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Laryngectomy scar — Clinical Guidelines

Overview

Total laryngectomy involves the surgical removal of the larynx, necessitating alternative methods for voice restoration and communication, primarily through tracheoesophageal voice prostheses, esophageal speech, or other prosthetic devices.

Diagnosis

Clinical Presentation: History of laryngectomy, difficulty in communication, and potential complications like hypertonicity of constrictor muscles 15.

Recommended Tests: Assessment of esophageal function, evaluation of voice prosthesis function, and cognitive screening 23.

Grading: No specific grading system mentioned; focus on functional outcomes and quality of life measures 8 26.

Management

First-Line Treatments:

- Tracheoesophageal Voice Prostheses: Immediate insertion at time of laryngectomy for optimal voice rehabilitation 20 24. - Esophageal Speech Training: Comprehensive training programs to enhance self-efficacy and speech intelligibility 9 17.

Adjunctive Treatments:

- Biofeedback Techniques: Use of intraesophageal impedance for improving esophageal speech quality 13. - Singing Training: Programs aimed at enhancing voice quality and extension in laryngectomees 18. - Myofascial Release: Techniques to reduce tension affecting esophageal function 21.

Special Populations

Elderly Patients: Effective tracheoesophageal voice rehabilitation is feasible with tailored approaches; outcomes vary but can be favorable 19.

Comorbidities: Cognitive function influences alaryngeal speech rehabilitation outcomes, necessitating cognitive assessment 23.

Key Recommendations

Immediate Insertion of Voice Prosthesis at Laryngectomy: Facilitates early voice rehabilitation and improved patient outcomes 20(Evidence: Strong).

Early and Comprehensive Speech Therapy: Initiating speech therapy early post-laryngectomy significantly enhances speech intelligibility and quality 17 18(Evidence: Moderate).

Incorporate Biofeedback and Alternative Training Methods: Utilizing advanced techniques like intraesophageal impedance biofeedback and singing training can improve speech outcomes 13 18(Evidence: Moderate).

References

1 Stanisce L, McGlone M, Koshkareva Y, Swendseid B, Lawrence I, Kubicek GJ et al.. Socioeconomic Influence on Speech Rehabilitation After Total Laryngectomy. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2023. link 2 Sparks F, Dipper L, Coffey M, Hilari K. Approaches to tracheoesophageal voice rehabilitation: a survey of the UK and Irish speech and language therapists' current practice and beliefs. International journal of language & communication disorders 2023. link 3 Bertolin A, Lionello M, de Robertis V, Barbara F, Cariti F, Barbara M. Fragility and contagiousness of the total laryngectomy patient in the COVID-19 pandemic. Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale 2022. link 4 Brenner MJ, Cramer JD, McGrath BA, Balakrishnan K, Stepan KO, Pandian V et al.. Oral Intubation Attempts in Patients With a Laryngectomy: A Significant Safety Threat. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2021. link 5 Leemans M, van Alphen MJA, Dirven R, Verkerke GJ, Hekman EEG, van den Brekel MWM. Improving Hands-free Speech Rehabilitation in Patients With a Laryngectomy: Proof-of-Concept of an Intratracheal Fixation Device. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2021. link 6 Elson NC, Martinez DC, Cervenka BP. Current opinions in otolaryngology and head and neck surgery: functional considerations in reconstruction after laryngectomy. Current opinion in otolaryngology & head and neck surgery 2020. link 7 Hancock KL, Ward EC, Hill AE. Factors contributing to clinician training and development in the clinical area of laryngectomy and tracheoesophageal voice. International journal of language & communication disorders 2020. link 8 Raquel ACS, Buzaneli EP, Silveira HSL, Simões-Zenari M, Kulcsar MAV, Kowalski LP et al.. Quality of life among total laryngectomized patients undergoing speech rehabilitation: correlation between several instruments. Clinics (Sao Paulo, Brazil) 2020. link 9 Chen Q, Luo J, Li JP, Jian DN, Yuchi Y, Ruan HX et al.. Influence of Collective Esophageal Speech Training on Self-efficacy in Chinese Laryngectomees: A Pretest-posttest Group Study. Current medical science 2019. link 10 Singer S, Vogel HJ, Guntinas-Lichius O, Erdmann-Reusch B, Fuchs M, Taylor K et al.. Multicenter prospective study on the use and outcome of rehabilitation after total laryngectomy in Germany. Head & neck 2019. link 11 Barber SR, Kozin ED, Naunheim MR, Sethi R, Remenschneider AK, Deschler DG. 3D-printed tracheoesophageal puncture and prosthesis placement simulator. American journal of otolaryngology 2018. link 12 Thylur DS, Villegas BC, Fisher LM, Sinha UK, Kokot N. Device Life of Two Generations of Provox Voice Prostheses. The Annals of otology, rhinology, and laryngology 2016. link 13 Şahin M, Ogut MF, Vardar R, Kirazli T, Engin EZ, Bor S. Novel esophageal speech therapy method in total laryngectomized patients: biofeedback by intraesophageal impedance. Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus 2016. link 14 Cnossen IC, van Uden-Kraan CF, Eerenstein SE, Rinkel RN, Aalders IJ, van den Berg K et al.. A Participatory Design Approach to Develop a Web-Based Self-Care Program Supporting Early Rehabilitation among Patients after Total Laryngectomy. Folia phoniatrica et logopaedica : official organ of the International Association of Logopedics and Phoniatrics (IALP) 2015. link 15 Benyamini L, Gil Z, Cohen JT. Management of aphonic patients following total laryngectomy and trachea esophageal puncture. The Israel Medical Association journal : IMAJ 2014. link 16 Singer S, Meyer A, Fuchs M, Schock J, Pabst F, Vogel HJ et al.. Motivation as a predictor of speech intelligibility after total laryngectomy. Head & neck 2013. link 17 Singer S, Wollbrück D, Dietz A, Schock J, Pabst F, Vogel HJ et al.. Speech rehabilitation during the first year after total laryngectomy. Head & neck 2013. link 18 Onofre F, Ricz HM, Takeshita-Monaretti TK, Prado MY, Aguiar-Ricz LN. Effect of singing training on total laryngectomees wearing a tracheoesophageal voice prosthesis. Acta cirurgica brasileira 2013. link 19 Cocuzza S, Bonfiglio M, Grillo C, Maiolino L, Malaguarnera M, Martines F et al.. Post laryngectomy speech rehabilitation outcome in elderly patients. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2013. link 20 Balm AJ, van den Brekel MW, Tan IB, Hilgers FJ. The indwelling voice prosthesis for speech rehabilitation after total laryngectomy: a safe approach. Otolaryngologia polska = The Polish otolaryngology 2011. link70731-4) 21 Marszałek S, Zebryk-Stopa A, Kraśny J, Obrebowski A, Golusiński W. Estimation of influence of myofascial release techniques on esophageal pressure in patients after total laryngectomy. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2009. link 22 Eadie TL. Application of the ICF in communication after total laryngectomy. Seminars in speech and language 2007. link 23 Ho TP, Gray J, Ratcliffe AA, Rees S, Rockey J, Wight RG. Does cognitive function influence alaryngeal speech rehabilitation?. Head & neck 2006. link 24 Chone CT, Spina AL, Crespo AN, Gripp FM. Speech rehabilitation after total laryngectomy: long-term results with indwelling voice prosthesis Blom-Singer. Brazilian journal of otorhinolaryngology 2005. link31207-6) 25 Smithwick L, Davis P, Dancer J, Hicks GS, Montague J. Female laryngectomees' satisfaction with communication methods and speech-language pathology services. Perceptual and motor skills 2002. link 26 Carr MM, Schmidbauer JA, Majaess L, Smith RL. Communication after laryngectomy: an assessment of quality of life. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2000. link70141-0) 27 Deschler DG, Doherty ET, Reed CG, Hayden RE, Singer MI. Prevention of pharyngoesophageal spasm after laryngectomy with a half-muscle closure technique. The Annals of otology, rhinology, and laryngology 2000. link 28 Vieira MB, Maia AF, Ribeiro JC. Speech rehabilitation after laryngectomy with the amatsu tracheoesophageal shunt. Auris, nasus, larynx 1999. link00065-0) 29 Chung RP, Geskus J, Mahieu HF. The ultra-low resistance Groningen voice prosthesis: aerodynamic properties. Revue de laryngologie - otologie - rhinologie 1999. link 30 Coltart L. Voice restoration after laryngectomy. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 1998. link 31 van den Hoogen FJ, Van den Berg RJ, Oudes MJ, Manni JJ. A prospective study of speech and voice rehabilitation after total laryngectomy with the low-resistance Groningen, Nijdam and Provox voice prostheses. Clinical otolaryngology and allied sciences 1998. link 32 Max L, De Bruyn W, Steurs W. Intelligibility of oesophageal and tracheo-oesophageal speech: preliminary observations. European journal of disorders of communication : the journal of the College of Speech and Language Therapists, London 1997. link 33 Brimacombe J, Brain A, Branagan H, Spry M, Schofield J. Optimal shape of the laryngeal mask cuff: the influence of three deflation techniques. Anaesthesia 1996. link 34 Geraghty JA, Wenig BL, Smith BE, Portugal LG. Long-term follow-up of tracheoesophageal puncture results. The Annals of otology, rhinology, and laryngology 1996. link 35 Parker AJ, Yardley M, Lacy P, Heaton JM, Parker G. Trends in voice rehabilitation in the United Kingdom. Folia phoniatrica et logopaedica : official organ of the International Association of Logopedics and Phoniatrics (IALP) 1995. link 36 Prichard AJ, Powell A, Samuel PR, Stafford FW. Surgical voice restoration: the Sunderland experience. Journal of the Royal College of Surgeons of Edinburgh 1994. link 37 Heaton JM, Parker AJ. Indwelling tracheo-oesophageal voice prostheses post-laryngectomy in Sheffield, UK: a 6-year review. Acta oto-laryngologica 1994. link 38 Subbarao PB, Shenoy AM, Nanjundappa, Anantha N. Post laryngectomy rehabilitation the case for planned early speech therapy. Indian journal of cancer 1991. link 39 Mathieson CM, Stam HJ, Scott JP. Psychosocial adjustment after laryngectomy: a review of the literature. The Journal of otolaryngology 1990. link 40 Singh W. Clinical application of electrolaryngograph for speech rehabilitation in near-total laryngectomy with myo-mucosal valved neoglottis. The Journal of laryngology and otology 1988. link 41 Graner D, Kanter A, Klor BM, Milianti FJ. Speech and swallow following Staffieri voice restoration procedure. The Journal of speech and hearing disorders 1982. link 42 Kelly DR, Adamovich BL, Roberts TA. Detailed investigation of alaryngeal speech to elucidate etiology of variation in quality. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 1981. link 43 Volin RA. Predicting failure to speak after laryngectomy. The Laryngoscope 1980. link 44 Welch RW, Gates GA, Luckmann KF, Ricks PM, Drake ST. Change in the force-summed pressure measurements of the upper esophageal sphincter prelaryngectomy and postlaryngectomy. The Annals of otology, rhinology, and laryngology 1979. link 45 Light J, Hill N. The use of a prosthetic speech aid for a laryngectomized esophageal speaker with right hemiparesis of the tongue: a case report. Journal of communication disorders 1978. link90032-1)

Laryngectomy scar