Kelli Hancock

Perceptual characteristics of tracheoesophageal speech production using the new indwelling Provox Vega voice prosthesis: A randomized controlled crossover trial†‡

The objective of this study was to determine if the design enhancements incorporated into the new Provox Vega Indwelling Voice prostheses result in any positive benefits in vivo.

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.

Speech Breathing Patterns During Tracheoesophageal Speech

Abstract Although tracheoesophageal speech (TES) uses pulmonary air to drive voice production, it was hypothesized that the speech breathing patterns of patients using TES would differ from normal speakers, as speakers compensated for the increased resistance associated with alaryngeal phonation and the effects of air loss from occasional incomplete stomal occlusion. Instrumental measurements of respiratory kinematics were used to study lung volume initiation, termination, and excursion in speech and nonspeech respiratory tasks for nine participants who used TES and nine matched controls. On the nonspeech tasks, the kinematic patterns of the TES group displayed no difference from the normal participants. On speech tasks, however, they demonstrated significantly (p <0.05) reduced lung volume excursions (LVE) in maximum sustained phonation and significantly increased LVEs in both reading and conversation. The results suggest that the TES group had less efficient use of their expiratory breath stream for maximum sustained phonation as signified by reduced LVEs. In the absence of reduced respiratory function in nonspeech tasks, this finding appears to relate to either increased phonatory resistance and/or possible stomal air loss associated with producing phonation. The results of the increased LVEs on the connected speech tasks demonstrate that patients employed active compensatory patterns of speech breathing to optimize utterance length.

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.

Use of simulation technology for clinical skills development in tracheostomy management

Dysphagia Research Society Annual Meeting and Post-Graduate Course March 7–12, 2012 The Ritz-Carlton Toronto, Ontario, Canada Springer Science+Business Media New York 2012

Tracheoesophageal speech restoration: issues for training and clinical support

Objective The management of tracheoesophageal speech (TES) is complex and invasive in nature. The current study was designed to examine the nature and perceived adequacy of clinical preparation and ongoing training currently available to clinicians working in this clinical field. A secondary aim was to explore associated workplace staffing and supports available to clinician’s across different services in order to consider additional factors impacting service delivery. Methods A secure online survey was distributed to individuals who were the main clinician responsible for managing caseloads that included patients using TES. Results Responses were received from 32 national centres providing TES services. Results suggested that access to support and training is meeting needs. A desire for more advanced-level professional development opportunities in TES management was indicated. Conclusion Issues from this national cohort study highlight positive results regarding availability of access to introductory clinical skills training in this field. Further enhancements could be achieved through development of advance/complex management training opportunities.

Factors influencing clinical consistency and variability in voice prosthesis management

Abstract Purpose: Anecdotally it is recognised that management of tracheoesophageal speech (TES) post-laryngectomy varies between speech language pathology (SLP) services and clinicians. This study reviewed patterns of practice for TES management to examine patterns of practice and explore factors influencing variability. Method: A national survey was completed by SLP’s from clinical services which manage TES. This online survey examined demographic and caseload information, initial voice prosthesis (VP) placement and procedures, VP cleaning and care recommendations, humidification management, equipment and service provision, and service delivery options at each site. Result: Lead clinicians from 34 sites (85% response rate) responded. Most clinical practice regarding initial VP insertion and management, as well as the timing and delivery of voice rehabilitation was highly consistent. Patient use of antifungal medications, TES and associated equipment provision, humidification management immediately post-surgery and some aspects of initial VP insertion were variable between services. The nature of the clinical setting, equipment funding and level of research evidence influenced variability in practice. Conclusion: Variability exists in a number of aspects of practice across Australian services offering TES management. Sources of variability need to be addressed nationally to ensure there is consistent, quality care available for all patients.