RESUMEN
Tracheo-esophageal speech using various prostheses is currently the most successful form of voice and speech rehabilitation for laryngectomies. Main inter-device differences are durability and trans-device pressure loss during speech. The valveless indwelling Nijdam voice prosthesis is a new voice prosthesis. A barrier mechanism is created by a combination of the esophageal mucosa and the umbrella-like "hat" of the prosthesis that covers the esophageal side of the tracheo-esophageal fistula. The Nijdam prosthesis can be used clinically for longer periods of time when compared to such other indwelling voice prostheses as the Provox prosthesis and the low-resistance Groningen prosthesis. However, transdevice pressure loss during speech has been unknown. Adjustment of the shft length of the Nijdam voice prosthesis to tracheo-esophageal wall thickness was expected to affect trans-device pressure loss during speech. We report the results of in vitro tests to quantify the effect of tracheo-esophageal wall thickness on trans-device pressure loss. In the present study pressure loss was measured at different air flow rates in relation to tracheo-esophageal wall thickness. Findings demonstrated that when shaft length of the Nijdam prosthesis corresponded exactly to tracheo-esophageal wall thickness, trans-device pressure loss was comparable to that of the Provox prosthesis. If a relatively shorter Nijdam prosthesis was chosen to prevent aspiration from occurring, the pressure loss across the prosthesis increased to that of the low-resistance Groningen prosthesis.
Asunto(s)
Laringectomía/rehabilitación , Laringe Artificial , Ventilación Pulmonar/fisiología , Voz Esofágica , Esófago/fisiopatología , Humanos , Fonación/fisiología , Diseño de Prótesis , Tráquea/fisiopatología , Transductores de PresiónRESUMEN
Voice prosthesis-assisted speech rehabilitation after total laryngectomy has proven to be successful in the majority of patients and exceeds the results of traditional oesophageal speech. Nevertheless 10-30% failure rates are still reported. In part this is due to prosthesis-related problems, in particular ingrowth of Candida species in the valve-bearing parts of the devices. A new indwelling, low-resistance and valveless voice prosthesis is described; the Nijdam voice prosthesis. The device has an average device lifetime of 19 weeks which appears to be superior to other indwelling voice prostheses. Replacement indications mainly comprise leakage or increased airflow resistance. Most frequent local complications are granulation tissue and hypertrophic scar tissue formation. These occur in 12% of the patients and can easily be treated. Replacement is a simple outpatient procedure. The prosthesis is interchangeable with other types of indwelling voice prosthesis.
Asunto(s)
Laringectomía , Laringe Artificial , Voz Alaríngea , Entrenamiento de la Voz , Diseño de Equipo , HumanosRESUMEN
The Groningen, Nijdam and Provox voice prostheses (VP) are all low-pressure, indwelling voice prostheses. Although there are differences concerning the valve mechanism, they have a similar design and are therefore interchangeable. In a prospective study, 845 consecutive replacements were evaluated in 158 patients. Average device lifetime differed significantly from 13 weeks for the Provox VP and 15.8 weeks for the Groningen VP, to 19 weeks for the Nijdam device. Leakage through or around a voice prosthesis was the main replacement indication. Leakage occurred significantly more often with the Provox VP (80.2%) than with the Groningen VP (58.8%) or the Nijdam VP (55%). Increased airflow resistance as a replacement indication occurred significantly more often with the Groningen VP (45.4%) and the Nijdam VP (45.9%) than with the Provox VP (22.7%). Complications during the replacement procedure were rare and usually mild. Replacement was usually an easy outpatient procedure; general anaesthesia was only necessary in 3.0% of 845 replacements, without any significant difference between the three devices. Granulation tissue and hypertrophic scar tissue formation were the most frequent local complications. They occurred in less than 10% of our patients but were significantly more common in patients with a Nijdam VP.
Asunto(s)
Laringe Artificial , Falla de Prótesis , Voz Alaríngea , Resistencia de las Vías Respiratorias , Humanos , Laringectomía , Estudios Prospectivos , Entrenamiento de la VozRESUMEN
Electrophysiological recordings were made from the hearing organs of young waltzing guinea pigs of different ages. Age-related morphological changes in the cochleas of the same animals were studied with scanning and transmission electron microscopy. Results were compared with the results of studying the cochleas of normal guinea pigs of the same age. Waltzing guinea pigs are born with a hearing loss, as can be concluded from the magnitude of the whole-nerve action potential and their lower than normal summating potentials. However, their cochlear microphonics are nearly normal until the time in the degeneration process when hair cells start to disappear. This degeneration process begins at the tops of the hair cells and is evident upon electron microscopical examination of these structures.
Asunto(s)
Potenciales Microfónicos de la Cóclea , Potenciales Evocados Auditivos , Células Ciliadas Auditivas/ultraestructura , Pérdida Auditiva/fisiopatología , Potenciales de Acción , Factores de Edad , Animales , Cóclea/fisiopatología , Cóclea/ultraestructura , Conductividad Eléctrica , Cobayas , Pérdida Auditiva/genética , Pérdida Auditiva/patologíaRESUMEN
Singer and Blom's endoscopic technique, using a single valved silicone prosthesis, constituted a dramatic advance in speech rehabilitation following total laryngectomy. Since 1980, we have developed a silicone biflanged prosthesis that overcomes some of the inconveniences of previous prostheses. Insertion via the mouth and the oesophagus, or as a primary procedure during total laryngectomy is easily done with the use of specially developed instruments. The success rate in 36 patients in which the voice button was inserted at the time of total laryngectomy was 86.2%.
Asunto(s)
Laringectomía/rehabilitación , Laringe Artificial , Adulto , Anciano , Femenino , Humanos , Laringectomía/métodos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Elastómeros de SiliconaRESUMEN
Compound action potentials (AP) are measured in guinea pigs during stimulation with damped waves or with tone bursts. Results are compared in order to investigate whether damped waves are suitable stimuli for brainstem-evoked response audiometry. This investigation was done because a combination of brainstem-evoked response audiometry with otometry was recently proposed. Otometry is a hearing aid fitting method using damped waves as acoustic stimuli.