Corina J. van As-Brooks

The effect of a Heat and Moisture Exchanger (Provox® HME) on pulmonary protection after total laryngectomy: a randomized controlled study

The goal of this randomized controlled study was to investigate the effect of Heat and Moisture Exchanger use on pulmonary symptoms and quality of life aspects in laryngectomized patients. Eighty laryngectomized patients were included and randomized into an HME and Control group. The effect of the HME was evaluated by means of Tally Sheets and Structured Questionnaires. The results showed a significant decrease in the frequency of coughing, forced expectoration, and stoma cleaning in the HME group. There were trends for the prosthetic speakers to report more fluent speech with the HME and for the HME group to report fewer sleeping problems. In conclusion, this study, performed in Poland, confirms the results of previous studies performed in other countries, showing that pulmonary symptoms decrease significantly with HME use and that related aspects such as speech and sleeping tend to improve, regardless of country or climate.

First clinical experience with a new non-indwelling voice prosthesis (Provox® NID™) for voice rehabilitation after total laryngectomy

Conclusion. The new Provox® NID™ non-indwelling voice prosthesis investigated in this study provides a good option for laryngectomized patients using non-indwelling voice prostheses and can potentially improve safety and increase patients’ satisfaction with their voice and speech. Objective. To investigate the feasibility of and patient satisfaction with the Provox NID non-indwelling voice prosthesis. Material and methods. Pre- and post-study questionnaires were used to evaluate the patients’ former voice prosthesis and the Provox NID voice prosthesis. In addition, measurements of pull-out force, maximum phonation time and loudness were made for both voice prostheses. In vitro measurements of airflow characteristics were also made. Following a 6-week trial, all patients provided feedback on the new voice prosthesis and the results were used to further improve the Provox NID. This final version of the new voice prosthesis was subsequently trialled and evaluated by 10 patients 6 months later. Results. Overall results showed that patient satisfaction with the Provox NID non-indwelling voice prosthesis was favourable. The pull-out force for the new prosthesis was significantly higher than that for the formerly used prosthesis and its aerodynamic characteristics were better.

The Relationship Between Acoustic Signal Typing and Perceptual Evaluation of Tracheoesophageal Voice Quality for Sustained Vowels

OBJECTIVES To investigate the relationship between acoustic signal typing and perceptual evaluation of sustained vowels produced by tracheoesophageal (TE) speakers and the use of signal typing in the clinical setting. METHODS Two evaluators independently categorized 1.75-second segments of narrow-band spectrograms according to acoustic signal typing and independently evaluated the recording of the same segments on a visual analog scale according to overall perceptual acoustic voice quality. The relationship between acoustic signal typing and overall voice quality (as a continuous scale and as a four-point ordinal scale) was investigated and the proportion of inter-rater agreement as well as the reliability between the two measures is reported. RESULTS The agreement between signal type (I-IV) and ordinal voice quality (four-point scale) was low but significant, and there was a significant linear relationship between the variables. Signal type correctly predicted less than half of the voice quality data. There was a significant main effect of signal type on continuous voice quality scores with significant differences in median quality scores between signal types I-IV, I-III, and I-II. CONCLUSIONS Signal typing can be used as an adjunct to perceptual and acoustic evaluation of the same stimuli for TE speech as part of a multidimensional evaluation protocol. Signal typing in its current form provides limited predictive information on voice quality, and there is significant overlap between signal types II and III and perceptual categories. Future work should consider whether the current four signal types could be refined.

A prospective, randomized comparative study of patient perceptions and preferences of two types of indwelling voice prostheses

BACKGROUND Technical and device life issues are frequently the focus of post-laryngectomy rehabilitation studies examining indwelling voice prostheses. Patient perceptions and preferences are considered less often. AIMS To determine patient perceptions of two indwelling voice prostheses across parameters relating to device use and maintenance and to determine what factors contribute to patient preferences. METHODS & PROCEDURES In a randomized, cross-over study, 31 laryngectomy patients completed a 3-week trial of both the new indwelling Provox Vega and a comparator device, the Blom-Singer Classic Indwelling. Patient perceptions of the insertion process, cleaning and care, and voicing were explored after each trial. At the end, overall preference and factors influencing device preference were examined. OUTCOME & RESULTS At the conclusion of the crossover trial, a significantly higher proportion of patients felt voice effort, overall voicing, bloating, and ease and effectiveness of cleaning were superior for the Provox Vega. No preference was noted for insertion processes. Overall device preference was influenced by improved voicing followed by cleaning and care. CONCLUSIONS & IMPLICATIONS Patients do not perceive all indwelling devices as equal and should have the opportunity to trial different devices to find the best device for their needs.

Surgical Improvement of Hypotonicity in Tracheoesophageal Speech

INTRODUCTION Over the last 25 years, tracheoesophageal speech has become the method of choice for restoring oral communication after total laryngectomy.1 The application of voice prostheses results in high success rates, both with respect to percentage of long-term users and voice quality.2 Irrespective of the type of voice prosthesis used, for the acquisition of fluent speech, optimal tonicity of the pharyngoesophageal (PE) segment, or neoglottis, plays a decisive role. Although there is no clear definition of what optimal tonicity means in quantitative terms, in qualitative terms, there are some useful descriptions based on videofluoroscopy imaging.3 A “normotonic” or slightly hypertonic neoglottis correlates best with a “good” voice, whereas both hypertonicity and hypotonicity significantly more often lead to a “poor” voice.4 In case of hypertonicity, characterized by a strained voice with a short phonation time, several good preventative and therapeutic options are available. During primary surgery, a short myotomy of the cricopharyngeus muscle or upper esophageal sphincter can prevent the development of hypertonicity to a great extent5 and also other surgical options, like nonor halfclosure of the constrictor pharyngeus muscles or unilateral neurectomy of the pharyngeal plexus have been described (for a recent review, see 6). The therapeutic option presently preferred, in case the problem occurs after surgery, is chemodenervation of the pharyngoesophageal musculature with botulinum toxin with a long constrictor pharyngeus myotomy as a backup method in cases refractory for Botox treatment.7 The other functional problem, hypotonicity, leads to a breathy, whispery, aphonic voice with an often short phonation time as well.8 The lack of tonicity in the neoglottis leads to poor contact between the mucosal walls and thus regular, sound-producing vibration of the mucosa is precluded.3 Moreover, the large distended subneoglottic area first has to be filled with air before voicing is even possible. This condition, most likely caused by inadvertent complete denervation of the constrictor pharyngeus muscles during laryngectomy, seems more difficult to treat than hypertonicity. In practice, only exerting external pressure, either digitally or with a custom-made pressure band, can result in some voice quality improvement.8 These methods are not all that easy to accomplish or comfortable for the patient. Digital pressure requires the use of an extra finger besides the finger used for occlusion of the stoma or in case of speech with an automatic speaking valve “spoils” the major benefit of hands-free speech. Use of an external pressure band is often reported as being uncomfortable, because of the constant pressure on the neck, interference with swallowing, perspiration, and the band losing its effect when shifting away from the optimal compression spot. In this case report, we describe an interesting surgical procedure, resulting in a clear improvement in voice quality, which might be applicable more often in motivated laryngectomized individuals with a hypotonic voice.

Biofilm formation on the Provox ActiValve: Composition and ingrowth analyzed by Illumina paired-end RNA sequencing, fluorescence in situ hybridization, and confocal laser scanning microscopy

The most frequent cause of voice prosthesis failure is microbial biofilm formation on the silicone valve, leading to destruction of the material and transprosthetic leakage. The Provox ActiValve valve is made of fluoroplastic, which should be insusceptible to destruction. The purpose of this study was to determine if fluoroplastic is insusceptible to destruction by Candida species.

Olfaction following total laryngectomy

Total laryngectomy (TL) results in the complete disconnection of the upper and lower respiratory tract, ceasing orthonasal airflow. Hence, olfaction and olfactory acuity are negatively impacted. Prior to the late 1990s, impaired olfaction was simply accepted as a negative consequence of TL surgery. However, a growing body of research conducted within this past decade has demonstrated that rehabilitation is possible with a simple and effective behavioral technique. The current review outlines the literature supporting the negative impact of altered olfaction on quality of life, details of known best practice methods for olfactory assessment both for research and clinical use, and outlines the evidence for interventions known to improve olfactory performance in the TL population. Intervention for olfactory impairment should be part of a holistic, evidence-based rehabilitation process for patients post-laryngectomy.

Biofilm formation on the Provox ActiValve: Composition and ingrowth analyzed by Illumina paired-end RNA sequencing, fluorescence in situ hybridization, and confocal laser scanning microscopy: Biofilm Formation on the Provox Activalve

The most frequent cause of voice prosthesis failure is microbial biofilm formation on the silicone valve, leading to destruction of the material and transprosthetic leakage. The Provox ActiValve valve is made of fluoroplastic, which should be insusceptible to destruction. The purpose of this study was to determine if fluoroplastic is insusceptible to destruction by Candida species.

Biofilm formation on the Provox ActiValve

The most frequent cause of voice prosthesis failure is microbial biofilm formation on the silicone valve, leading to destruction of the material and transprosthetic leakage. The Provox ActiValve valve is made of fluoroplastic, which should be insusceptible to destruction. The purpose of this study was to determine if fluoroplastic is insusceptible to destruction by Candida species.