Voice prosthesis

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Voice prosthesis

A voice prosthesis is an aid that enables those affected to speak after a laryngectomy . This is necessary because a laryngectomy removes the larynx , which connects the trachea and esophagus to the throat . The windpipe is then connected to the tracheostoma and the esophagus to the throat. Since the vocal folds are removed with the larynx during a larnygectomy, no more voice-forming vibrations can be generated in the area of ​​the tracheostoma exit.

Without aids, those affected are severely impaired in communication . The establishment of a connection between the trachea and the esophagus enables the air required for speaking to be pushed into the pharynx by closing the outer opening of the tracheostoma (with a finger). Voice training then takes place there. The mucous membrane parts of the pharynx are set in motion. One speaks of a pseudoglottis. The voice-like noise generated in this way can be modulated in the nozzle just like the previous physiological voice. What is a disease as a tracheo-oesophageal fistula is surgically brought about here. To prevent saliva, liquids and solid food from entering the lungs from the esophagus, the prosthesis has a flap on the side of the esophagus.

In addition to the voice prosthesis, other language aids are also offered, such as the electrolarynx.

history

Artificial larynx

In 1869 Czermak constructed the first artificial larynx. In 1873 Theodor Billroth performed a laryngectomy and provided the patient with an artificial larynx. A current development is experimental.

Voice prosthesis

A description of a voice prosthesis in today's form was made in 1972 by Erwin Mozolewski. Since then, there have been numerous developments and advances in this area of rehabilitation . The leading manufacturers are Adeva, Eska, Heimomed, InHealth and Atos Medical.

The first prosthesis available on the market was offered in 1980. The "Blom-Singer Duckbill", an interchangeable prosthesis with a diameter of 5.3 mm (16 French), without tabs that the patient could remove, clean and replace himself. The first indwelling prosthesis was described in 1984.

Examples of development processes

Atos Medical (Provox)
In 1990 the first Provox voice prosthesis, manufactured by Atos Medical, was introduced.
This was followed in 1997 by the Provox2 and in 2003 by the Provox ActiValve and in 2005 by the Provox NID indwelling prosthesis

The third generation from 2009 was Provox Vega with the SmartInserter introducer.

InHealth (Blom-Singer)
1994 Market launch of the Blom-Singer Classic indwelling prosthesis. This voice prosthesis, like the Blom-Singer Advantage indwelling prosthesis, can only be used and replaced by medical professionals such as doctors or speech therapists .

Replacement and indwelling prostheses

Interchangeable prostheses can be changed by the patient himself, while indwelling prostheses have to be changed by a doctor. Interchangeable prostheses have a safety band and sometimes a cord with a safety plate that is too large to slip into the tracheostoma.

Design of voice prostheses

The different voice prostheses have a similar design, even if they differ from one another in details. The connecting tube has a flange on both sides. The flange on the esophageal side is usually stronger. The seat of the valve flap is often identified and reinforced by a colored ring, which is also X-ray positive .

All voice prostheses have a safety band, which is cut off after insertion in interchangeable prostheses and attached to the neck in indwelling prostheses.

The properties of voice prostheses

material

Voice prostheses are usually made from silicone rubber . The valve flap and the valve seat are made of silicone or fluoroplastic and are partially coated with silver oxide.

size

The size of the voice prosthesis depends on the thickness of the layer between the esophagus and trachea. Accordingly, the speech prosthesis is between 4 and 22 mm long. The outer diameter is between 5.3 and 7.5 mm.

Studies have shown that larger outer diameters of the voice prosthesis promote airflow and therefore improve speech quality.

Voice prosthesis and fungal infection

Fungal infestation is a particular problem with voice prostheses that can severely impair the service life, as it disrupts their locking function. Some voice prostheses therefore have a magnet for support, while others are coated or coated with silver oxide to prevent the formation of a biofilm . However, the use of silver is the subject of research. The fungal infestation that shortens the length of time the prosthesis remains can be reduced through appropriate nutrition. Lactic acidic foods reduce, sugar-rich and carbohydrate-rich foods promote fungal attack.

cleaning

Regular cleaning of the voice prosthesis is important because the ( silicone ) material is exposed to fungi and bacteria that are naturally present there. The growth of yeast on or in the area of ​​the valve flap of the voice prosthesis can impair its function.

to brush

The inside of the voice prosthesis is usually cleaned with a brush to remove saliva and food particles. This should be done regularly in order to maintain their function and increase their service life.

do the washing up

The voice prosthesis can also be rinsed with water or air. A combination of both approaches is common.

Disruptions

Voice prostheses have to be replaced regularly because they no longer work properly due to deposits and therefore saliva and drinks get from the esophagus into the airways and trigger a coughing sensation there. If these disturbances cannot be eliminated by cleaning, this is a sign that a change is necessary. If this is not possible for a short time, the connection can be blocked for eating and drinking.

Lifespan of voice prostheses

The lifespan of voice prostheses ranges from a few weeks to two years, depending on the circumstances of the individual case.

The lifespan of voice prostheses is also determined by the daily food intake, which influences the infestation by fungi. A radiation therapy and gastroesophageal reflux disease (heartburn) influence the life of voice prostheses.

The reasons for the need to change are usually leaks, but also fistula formation, granulations, increased opening pressure and loss of the voice prosthesis.

Speech quality and language effort

The speech quality when using a speech prosthesis depends on breathing performance, the air resistance of the prosthesis and the voice source.

Speech prosthesis and respiratory gas humidification

Breathing gas humidification is important for use .

Other language aids

Because of the elementary importance of language for social interaction , numerous speech aids have been developed.

  • Electrolarynx . This generates sound vibrations that the person concerned can modulate with the remaining parts of the speaking tract .

Other alternative language forms

  • Oesophageal , even Rülpsstimme or Ructusstimme or Pharynxsprache called
  • Electronic voice simulator
  • Electronic voice amplifier
  • Use of the whisper or pseudo-whisper

literature

Web links

Remarks

  1. ↑ The name 'voice prosthesis' is common, although the voice is not formed by this aid
  2. ↑ Provox is the trademark of the Atos Medical Group and stands for the design
  3. ↑ Blom-Singer is the trademark of InHealth and stands for the design
  4. ↑ This poses a challenge to the material properties and auxiliary devices. For example "Adeva BigFlow", in which the esophageal flange is folded up in the shunt and pushed into the tracheostoma of the esophagotracheal fistula.
  5. ↑ A study by the Free University of Berlin comes to a different conclusion
  6. ↑ Learning is not always successful

Individual evidence

  1. ↑ UltraVoice - Traditional Options Comparison With UltraVoice Plus . Retrieved January 10, 2017.
  2. ↑ [ http://www.ultravoice.com/index.htm UltraVoice Plus is the breakthrough you've been looking for! The Loudest, Clearest, and Most Natural!] . Retrieved January 10, 2017.
  3. ↑ Sabine Reutter: Prosthetic voice rehabilitation after total larynx removal - a historical treatise since Billroth (1873) . University, Ear, Nose and Throat Clinic Ulm. Retrieved February 16, 2018.
  4. ^ Prosthetic voice rehabilitation after total larynx removal - a historical treatise since Billroth (1873) . Retrieved January 8, 2017.
  5. ↑ First implantation of an artificial larynx. Retrieved April 16, 2019 .
  6. ↑ E. Mozolewski: Surgical rehabilitation of voice and speech Following laryngectomy . In: Otolaryngol Pol (ed.): Otolaryngol Pol . , 26 (6) 1972, pp. 653-661.
  7. ↑ Adeva BigFlow . Archived from the original on January 10, 2017. Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved January 8, 2017. @1@ 2Template: Webachiv / IABot / www.stimmprothese.com
  8. ↑ Heimomed Phonax prosthesis . Accessed December 30, 2018.
  9. ↑ InHealth Technologies . Retrieved January 9, 2017.
  10. ↑ Who we are . Retrieved January 9, 2017.
  11. ↑ MI Singer, Blom ED .: An endoscopic technique for restoration of voice after laryngectomy . In: Ann Otol Rhinol Laryngol . 89, No. 6 Pt 1, 1980, pp. 529-533. PMID 7458140 .
  12. ^ Manni JJ, van den Broek P, de Groot MA, Berends E: Voice rehabilitation after laryngectomy with the Groningen prosthesis . In: J Otolaryngol . 13, No. 5, 1984, pp. 333-336. PMID 6544851 .
  13. ^ FJ Hilgers, Schouwenburg PF: A new low-resistance, self-retaining prosthesis (Provox) for voice rehabilitation after total laryngectomy . In: Laryngoscope . 100, No. 11, 1990, pp. 1202-1207. doi : 10.1288 / 00005537-199011000-00014 . PMID 2233085 .
  14. ↑ FJ Hilgers, Ackerstaff AH., Balm AJ. Tan IB. Aaronson NK., Persson JO .: Development and clinical evaluation of a second-generation voice prosthesis (Provox 2), designed for anterograde and retrograde insertion . In: Acta Otolaryngol . 117, No. 6, 1997, pp. 889-896. doi : 10.3109 / 00016489709114220 . PMID 9442833 .
  15. ↑ FJ., Hilgers, Ackerstaff AH., Balm AJ., Van den Brekel MW., Bing Tan I., Persson JO .: A new problem-solving indwelling voice prosthesis, eliminating the need for frequent Candida and "underpressure" - related replacements: Provox ActiValve . In: Acta Otolaryngol . 123, No. 8, 2003, pp. 972-979. doi : 10.1080 / 00016480310015371 . PMID 14606602 .
  16. ↑ K Hancock, Houghton B., As-Brooks CJ., Coman W.,: First clinical experience with a new non-indwelling voice prosthesis (Provox NID) for voice rehabilitation after total laryngectomy . In: Acta Otolaryngol . 125, No. 9, 2005, pp. 981-990. doi : 10.1080 / 00016480510043486 . PMID 16109676 .
  17. ^ FJ Hilgers, Ackerstaff AH., Van RM., Jacobi I., Balm AJ., Tan IB., Van Den Brekel MW .: Clinical phase I / feasibility study of the next generation indwelling Provox voice prosthesis (Provox Vega) . In: Acta Otolaryngol . 130, No. 4, 2010, pp. 511-519.
  18. ↑ FJ. Hilgers, Ackerstaff AH., Jacobi I., Balm AJ., Tan IB., Van den Brekel MW .: Prospective clinical phase II study of two new indwelling voice prostheses (Provox Vega 22.5 and 20 Fr) and a novel anterograde insertion device ( Provox Smart Inserter) . In: Laryngoscope . 120, No. 6, 2010, pp. 1135-1143. doi : 10.1002 / lary.20925 . PMID 20513030 .
  19. ^ Ward EC, K. Hancock, N. Lawson, van As-Brooks CJ .: Perceptual characteristics of tracheoesophageal speech production using the new indwelling Provox Vega voice prosthesis: a randomized controlled crossover trial . In: Head Neck . 33, No. 1, 2011, pp. 13-19 . Doi : 10.1002 / hed.21389 . PMID 20848411 .
  20. ^ P Kress, Schafer P., Schwerdtfeger FP., Roesler S .: Measurement and comparison of in vitro air-flow characteristics of the most frequently used European indwelling voice prostheses types . In: 6th European Congress of oto-Rhino-Laryngology Head and Neck Surgery, June 30 - July 4, 2007, Vienna, Austria . 2007.
  21. ^ Hancock K, B. Houghton, As-Brooks CJ, Coman W: First clinical experience with a new non-indwelling voice prosthesis (Provox NID) for voice rehabilitation after total laryngectomy . In: Acta Otolaryngol . 125, No. 9, 2005, pp. 981-990. doi : 10.1080 / 00016480510043486 . PMID 16109676 .
  22. ↑ Provox NID Deployment Procedure . Archived from the original on January 10, 2017. Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved January 9, 2017. @1@ 2Template: Webachiv / IABot / www.stimmprothese.com
  23. ^ FJ Hilgers, Ackerstaff AH, van RM: Clinical phase I / feasibility study of the next generation indwelling Provox voice prosthesis (Provox Vega) . In: Acta Otolaryngol . 2010.
  24. ↑ Influence of silver on the vitality of biofilms of clinically relevant bacteria . Retrieved January 9, 2017.
  25. ↑ Silver is not a well-tolerated bacteria killer . Retrieved January 9, 2017.
  26. ↑ ATOS: HMEs - How can I prevent fungal infections on the voice prosthesis? . Retrieved March 10, 2017.
  27. ^ R Van Weissenbruch, Albers FW, Bouckaert S, HJ Nelis, G Criel, JP Remon, AM Sulter: Deterioration of the Provox silicone tracheoesophageal voice prosthesis: microbial aspects and structural changes . In: Acta Otolaryngol . 117, No. 3, 1997, pp. 452-458. doi : 10.3109 / 00016489709113420 . PMID 9199534 .
  28. ↑ RH Free, Van der Mei HC, Elving GJ, Van Weissenbruch R, Albers FW, Busscher HJ: Influence of the Provox Flush, blowing and imitated coughing on voice prosthetic biofilms in vitro . In: Acta Otolaryngol . 123, No. 4, 2003, pp. 547-551. doi : 10.1080 / 0036554021000028118 . PMID 12797592 .
  29. ↑ Blom-Singer rinsing pipette . Archived from the original on April 18, 2017. Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved March 6, 2017. @1@ 2Template: Webachiv / IABot / www.fahl-medizintechnik.de
  30. ↑ FJ Hilgers, Balm AJ: Long-term results of vocal rehabilitation after total laryngectomy with the low-resistance, indwelling Provox voice prosthesis system . In: Clin Otolaryngol . 18, No. 6, 1993, pp. 517-523. doi : 10.1111 / j.1365-2273.1993.tb00627.x . PMID 8877233 .
  31. ↑ LQ Schwandt, van WR, Van der Mei HC, Busscher HJ, Albers FW: Effect of dairy products on the lifetime of Provox2 voice prostheses in vitro and in vivo . In: Head Neck . 27, No. 6, 2005, pp. 471-477. doi : 10.1002 / hed.20180 . PMID 15825199 .
  32. ^ P Boscolo-Rizzo, Marchiori C, Gava A, Da Mosto MC: The impact of radiotherapy and GERD on in situ lifetime of indwelling voice prostheses . In: Eur Arch Otorhinolaryngol . 265, No. 7, 2008, pp. 791-796. doi : 10.1007 / s00405-007-0536-1 . PMID 18008081 .
  33. ↑ Lifespan of voice prostheses . Free University of Berlin . Retrieved March 10, 2017.
  34. ^ FJ Hilgers, Cornelissen MW, Balm AJ: Aerodynamic characteristics of the Provox low-resistance indwelling voice prosthesis . In: Eur Arch Otorhinolaryngol . 250, No. 7, 1993, pp. 375-378. doi : 10.1007 / bf00180379 . PMID 8286099 .
  35. ^ FJ Hilgers, Ackerstaff AH, van RM, I Jacobi, AJ Balm, IB Tan, MW Van Den Brekel: Clinical phase I / feasibility study of the next generation indwelling Provox voice prosthesis (Provox Vega) . In: Acta Otolaryngol . 130, No. 4, 2010, pp. 511-519. doi : 10.3109 / 00016480903283766 . PMID 19895334 .
  36. ↑ VH Balle, Rindso L, Thomsen JC: Primary speech restoration at laryngectomy by insertion of voice prosthesis-10 years' experience . In: Acta Otolaryngol Suppl . 543, 2000, pp. 244-245. doi : 10.1080 / 000164800454512 . PMID 10909032 .
  37. ↑ ElectroLarynx speaking aid . Archived from the original on June 26, 2016. Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved March 6, 2017. @1@ 2Template: Webachiv / IABot / www.fahl-medizintechnik.de
  38. ↑ Video ( s )
  39. ↑ Hans-Georg Boenninghaus: Otolaryngology for medical students: structured according to the subject catalog 3 , 10th edition, Springer, Berlin; Heidelberg; New York; London; Paris; Tokyo; Hong Kong; Barcelona; Budapest 1993, ISBN 978-3-540-56122-4 , p. 255.
  40. ↑ Voice amplifier (with audio samples) ( en ) Accessed March 8, 2017.
  41. ↑ Voicetec® voice amplifier . Archived from the original on April 19, 2017. Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved March 8, 2017. @1@ 2Template: Webachiv / IABot / www.fahl-medizintechnik.de
  42. ↑ Procedure and system for speech recognition - speaking with a whisper or a pseudo-whisper . Retrieved March 8, 2017.