Total larenjektomiden sonra vokal rehabilitasyon

Total larenjektomi sonrası kalıcı ses kaybı, rutin uygulamaları kötü yönde etkilemekte, ekonomik, sosyal ve psikolojik değişimlere sebebiyet vermektedir. Larenks olmaksızın konuşmadaki etkin gelişmeler, larenjektomili hastanın rehabilitasyonunda büyük bir önem taşımaktadır. Larenjektomili hastaların vokal rehabilitasyonunda uygulanan metodlar, özofageal konuşmadaki gelişmeler, yapay larenksler ve son zamanlarda sesin cerrahi restorasyonunu içermektedir. Trekeoözofageal fistül tekniği ve valvüllü ses protezlerinin uygulanmaya başlanması larenjektomililerin konuşma rehabilitasyonuna üçüncü bir alternatif sunmuştur. Total larenjektomi sonrası ses rehabilitasyonunu gerçekleştirmek, pulmoner havayı özofagus veya hipofarenkse yönlendirmekle olur. Cerrahpaşa Tıp Fakültesi KBB Anabilim Dalında 1993 yılından 2000 yılına kadar total larenjektomi uygulanmış ve özofagus konuşmasından yarar görememiş 20 hastaya sekonder ses restorasyonu, 15 hastaya da total larenjektomi operasyonu esnasında primer ses restorasyonu uygulanmıştır. 35 hastanın 20 tanesine provox, 15 tanesine de Blom-Singer silikon ses protezleri takılmıştır. Çalışmamızda Trekeoözofageal fistül tekniği ile takılan Provox ve Blom Singer silikon ses protezleri arasındaki ses kalitesi avantaj ve dezavantajları literatür ışığında tartışılmıştır.

Vocal rehabilitation following total laryngectomy

Background and Design.- Permanent loss of voice severely disrupts routine interaction and can result in economic, social and psychological change. The development of effective alaryngeal speech is a major step in rehabilitation of a laryngectomy patient. Current methods of vocal rehabilitation after laryngectomy includes development of esophegeal speech, use of artificial larynges and more recently, surgical restoration of voice. With the introduction of the tracheoesophageal puncture technique and valved prosthesis, a third alternative for alaryngeal speech rehabilitation became available. Restoration of voice after total laryngectomy may occur with diversion of exhaled pulmonary air into the esophagus or hypopharynx. The aim of this study was to compare the speech quality and complications between Provox and Blom-Singer voice prostheses in 35 patients who were operated at Cerrahpaşa School of Medicine Otolaryngology department. Results.- Overall, Provox and Blom-Singer prosthesis give very similar voice quality, life time, and patient satisfaction. Cleaning management is somewhat better than Provox but there is a trend toward better voice quality for Blom-Singer prosthesis. Secondarily placed prostheses scores are better than primary placements, and the patients with total laryngectomy have better voices than patients with extended laryngectomy combined with partial laryngectomy. Conclusion.- We discussed the advantages and disadvantages of Provox and Blom Singer silicon voice prosthesis which are inserted by tracheooesophageal puncture technique. Given the equal and good results in terms of voice quality, other factors such as cost, maintenance and patient reference should be taken into consideration when deciding which type of tracheooesophageal voice prosthesis to use.

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