade de procedimentos agressivos que podem causar lesões estéticas e funcionais irrecuperáveis, tais como o uso de sonda nasogástrica, traqueostoma, perda da fala e do sentido olfativo, dificuldade para engolir certos alimentos e a impossibilidade de imersão em líquidos, acarretando uma série de repercussões em uma dimensão psicossocial. Através de uma metodologia qualitativa, baseada na narrativa dos pacientes e seus cuidadores, objetivamos investigar as possíveis repercussões psicossociais na construção subjetiva de pacientes submetidos à LT. Caracterizamos mudanças ocorridas no cotidiano dos pacientes e em suas relações familiares e sociais, com o intuito de compreender como estas mudanças afetam o seu equilíbrio emocional e as suas estratégias de enfrentamento psicológico frente a elas. Todo o percurso em torno da doença é vivido pelo paciente e por sua família como um momento de crise, atravessado por um profundo sentimento de precariedade, que exige uma série de readaptações que afetam expressivamente a rotina e o contexto social em que vivem. Diante das diversas seqüelas físicas decorrentes da LT e do seu tratamento, a perda da fala assume papel prioritário levando o paciente a isolar-se do seu convívio social, afastar-se de suas funções profissionais, o que gera, conseqüentemente, sentimentos de inadequação, baixa auto-estima, vergonha e, até mesmo, culpa pela crença de que seus maus hábitos contribuíram para o adoecer. A família, por seu turno, sofre duplamente: de um lado pela percepção de fragilidade e medo de perda de um ente querido e, de outro, por tentativas, nem sempre bem sucedidas, de dar suporte e oferecer ambiência para as novas necessidades que se apresentam. Percebe-se, ainda, que os aspectos ligados à religiosidade, ao apoio da família e confiabilidade na equipe são encarados como fonte de motivação para o tratamento. A experiência do adoecimento é extremamente rica de sentidos: des-armando, des-pre-ocupando para ocupar-se com o que interessa e realmente está presente no aqui e agora, pedindo espaços de amparo onde o abdicar de si implica em abrir-se para outro. Além de aprofundar temáticas relativas à Psicologia Clínica e Hospitalar, acreditamos que essa pesquisa pôde nos auxiliar na identificação de dispositivos clínicos para a ação do Psicólogo que trabalha nesse contexto. Outros estudos e reflexões são necessários para que possamos melhor compreender essas tantas facetas que envolvem o humano, sem aprisioná-lo, considerando-o em sua singularidade múltipla. No entanto, podemos afirmar que o contato com esses pacientes e a busca de compreensão de seus sofrimentos leva-nos, cada vez mais, a tomar a ética do cuidado como o principal referencial em nossa atividade Clínica
The treatment of patients with larynx cancer who carry through the surgery of Total Laringectomy (TL), frequently implies the necessity of aggressive procedures that they can cause irretrievable esthetic and functional injuries, such as the use of nasogastric feeding, stoma, loss of speaks and the olfactive sense, difficulty to swallow certain foods and the impossibility of immersion in liquids, causing a series of repercussions a psychosocial dimension. Through a qualitative methodology based in the narrative of the patients and its caregivers, we objectify to investigate the possible psychosocial repercussions in the subjective construction of patients submitted to the TL. We search, also, to characterize the occured changes in the daily one of the patients, its familiar and social relations, with intention to understand as these changes affect its emotional balance and to understand its strategies of psychological confrontation. All the passage around the illness is lived by the patient and its family as a moment of crisis, crossed for a deep feeling of precariousness, demanding a series of readjustments that affect its routine expressivelly and of its family ones. Ahead of the diverse physical sequels decurrent of the TL and its treatment, the loss of speaks assumes with priority role taking the patient to isolate itself of its social conviviality, to move away from its professional functions, what it generates, consequently, improper feelings, low auto-esteem, shame and, even though, guilt for the belief of that its bad habits had contributed to become sick. The family, for its turn, suffers doubly: of a side for the perception of fragility and fear of loss and, of another one for attempts, nor always successful, to give support and to offer ambience for the new necessities that if present. One perceives, still, that on aspects to the religiosity, to the support of the family and trustworthiness in the team are faced as source of motivation for the treatment. The experience of become sick is extremely rich of is felt: dis-arming, easying to occupy with what it interests and reallyis present in here and now, asking for support spaces where abdicating of itself it implies in confiding for another one. Beyond going deep thematic relative to Clinical and Hospital Psychology, we believe that this research could assisting in them in the identification of clinical devices for the action of the Psychologist who works in this context. Other studies and reflections are necessary so that let us can more good understand these as much faces that involved the human being, without imprisoning it, considering it in its multiple singularity, however, can affirm that the contact with these patients and the search of understanding of its sufferings take us, each time more, to take the ethics of the care as the main referencial in our Clinical activity