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Laryngectomy – surgical and SLT perspectives

Mr Hartley SRH Mr O’Hara SRH Mr Ragbir RVI. Lynn Bolden SRH/FH Sarah Owen FH. Laryngectomy – surgical and SLT perspectives. Programme. Options and selection Swallowing problems Valve complications Quiz. History of speech rehabilitation in laryngectomy. Oesophageal voice

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Laryngectomy – surgical and SLT perspectives

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  1. Mr Hartley SRH Mr O’Hara SRH Mr Ragbir RVI Lynn Bolden SRH/FH Sarah Owen FH Laryngectomy – surgical and SLT perspectives

  2. Programme • Options and selection • Swallowing problems • Valve complications • Quiz

  3. History of speech rehabilitation in laryngectomy • Oesophageal voice • 1932: Ice pick • Electro-larynx • 1980 Secondary SVR • 1985 Primary SVR • 2011…..

  4. Surgical and SLT perspectives: • Communication options • Characteristics, advantages and disadvantages • Selection • Surgical/medical/non-surgical/outcome/evidence • Measuring outcomes

  5. Electrolarynx Oesophageal voice

  6. Surgical voice restoration (SVR)

  7. Production of voice

  8. Impact of altered speech • Verbal • Basic or complex information, telephone, social exchanges • Non verbal expression • Power, superiority, trust, seduction, vulnerable, encouragement etc • Emotional expression • Joy, fear, sadness, anger • Physical changes • Effort, fatigue, breathing, volume, pitch, intonation • Inconsistent and unreliable (E.L. ex)

  9. Cont. • Vocal Image • Gender, culture, intelligence, class, personality: kind, warm.. • Reactions from others • Deaf, low intelligence • Left out, avoided • Adverse attention or comments • misunderstandings • Environmental/situational limitations • Noisy or smoky environments • Telephone • Meal times • Group situations

  10. Communication options and voice characteristics. Exercise 1 • Use exercise 1 sheet to rate/describe voices • Recordings • E1, M Scar, OV, MDay • Next slide valve • DVD TW • Then… WLvs D Wil, JMc, N Murph, Len

  11. Communication options - selection • Exercise 2 • Divide into 3 groups • Mixture of Senior and junior SpRs

  12. Summary of surgical and SLT considerations/literature

  13. “Primary SVR should be offered to all patients undergoing laryngectomy” (H & N guidelines ‘11) • Discuss…

  14. Swallowing in laryngectomy • Swallowing problems and outcomes • ENT and plastic’s perspectives • Assessment and management

  15. Exercise 3 • Swallowing is the main concern for your patient. He is making the decision about whether to have treatment, or which treatment option to have, based on the information you give. • Describe the short and long term swallowing outcomes for your patient. Explain the sorts of problems he may encounter and any future assessments or treatments that may be required.

  16. Clinical presentation • Increased effort & time to eat • Sticking • Limited consistencies • Weight loss • Regurgitation – nasal/oral • Bloating/belching • Voice and valve problems • Other – upper/lower GI…

  17. ENT perspective

  18. Plastic’s perspective

  19. Assessments • Which assessment when? • Comprehensive history - may have been assessed extensively! • EUA • TNO • Ba Swallow/Videofluoroscopy/combined • Other imaging • Valve assessment • Other

  20. Case recordings/images • Normal swallow, Jej, ALT, pseudo-epiglottis, stricture, multiple problems • Surgical management • Other: SLT, lymphoedema, nutrition, psychology/support groups

  21. Which outcomes should we measure? • Discuss

  22. Multi-perspective Patient: voice/swallow related QOL Voice: quality Intelligibility Valve complications Cost Dietary intake WST Longitudinal Comparison with other methods – Do patients adapt what ever their communication method? Primary Vs secondary Outcome measurements

  23. What outcomes should we measure? • Multi-perspective • Primary Vs Secondary SVR??? • Validated/ratings of voice and swallow function • SRH rating scale • Intelligibility? % use by patient? • Normalcy of diet, WST • Validated questionnaires of patient’s perception • Valve complications • Valve cost • Enteral feeding

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