| When the tumor is malignant | When is surgery needed? |
| T - tumor size (1-4)
N- number of nodes that are invaded
M- presence or absence of metathesis | The TNM --> tumor nodule status refers to what? |
| injection and inhalation method | What are two methods of esophageal speech? |
| Patient takes air in their mouth and pushes it down into the esophagus with their tongue, then expelled for esophageal speech | What is the injection method of esophageal speech? |
| Patient inhales rapidly while keeping their UES open/relaxed and creates negative pressure in their esophagus to draw in air, which is then expelled for esophageal speech | What is the inhalation method of esophageal speech? (through the stoma) |
| Breathing is done through the nose and mouth
Larynx is intact with no anatomical changes
Nose and mouth are attached to esophagus and trachea
Nose and mouth moisten, filter and heat air before it enters lungs
Sound generated by the VFs
Aspiration can occur ! | How does a patient breathe and talk prior to a laryngectomy ? |
| - Everything from the epiglottis to the glottis is removed (larynx)
- Breathe through the stoma (permanent opening in the neck) with no connection to the mouth
- Air is no longer filtered, heated or moisturized
- Mucus is expelled through stoma
- Sound is generated by a sound source (AL, TEP, esophageal speech)
- Not able to aspirate due to the disconnection between the aerodigestive track separation | How does a patient breathe and talk after a laryngectomy? |
| - the larynx is intact
- patient breathes through a tracheostomy that is temporary/permanent
- wears a trachesotomy tube
- can use a one-way valve
- cannot use a voice prosthesis | A tracheostomy results in... |
| - Larynx is removed
- Breathes through stoma (permanent)
- May wear larytube, a tracheostomy tube, or no tube
- Cannot use a one-way valve
- May use voice prosthesis | A laryngectomy results in... |
| - Stoma is between the trachea and esophagus
- Prosthesis inserted to enable voice production
Allows air into the esophagus, which is vibrated to produce sound phonation
Placed from the posterior tracheal wall and the anterior esophageal wall
You can close the stoma with your finger or one way valve
Patient is at risk for aspiration around or through the TEP | Characteristics of a tracheo-esophageal puncture (TEP) |
| heats, humidifies and filters air. | The main functions of a heat and moisture exchanging device are.. |
| stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint, which may be the result of injury or disease. | What is ankylosis? |
| arthritis, trauma, joint disease | what can cause ankylosis? |
| Hoarseness , Breathiness , Low pitch | What would be the main perceptual vocal signs of an adult with papilomas? |
| Respiratory distress
Chronic cough
Weak cry
Dysphagia
Stridor | Infants with papilomas will have: |
| Laryngeal webs | Which organic disease could be acquired or congenital? |
| incomplete maturation/ development of the larynx in utero | Laryngeal webs can be congenital due to ... |
| surgery, trauma, severe laryngeal infection, forceful intubation | Laryngeal webs can be acquired due to.. |
| TEP because...
Ease of use - vibratory source (PE segment)
Most natural sounding
Increases social interaction | Which Alaryngeal speech option is the best “gold standard” and why? |
| More susceptible to bacteria / needs to be changed often
A lot of keep up and maintenance
High cost (one-way valve)
New way of breathing and talking | What are the disadvantages of TEP? |
| TEP, artificial larynx (electrolarynx), and esophageal speech | what are the three alaryngeal speech options? |
| the articulators and neck | An artificial larynx (electrolarynx) involves the use of.. |
| Easy to use
Battery operated or USB vibratory source (external apparatus)
Readily available | What are the advantages of an artificial larynx? |
| Unnatural sounding due to radiation or swelling
External power source
Need their hands | what are the disadvantages of an artificial larynx? |
| stoma | when a laryngectomy patient coughs it goes through the ... |
| Stomas are too low
A lot of upkeep and maintenance needed
Health status - respiratory difficulties
Co-morbidities: dementia | Why are some patients after a laryngectomy not good candidates for a TEP? |
| Most cost effective
Use their own air and muscles → pharyngoesophageal (PE) segment
No external apparatus | What are the advantages of esophageal speech? |
| hard to learn
least intelligible | what are the disadvantages of esophageal speech? |
