Arquivo da tag: speech

Speech and swallowing after surgical treatment of advanced oral and oropharyngeal carcinoma: a systematic review of the literature

Anne Marijn Kreeft, Lisette van der Molen, Frans J. Hilgers, Alfons J. Balm

November 2009, Volume 266, Issue 11, pp 1687-1698


Purpose of this review is the evaluation of speech and swallowing function after surgical treatment for advanced oral and oropharyngeal carcinoma. A systematic literature search (1993–2009), yielding 1,220 hits. The predefined criteria for inclusion in this systematic review were oral or oropharyngeal cancer, surgical treatment, speech and/or swallow function outcome, T-stage ≥ 2, patient cohort > 20, adequate description of the patient cohort in terms of tumor (sub) site, and low risk of bias (Cochrane criteria). Twelve studies fulfilled the predefined criteria. The results for speech more than 1 year after resection of oral or oropharyngeal cancer are reported to be moderate to good; although in the majority of patients speech is experienced as deviant. Overall sentence intelligibility scores are normal (92–98%). Swallowing is reported to be often already disturbed before treatment and is even more severely compromised after treatment. Aspiration rates of liquids vary from 12 to 50% and especially after oropharyngeal resection, pharyngeal transit times are delayed. Postoperative radiotherapy further increases function disturbances significantly. Critical subsites with regard to speech are the mobile tongue, and the soft palate and for swallowing, the floor of the mouth, the posterior base of tongue and the hard and soft palate. Prosthetic appliances (e.g., obturators, palatal augmentation prostheses) can diminish function losses considerably. Surgery for oral and oropharyngeal cancer yields function deficits, most notably with regard to swallowing. Series are small and outcome measurements vary. Therefore, to optimize pre-operative risk assessment, there is a need for internationally standardized outcome measurements.

Facilitating speech in the patient with a tracheostomy

Hess DR

Respir Care; 50(4): 519-25, 2005 Apr.
A tracheostomy tube decreases the ability of the patient to communicate effectively. The ability to speak provides an important improvement in the quality of life for a patient with a tracheostomy. In mechanically ventilated patients, speech can be provided by the use of a talking tracheostomy tube, using a cuff-down technique with a speaking valve, and using a cuff-down technique without a speaking valve. Speech can be facilitated in patients with a tracheostomy tube who are breathing spontaneously by use of a talking tracheostomy tube, by using a cuff-down technique with finger occlusion of the proximal tracheostomy tube, and with the use of a cuff-down technique with a speaking valve. Teamwork between the patient and the patient care team (respiratory therapist, speech-language pathologist, nurse, and physician) can result in effective restoration of speech in many patients with a long-term tracheostomy.