Investigation And Evaluation Of The Dalian Area After Total Laryngectomy Voice Way

Background:Laryngeal cancer and stomach cancer is clinically common malignant tumor in otolaryngology head and neck surgery.Laryngeal carcinoma accounts for ENT malignant tumor 11%-22% and hypopharyngeal cancer accounts for 1.4%-5%.Total laryngectomy for laryngeal cancer has 100 years of history,is the most basic operation in the treatment of throat malignant tumor,accounting for laryngeal cancer operation in clinical use of 50%-60%.Total laryngectomy patients after oral intake, breathing through tracheal stoma, loss of self-speech function, leading to decreased quality of life.Current clinical after total laryngectomy phonation methods including surgical reconstruction(including tracheoesophageal fistula voice reconstruction, placing pronunciation button and placing pronunciation tube), esophageal phonation method, artificial instruments(including electronic artificial larynx larynx, etc.).Choose the best vocal after total laryngectomy, is the Department of ENT doctor constantly explore the topic.Estimating voice after total laryngectomy is the main method for selecting operation mode of sound.At present the subjective evaluation of commonly used methods include the GRBAS evaluation method is proposed by Japanese language voice medicine and CAPE-V evaluation method proposed by American speech and hearing association. Objective evaluation method of voice, including testing aerodynamics; voice acoustic analysis and detection; observation of vocal cord movement; laryngeal nerve EMG analysis etc.. One of the more widely used is the voice acoustic analysis and detection.Objective: To investigate the application of patients after total laryngectomy in Dalian auxiliary sound manner; Cutthroat patients by comparing voice quality sound emitted by a variety of ways to choose the best assist patients without larynx sound way to provide a reference.Methods: To review 73 patients after total laryngectomy with laryngeal carcinoma or hypopharyngeal carcinoma in Second Hospital Affiliated to Dalian Medical University, Zhongshan Hospital Affiliated to Dalian University and Dalian Friendship Hospital. Select artificial laryngeal reconstruction in 20 cases, electronic laryngeal reconstruction in 12 cases, 6 cases of esophageal phonation.Subjective assessment of voice: respectively evaluate voice in the speech clear degree, verbal fluency, sound intensity and timbre, through the 5 score. Voice objective assessment:The Xion speech spectrum analyzer Made in Germany is used for objective evaluation analysis, related parameters including; fundamental frequency; sound intensity; fundamental frequency perturbation, maximum phonation time and breath syllables.Results: 1. follow-up of 73 cases of total laryngectomy patients, including 27 cases of artificial larynx voice, accounted for 36.99%; 14 cases of electronic laryngeal, accounted for 19.18%; 6 cases of esophageal phonation, accounted for 8.22%, more than 35.61% to handwritten or hand gestures to communicate. 2. In the speech articulation and coherence,the difference was statistically significant of artificial in larynx group and electronic larynx group(P < 0.01), there was significant difference in speech intelligibility, coherence, sound and tone of artificial larynx group and esophageal phonation group(P < 0.01). Subjective assessment of artificial larynx voice quality is better than the group electronic larynx group, esophageal phonation group. 3. The artificial larynx group, electronic throat voice fundamental frequency, sound intensity is higher than esophageal voice. 4. Artificial larynx fundamental frequency perturbation lower esophageal voice group, electronic larynx group 5. Artificial laryngeal voice pronunciation longest time, relief syllable number higher than that of esophageal voice group. 6. There is a correlation between the objective analysis of parameters and subjective evaluation scores.Conclusion: Dalian area after total laryngectomy patients using artificial laryngeal vocal majority, application of artificial laryngeal vocal language, fluent, coherent noise, to meet the basic needs of daily conversation, is the first choice after total laryngectomy voice reconstruction.