Rehabilitation of the Laryngectomized Patients

Abstract

The recent advancement in the management of the laryngeal cancer has raised the overall cure rate to over 75%, which is uniquely high as a cancer cure rate. The number of laryngectomees going back to the society with various handicaps increases each year. The rehabilition of these people is an urgent problem.
There are four problems in rehabilitation. The first is the management of problems related to the use of a new air way. The others are the rehabilitation of voice, mental rehabilitation and the management of the senile diseases.
The department of otolaryngology, the university of Osaka has a laryngectomees' association, which consists of about 700 patients. These laryngectomees were questioned about the physical complaints. Besides the loss of speech, their complaints included intolerance of hot foods, aerophagia, difficult sipping, anosmia, tracheal bleeding in winter, abdominal blowing, frequent breaking wind, difficult straining, stenosis of tracheal stoma and urticaria.
I). The most important problem of all is a tracheal bleeding in winter. The typical finding of tracheo-bronchitis sicca hemorrhagica diffusa is the obstruction of the trachea and the bronchi due to an accumulation of blood crusts. Endoscopic removal of crusts is necessary. Patients should be instructed to maintain an adequate temperature and humidity to the air way.
II). The speech rehabilitation is the most important for laryngectomees. In Japan, Tapia's artificial larynx is widely used as an excellent substitute. Some improvements need to be directed for the easier use by begginers. The conventional type has to be raised from the tracheal stoma during each inspiration. The new type revised by us has an inspiratory valve in such a way that patient can inspire without releasing the pipe from the tracheal stoma.
Of course, the ideal substitute for normal voice is esophageal speech. To obtain the data for the more effective way of teaching esophageal speech, the mechanism of speech was studied using X-ray cinematography in 50 patients with esophageal voice. The relation of esophageal speech to respiration was studied using an indicator, which showed the direction of air current during respiration. The direction thus recorded is shown as a line in the films.
The author could obtain some additional informations from the present study, by correlating the air intake to the phase of respiration. The modes of air intake are best classified into these five types; injection during inspiration, direct inhalation without injection independent of respiration, injection during expiratory phase and combined type of inhalation and injection.
The shape of the pseudoglottis can be classified into these five types; simle form, simple form with subglottic space, larynx-like form, multiglottic form and incomplete form.
From the proficiency of speech, which was evaluated phonetically, the author summarized that good esophageal voice is produced by
1). air intake by injection during inspiration,
2). pseudoglottis formation by simple form or simple form with subglottic space, and
3). ejection of air by uniform contraction of the lower esophagus and“squeezing up”contraction of the upper esophagus.
III). The mental rehabilitation of laryngectomees is an urgent problem in the social and clinical aspects, too, They can not laugh and speak emotionally. Doctors must lead them to be going back to the society with the normal mental condition.
IV). In the management of the diseases of old age of the laryngectomees, there are several important problems. The most cardinal of them is the early diagnosis of lung metastasis and double cancer in other organs. Laryngectomees should be instructed to maintain a comfortable circumstances with an adequate temperature and humidity in winter.