Rehabilitation : Esophageal speech & Artificial larynx
KUNNAMPALLIL GEJO JOHN BASLP,MASLP AUDIOLOGIST
KUNNAMPALLIL GEJO JOHN
KUNNAMPALLIL GEJO JOHN
ESOPHAGEAL SPEECH
Air is compressed within the oropharynx This dense air is injected into the esophagus Denser air moves in towards more rarefied bodies of air This sets up a vibration of the pharyngo-esophageal segment These vibrations act as voice
KUNNAMPALLIL GEJO JOHN
PHARYNGO-ESOPHAGEAL SEGMENT
Portion of the pharynx and esophagus where muscle fibres from esophagus, inferior constrictor and cricopharyngeus blend together These fibres are under voluntary control of the individual Anterior fibres of cricopharyngeus are sutured, creating a complete muscle sphincter around the esophagus
KUNNAMPALLIL GEJO JOHN
Normal tonicity of PE segment is essential for the acquisition of esophageal speech or TEP speech Candidacy for esophageal or TEP speech can be determined by administering the Air Insufflation Test
KUNNAMPALLIL GEJO JOHN
Esophageal speech is based on the technique in which the patient transports a small amount (75 ml) of air into the esophagus. Probably due to an increased thoracic pressure, the air is forced back past the pharyngoesophageal (PE) segment to induce resonance. This resonance is the sound source that allows speech. Rapid repetition of the aforementioned air transport can produce understandable speec
KUNNAMPALLIL GEJO JOHN
Esophageal speech
Goals of esophageal speech( A. E. Aronson 85) Reliable phonation on demand Rapid air intake Short latency between air intake and phonation 4-9 syllables per air charge 2-3 secs of voice duration per air intake Good intelligibility
KUNNAMPALLIL GEJO JOHN
KUNNAMPALLIL GEJO JOHN
KUNNAMPALLIL GEJO JOHN
Air at atmosphere continues to circulate with in the nasal , oral and pharyngeal cavities. The PE segment is tonically contracted and registered positive pressure while the oesophagus is closed down and registered negative air pressure
KUNNAMPALLIL GEJO JOHN
Air must pass through PE segment and enter into the esophagus which will then register a positive presdsure relative to that in the oral and pharyngeal cavities
KUNNAMPALLIL GEJO JOHN
The tonicity of the PE segment may be overcome by voluntary relaxation ( Inhalation technique is based on this ) or by applying pressure by forcing the air into the esophagus ( Injection technique )
KUNNAMPALLIL GEJO JOHN
AIR INSUFFLATION TEST
The oral and nasal cavities are anaesthetized using a local anesthetic. A catheter is inserted through the nostril till the PE segment The person is asked to phonate The clinician blows in through the open end of the catheter and the individual has to phonate again, keeping the stoma closed Strained, effortful voice: Hypertonic Breathy voice: Hypotonic Esophageal speech is not advised in either of the KUNNAMPALLIL GEJO JOHN above cases
METHODS OF AIR INTAKE
INHALATION
INJECTION
CONSONANT INJECTION
KUNNAMPALLIL GEJO JOHN
GLOSSAL PRESS
INHALATION
The patient is told to close his mouth and imagine he is sniffing through his nose (Diedrich and Youngstrom, 1966) The sniffing is often accompanied by esophageal dilation Air rushes into the esophagus
This air is expelled by belching it out, vibrating the PE segment as it is expelled
KUNNAMPALLIL GEJO JOHN
CONSONANT INJECTION
A plosive or affricate is used to inject air into the esophagus /p/, /t/, /k/, /s/, // and /t/ are the recommended phonemes (Diedrich & Youngstrom, 1966; Moolenaar-Bijl, 1953; Stetson, 1937) Production of the consonants facilitates the transfer of air into the esophagus
KUNNAMPALLIL GEJO JOHN
GLOSSAL PRESS( Gateley 71)
Tongue is elevated against the hard palate Tongue body is swept backwards towards the pharynx, loading air into the esophagus till a klunk is heard Carbonated beverages and water may assist in creating a pocket of air in the esophagus
Thoracic compression forces the air out
KUNNAMPALLIL GEJO JOHN
GLOSSAL PRESS
Tongue is elevated against the hard palate Tongue body is swept backwards towards the pharynx, loading air into the esophagus till a klunk is heard Carbonated beverages and water may assist in creating a pocket of air in the esophagus
Thoracic compression forces the air out
KUNNAMPALLIL GEJO JOHN
ADVANTAGES OF ESOPHAGEAL SPEECH
No external devices necessary More natural voice compared to that produced using an artificial larynx To some extent, pitch and intensity can be varied No dependence on batteries, chargers, etc No costs involved Hands free speech
KUNNAMPALLIL GEJO JOHN
DISADVANTAGES OF ESOPHAGEAL SPEECH
Takes long to learn and master Must have good articulatory abilities, or else speech will be extremely unintelligible Listeners reportedly find esophageal speech least preferable compared to other types of alternate sound production (Carpenter, 1991)
Voice may be too soft to be heard above
background noise
KUNNAMPALLIL GEJO JOHN
Artificial larynx
KUNNAMPALLIL GEJO JOHN
Artificial Larynx
Is a device which is placed externally for the purpose of sound production in those cases from which the real larynx is removed As a device that replaces the laryngeal source with an external sound producing mechanism
KUNNAMPALLIL GEJO JOHN
The essential components
Power supply Oscilltor which vibrates Diaphragm
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Control
On / off Volume control Tone control Pitch control
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Types
Pneumatic type Electronic type
KUNNAMPALLIL GEJO JOHN
Pneumatic type Utilizes pulmonary air as its power source A cuff that contains reed or a membrane fits over the stoma As the patient expels the air from stoma for speech , the vibrations from the membrane arte transmitted by a flexible rubber or plastic tube into the patients mouth The patient articulates as the sound is produced
KUNNAMPALLIL GEJO JOHN
F0 is determined by the width and the tension of the membrane Pitch and loudness can be achieved by varying the force of air expelled from the lungs
KUNNAMPALLIL GEJO JOHN
Components
Neck tube Stoma tube Stoma cover fits into the stoma Mouth Tube placed in the mouth between lips and cheek Vibrating structure made up of rubber strings- kept in the pocket
KUNNAMPALLIL GEJO JOHN
Types
Tokyo Van Humen OSAKA Western type Memacan
KUNNAMPALLIL GEJO JOHN
Tokyo Type
KUNNAMPALLIL GEJO JOHN
Advantages
Sound quality from the pneumatic larynx is more pleasing than the electro mechanical devics No electronic noise or buzzing sound Less expensive
KUNNAMPALLIL GEJO JOHN
Disadvantage
Presence of the tube in the mouth Which interferes with articulation and collect saliva Cuff may clogged with mucous Does require the use of one hand for placement of the cuff
KUNNAMPALLIL GEJO JOHN
Electronic type
Is a battery powered sound generator These devices may differ in size and shape, quality of sound, ability to control pitch ,volume, type of batteries
KUNNAMPALLIL GEJO JOHN
Types
Intra oral devices Neck type
KUNNAMPALLIL GEJO JOHN
KUNNAMPALLIL GEJO JOHN
Components of intra oral devices
Battery compartment Pulse generator Mouth tube to vibrator Vibrator
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Models of Intra oral devices
Cooper rand 15 volt electronic speech aid Cooper rand 9 volt electronic speech aid Aurex neovox M -550
KUNNAMPALLIL GEJO JOHN
Advantage
Is ideal for patients who has scar tissue or edema of the neck Can use immediately after following surgery
KUNNAMPALLIL GEJO JOHN
Disadvantage
Presence of the tube in the mouth Which interferes with articulation and collect saliva Cuff may clogged with mucous Does require the use of one hand for placement of the cuff
KUNNAMPALLIL GEJO JOHN
KUNNAMPALLIL GEJO JOHN
KUNNAMPALLIL GEJO JOHN
NU-VOIS III Digital Artificial Larynx
KUNNAMPALLIL GEJO JOHN
Neck Type
Are popular devices Relatively easy to learn to use Provides immediate speech Restoration Placing the head of the device firmly against the neck allowing for the sound to be transmitted to through the tissue of the neck and into the oral cavity It allows variation in volume and pitch
KUNNAMPALLIL GEJO JOHN
types
Western electronic 5 A AT & T 5e electronic artificial larynx Denrick DR-1 speech aid Aurex nevox electronic artificial larynx Servox electronic artificial larynx Servox Inton Romet electronic speech aid
KUNNAMPALLIL GEJO JOHN
KUNNAMPALLIL GEJO JOHN
How to teach
Acceptance Orientation Selection Placement On-off timing Articulation Rate Phrasing Modification of Pitch & loudness
KUNNAMPALLIL GEJO JOHN
Advantages
Immediate restoration & easy to learn Early return to the work is possible Can be used as a initial method for the restoration of esophageal speech Free from stoma noise
KUNNAMPALLIL GEJO JOHN
Disadvantage
Produces unexpectable sounds because of which sound becomes unintelligeble Causes attention& bulky Acts as a crutch and not hands free speech Costly & maintenance is a problem
KUNNAMPALLIL GEJO JOHN
The major disadvantages of these electromechanical devices is the distinct voice quality. The voice production sounds mechanical and even robot like, distracting the listeners attention. The electrolarynx requires the use of a hand and has a conspicuous appearance
KUNNAMPALLIL GEJO JOHN
Electromechanical devices can be a useful treatment option in the early postoperative phase when the patient can not use other voice rehabilitation techniques, thereby limiting the frustration of speechlessness. Electrolarynx devices can also be of value in addition to other voice rehabilitation methods
KUNNAMPALLIL GEJO JOHN
