Gotowa bibliografia na temat „Prosthetic esophageal”

Educational objectives: To understand the prospects of postlaryngectomy prosthetic voice and pulmonary rehabilitation with an indwelling voice prosthesis system, related appliances and HME and to comprehend the possibilities of prosthetic voice rehabilitation after various pharyngeal and/or esophageal reconstructions.

Introduction Voice rehabilitation is the most important issue after total laryngectomy as source of vibration is removed. Three options are there like esophageal voice, electrolarynx and surgical prosthetic voice. Best is the prosthetic speech as voice is generated by lung powered air column. Provox prosthesis is the standard on and most commonly used. But it is costly for the class of patients presenting to our government hospitals. Duckbill prosthesis is very economical and may be helpful for them. There is very limited number of studies with duckbill prosthesis. Materials and Methods Twenty two post-laryngectomy patients was selected for this study. Proper counselling was done regarding cost, pros and cons of Provox and Duckbill prosthesis. Fifteen patient selected Duckbill where as seven patient have chosen Provox prosthasis. Voice analysis was done after one month of speech therapy by perceptual voice analysis protocol. Safety and complications arising from prosthesis were also noted. Results There was no significant difference in quality of voice.Both prosthesis are safe if prolong use is avoided. Conclusion There is no significant difference in the quality and safety of both the prosthesis, but huge difference in cost is present. More over it is recurrent cost as it should be changed every year or earlier. One Provox costs around rupees fifty thousand whereas a duckbill prosthesis costs rupees one thousand approximately in Indian market.

e17549 Background: Patients undergoing total laryngectomy require subsequent voice rehabilitation, which can be done by different modalities. The tracheo-esophageal voice prosthesis provides the clarity of speech and has a high rate of success in terms of acquisition of post laryngectomy speech.In this pilot study we evaluate the functionality of a modified trachea- oesophageal prosthesis to be used in primary and secondary trachea- esophageal puncture in 30 patients of total laryngectomy. Methods: This study was conducted at Health care Global Cancer Centre to evaluate the role of a novel trachea-oesophageal prosthesis for total laryngectomy +/- partial pharyngectomy patients from 2015-2016. 30 patients will be enrolled as an inpatient or outpatient. Post TEP insertion evaluation: Patients, who are undergoing primary TEP insertion, will be evaluated for speech/ voice interval of 6weeks, 12 weeks and 6 months. Objective assessment of speech Assessment of the incidence of TEP leak clinically after a test fluid feed. Through the prosthesis (intra TEP leak) Around the TEP leak (peri TEP leak) Assessment of the extrusion rate of the TEP device Assessment of the complication rate associated with the procedure/TEP Results: On objective assemsmsent of speech, all patients (100%) used prosthesis were able able to phonate and communicate using intelligible speech. 10% patients developed intra TEP leak immediately after insertion of prosthesis, 6% within 3 months of insertion, & 3% developed peri tep leak. All patients were immedaitely given a repalcement prosthesis and leaks corrected. Extrusion was seen in 3% of the patients. None reported any complications. Conclusions: Aum voice prosthesis is a excellent and affrodable tracheo oesophageal prosthetic device to enable and empower patients speeech rehabilitation. Clinical trial information: NCT03039465.

ABSTRACT Background/Objectives Mechanical prosthetic valve rehabili tation after total laryngectomy have a success rates of 90% in restoring voice. The effective speech is achieved better with mechanical voice prosthesis when compared to esophageal speech and electrolarynx. Candidal growth and tubal blockage are the commonest cause of peri and endotubal leakage causing prosthesis failure. Case report A 50-year-old male who had undergone wide field laryngectomy with primary tracheoesophageal puncture (TEP) with voice prosthesis 18 months back complained of blocked voice prosthesis and peritubal leakage. The tip of the cleaning brush which had blocked the opening was removed in the outpa tients under topical anesthesia and the peritubal block reduced. Conclusion Mechanical valve prosthesis rehabilitation after primary tracheoesophageal puncture is the standard voice rehabilitation of laryngectomized patients. Patient education regarding maintenance of the prosthesis and the care for the tracheostoma is important in reducing the complications. How to cite this article Halkud R, Shenoy AM, Sunil KC, Samskruthi M, Sarvadyna J, Biswas S, Chavan P, Siddappa KT, Shivappa A, Naik SM. Blocked voice Prosthesis: A Common Complication Reducing the Prosthesis Longevity. Int J Head Neck Surg 2014;5(2):66-71.

The Singer-Blom tracheoesophageal puncture procedure for surgical-prosthetic voice restoration has proved to be a viable option for alaryngeal speech rehabilitation. Following tracheoesophageal puncture, occlusion of the tracheostoma shunts pulmonary air through the Blom-Singer prosthesis into the cervical esophagus. The pulmonary air passing through the cervical esophagus and into the hypopharynx causes a portion of the upper alimentary tract to vibrate in a manner similar to that of the pharyngoesophageal segment during the production of esophageal speech. To study the location and shape of the vibratory segment in tracheoesophageal speakers, videofluoroscopy and simultaneous voice recording were performed with 16 patients. To analyze the vibratory segment(s), photographs were made of the videotaped image white it was stopped during the patients' production of the /a/ sound. The most frequent location of the vibratory segment was in the lower third of the neck, which corresponds to cervical vertebrae C5 through C7. Five of the subjects had two separate vibratory segments and two other subjects had long vibratory segments. The vibratory segment(s) in tracheoesophageal speakers was found to be similar to the vibratory segment(s) in esophageal speakers.

ABSTRACT Background/objectives Prosthetic voice rehabilitation after total laryngectomy has proven to be successful in restoring proper speech function in over 90% of patients. The possibility of achieving effective speech using the voice prosthesis is superior to esophageal speech and electrolarynx. Setting Department of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru. Case report A 75-year-old female who had undergone wide field laryngectomy 14 months back came with history of lost voice prosthesis which was later found aspirated. It was removed by the bronchoscopic forceps under topical anesthesia by visualizing it by a nasal 0° wide angle endoscope. The puncture site was cleaned and allowed to cicatrize and narrow down. The fistula was closed by topical application of silver nitrate. Conclusion Tracheoesophageal puncture and prosthesis rehabilitation has emerged as the standard voice rehabilitation of laryngectomized patients. Patient education regarding maintenance of the prosthesis and the care for the tracheostoma is important in reducing the complications. How to cite this article Naik SM. Aspirated Voice Prosthesis: A Unique Complication of Post Total Laryngectomy Voice Rehabilitation. Int J Phonosurg Laryngol 2012;2(1):41-45.

Specialty literature demonstrates the direct link between gastro-esophageal reflux diseases (GERD) and dental errosion (DE). Patients diagnosed with GERD often shown dental tissue loss in the enamel and dentine, somentimes going as far as opening the pulp chamber. Modern minimal invasive treatments make use of the current performance of cements and prosthetic materials (composites and ceramics) to conserve healthy enamel and dentine, in comparison to classic reconstruction methods.

AbstractEsophageal lung is a rare bronchopulmonary foregut malformation characterized by an anomalous origin of one of the main bronchi which arises from the esophagus. Less than 30 cases are reported in the literature. Therefore, there are no standardized guidelines for the treatment of this condition. We report a case of right esophageal lung diagnosed in a neonate. The patient was treated with thoracoscopic closure of the ectopic main bronchus in the neonatal period, followed by delayed pneumonectomy at 5 months of age. No prosthetic substitute was implanted in the ipsilateral hemithorax after pneumonectomy. The patient is now 4 years old and doing well, postpneumonectomy syndrome was never observed. Our strategy and the possible alternatives are discussed here.

The human respiratory system plays a crucial role in breathing and swallow ing. However, it also plays an essential role in speech production, which is unique to humans. Speech production involves expelling air from the lungs. As the air flows from the lungs to the lips, some kinetic energy gets con verted to sound. Different structures modulate the generated sound, which is finally radiated out of the lips. The speech consists of various informa tion such as linguistic content, speaker identity, emotional state, accent, etc. Apart from speech, there are various scenarios where the sound is generated in the human respiratory system. These could be due to abnor malities in the muscles, motor control unit, or the lungs, which can directly affect generated speech as well. A variety of sounds are also generated by these structures while breathing including snoring, Stridor, Dysphagia, and Cough. The source filter (SF) model of speech is one of the earlier models of speech production. It assumes that speech is a result of filtering an excita tion or source signal by a linear filter. The source and filter are assumed to be independent. Even though the SF model represents the speech pro duction mechanism, there needs to be a tractable way of estimating the excitation and the filter. The estimation of both of them given speech falls under the general category of signal deconvolution problem, and, hence, there is no unique solution. There are several variations of the source-filter model in the literature by assuming different structures on the source/filter. There are various ways to estimate the parameters of the source and the filter. The estimated parameters are used in various speech applications such as automatic speech recognition, text to speech, speech enhancement etc. Even though the SF model is a model of speech production, it is used in applications including Parkinson’s Disease classification, asthma classification. The existing source filter models show much success in various appli cations, however, we believe that the models mainly lack two respects. The first limitation is that these models lack the connection to the physics of sound generation or propagation. The second limitation of the cur rent models is that they are not fully probabilistic. The inherent nature of the airflow is stochastic because of the presence of turbulence. Hence, probabilistic modeling is necessary to model the stochastic process. The probabilistic models come with several other advantages: 1) systematically inducing the prior knowledge into the models through probabilistic priors, 2) the estimation of the uncertainty of the model parameters, 3) allows sampling of new data points 4) evaluation of the likelihood of the observed speech. We start with the governing equation of sound generation and use a simplified geometry of the vocal folds. We show that the sound generated by the vocal folds consists of two parts. The first part is because of the difference between the subglottal and supra glottal pressure difference. The second part is because of the sound generated by turbulence. The first kind is dominant in the voiced sounds, and the second part is dominant in the unvoiced sounds. We further assume the plane wave propagation in the vo cal tract, and there is no feedback from the vocal tract on the vocal folds. The resulting model is the excitation passing through an all-pole filter, and the excitation is the sum of two signals. The first signal is quasi-periodic, and the shape of each cycle depends on the time-varying area of the glottis. The second part is stochastic because the turbulence is modeled as a white noise passed through a filter. We further convert the model into a proba bilistic one by assuming the following distribution on the excitations and filters. We model the excitation using a Bernoulli Gaussian distribution. Filter coefficients are modeled using the Gaussian distribution. The noise distribution is also Gaussian. Given these distributions, the likelihood of the speech can be derived as a closed-form expression. Similarly, we im pose an appropriate prior to the model’s parameters and make a maximum a posteriori (MAP) estimation of the parameters. The MAP estimation of parameters can be computationally complex. But the model assumption can be changed/approximated with respect to the application and result ing in different estimation procedures. To validate the model, we apply this model to seven applications as follows: 1. Analysis and Synthesis: This ap plication is to understand the representation power of the model. 2. Robust GCI detection: This shows the usefulness of estimated excitation, and the probabilistic modeling helps to incorporate the second-order statistics for robust the excitation estimation. 3. Probabilistic glottal inverse filtering: This application shows the usefulness of the prior distribution on filters. 4. Neural speech synthesis: We show that the model’s reformulation with the neural network results in a computationally efficient neural speech synthe sis. 5. Prosthetic esophageal (PE) to normal speech conversion: We use the probabilistic model for detecting the impulses in the noisy signal to convert the PE speech to normal speech. 6. Robust essential vocal tremor classification: The usefulness of robust excitation estimation in pathological speech such as essential vocal tremor. 7. Snorer group classification: Based on the analogy between voiced speech production and snore production, the derived model is applicable for snore signals. We also use the parameter of the model to classify the snorer groups.

A total laryngectomy (TL) affects the quality of life (QoL) of individuals who have undergone this surgical procedure, as changes are seen in respiration, swallowing and communication. The aim of this study was to gather perspectives of the hallmarks of successful alaryngeal voice rehabilitation by tracheo-esophageal puncture (TEP) with voice prosthesis of laryngectomy patients from key role players based at a public hospital in Gauteng Province, South Africa. A qualitative method of inquiry was used, namely a single-program, collective case study. A focus group, comprising of four individuals who had undergone a total laryngectomy, was held to identify the participants‟ views about successful voice rehabilitation. From this focus group, one successful communicator was identified to be interviewed individually. Five semi-structured, face-to-face individual interviews using open-ended questions were conducted with five key role players in alaryngeal voice rehabilitation. The interviewees comprised of the successfully rehabilitated person with total laryngectomy (PWTL), his caregiver, an ear, nose and throat surgeon, speech-language pathologist and specialist nurse, to gather their perspectives on the factors that contributed to successful alaryngeal voice rehabilitation using TES. The Thematic Framework Approach was used to qualitatively analyze the data. Factors identified as contributing to success included patient selection for tracheo-esophageal puncture, information provision, support in the form of support groups, spiritual as well as family support, stomal care, the skill of the team and key management issues. Issues related to finance adversely affect the provision of voice prostheses and/or the provision of correctly sized prostheses and accessories. Systems have been implemented at the hospital to provide the option of TEP with voice prosthesis without much consideration to the other two alaryngeal options; namely esophageal speech and electrolarynx speech. Implications for clinical practice have been identified especially the need to provide more social support services to persons with TL.
Thesis (M.Sc.)-University of KwaZulu-Natal, Westville, 2012.

Introduction. The quality of substitute speech with laryngectomees patients with or without the implanted voice prosthesis type Provox II on the bases of two clinical cases was compared. Material and methods. The evaluation of voice was compared on the bases of two patients treated in Otolaryngological and Laryngological Oncology Clinic. The patients K.P. aged 46 (medical history number 2778/2008) who, on March 12, 2008 underwent total laryngectomy with the Rethie method including the removal of left thyroid lobe due to thyroid and larynx cancer. The patients D.K. ages 44 (medical history number 13705/2010) who on November 4, 2010 underwent total laryngectomy with the Rethie method including selective lymphe node operation of Region II on the right side with the implanting of the voice prosthesis type Provox II due to larynx cancer. Each patients was instructed on tracheostomy care and systematic performing of the fallowing exercises: diaphragmatic‑ribbed tract breathing loosening masseter muscle system and esophageal sphincter, the use of lauder reflection in the process of voice production, the method of obtaining loud reflection lengthening of the time of phonation and eliminating breath sounds. The evaluation of the quality of substitutive speech was performed after three months. Results. On the basis of the conversation with the patients, it turned out that the patient with the implanted voice prosthesis had better quality of substitutive speech and better communication possibility. Conclusions. The learned substitutive speech with the interoperatively implanted the voice prosthesis type P. II turned out to be the best way of communication.

Total laryngectomy is still the final therapeutic solution in cases of locally advanced laryngeal cancer, as well as in cases of therapeutic failure of organ-sparing surgery or radiation therapy. Following excision of the larynx, the remaining pharynx is reconstructed to obtain continuity of the upper digestive tract. One of the most common complications in these patients, despite constant refinement of the procedure, is the development of a pharyngo-cutaneous fistula. These fistulas prolong hospital stay and often require a second surgical procedure, increasing morbidity and cost for the patient, while diminishing his quality of life. Some risk-factors have been identified, but only some may be corrected before surgery to lower this risk. Managing the fistula once present depends on multiple factors, essential being the size of the fistula as well as the position and concomitant factors, with options ranging from conservative measures to aggressive reconstructive surgery with local miocutaneous flaps. Modern vocal rehabilitation with T.E.P. (tracheo-esophageal puncture) and vocal prosthesis placement presents a new challenge – because of the risk of developing a tracheo-esophageal fistula, with an even higher risk for the patient because of tracheal aspiration. Understanding healing mechanisms of these structures is key to proper management of this complication.