Esophageal speech

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Œsophageal speech
Œ
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Entity (decimal)Œ
Unicode (hex)U+0152

Esophageal speech, also known as esophageal voice, is an airstream mechanism for speech that involves oscillation of the esophagus. This contrasts with traditional laryngeal speech, which involves oscillation of the vocal folds. In esophageal speech, pressurized air is injected into the upper esophagus and then released in a controlled manner to create the airstream necessary for speech. Esophageal speech is a learned skill that requires speech training and much practice. On average it takes 6 months to a year to learn this form of speech. Because of the high level of difficulty in learning esophageal speech, some patients are unable to master the skill.

Contents

The Voice Quality Symbol for esophageal speech is Œ.

Clinical

Esophageal speech is a skill that can help patients to communicate after a laryngectomy, the most common surgery used for the treatment of laryngeal cancer. In the operation, the larynx and the vocal cords are removed completely. After this, the end of the trachea is sewn onto the edge of an opening cut out at the lower part of the neck, creating an opening (stoma) the patient will breathe from and cough out mucus from. This hole is called a tracheostoma; the patient uses it to breathe through and cough through after the operation.

Character

The air moves from outside the body through the tracheostoma directly to the lungs, without passing through the upper respiratory organs of the nose, mouth, and throat. Because it bypasses the vocal folds, speech can be severely impaired, and the development of an esophageal voice becomes necessary. Esophageal speech is produced without an artificial larynx, and is achieved by pumping air from the mouth into the upper esophagus. The esophagus is slightly expanded. The air is then released in a regulated manner through the mouth, with simultaneous articulation of words. Vibration of the pharyngoesophageal sphincter replaces vibration of the glottis to produce the esophageal voice.

Many people learn a basic form of esophageal speech as children, when they speak words while burping, e.g. in competitions with friends to see who can say more of the alphabet during a burp. [1]

Esophageal speech is quieter and more strenuous than laryngeal speech, and fewer words can be produced successively. Good esophageal speakers can produce an average of 5 words per breath and 120 words per minute. Very good esophageal speakers speak very similarly to TEP speakers.[ citation needed ]

Because of the large, vibrating pharyngo-esophageal segment, the pitch of esophageal speech is very low—between 50 and 100 Hz. In esophageal speech, pitch and intensity correlate: a low-pitched voice is produced with low intensity and a high-pitched voice is produced with high intensity. The production of the latter is more exhausting.

The voice of a speaker without a larynx sometimes has what appears to be a nasal tone to it, even though the nasal passage is no longer connected in a post-surgery laryngectomy patient. In other esophageal speakers, the tone is more similar to a deep belch. [2]

Tracheoesophageal puncture

Tracheo-œsophageal speech
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Entity (decimal)Ю
Unicode (hex)U+042E

Another option for restoring speech after a laryngectomy is the tracheoesophageal puncture or TEP. In this simple surgical procedure, a small puncture is made between the trachea and the esophagus, and a one-way air valve is inserted. This air supply can be used to cause vibrations of the pharyngoesophageal sphincter in a similar manner to esophageal speech. This surgical procedure may occur during the laryngectomy (primary TEP) or after a period of time (secondary TEP).

The prosthesis is placed approximately 1014 days post operation by a certified speech language pathologist (SLP) who specializes in ENT work. During the placement of a prosthesis, the SLP measures the depth of the puncture, chooses the correct prosthesis, and inserts it with a loading device (the entire process can occur in 30–45 minutes pending complications). Patients return for the puncture to be resized every few months after surgery. When the puncture site stops changing sizes, then a more permanent prosthesis can be placed that will last approximately 6–12 months (indwelling prosthesis). Patients may choose this route, in which case they will return to the SLP for placement every 6–12 months, or may choose a low pressure, or duckbill prosthesis that they can change independently at home every few months. This option has become increasingly popular in the past 10 years, as in many cases intelligible voicing may be achieved within minutes of placement of the prosthesis. Some of the advantages to tracheoesophageal puncture are a higher success rate at about 95% of vocal rehabilitation and a much faster time frame compared to esophageal speech. [3]

Electrolarynx

Electrolaryngeal speech
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Entity (decimal)И
Unicode (hex)U+0418

An electrolarynx is a handheld device which is held against the throat and provides vibrations to allow speech. Electrolarynges may be used immediately post-surgery with an oral adapter (the neck being too tender right after surgery). Esophageal and electrolaryngeal speech (speech with an electrolarynx) may take weeks or months of training for patients to achieve functional voicing.

See also

Related Research Articles

<span class="mw-page-title-main">Human voice</span> Sound made by a human being using the vocal tract

The human voice consists of sound made by a human being using the vocal tract, including talking, singing, laughing, crying, screaming, shouting, humming or yelling. The human voice frequency is specifically a part of human sound production in which the vocal folds are the primary sound source.

<span class="mw-page-title-main">Larynx</span> Voice box, an organ in the neck of amphibians, reptiles, and mammals

The larynx, commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about 4–5 centimeters in diameter. The larynx houses the vocal cords, and manipulates pitch and volume, which is essential for phonation. It is situated just below where the tract of the pharynx splits into the trachea and the esophagus. The word ʻlarynxʼ comes from the Ancient Greek word lárunx ʻlarynx, gullet, throat.ʼ

This is a glossary of medical terms related to communication disorders which are psychological or medical conditions that could have the potential to affect the ways in which individuals can hear, listen, understand, speak and respond to others.

The field of articulatory phonetics is a subfield of phonetics that studies articulation and ways that humans produce speech. Articulatory phoneticians explain how humans produce speech sounds via the interaction of different physiological structures. Generally, articulatory phonetics is concerned with the transformation of aerodynamic energy into acoustic energy. Aerodynamic energy refers to the airflow through the vocal tract. Its potential form is air pressure; its kinetic form is the actual dynamic airflow. Acoustic energy is variation in the air pressure that can be represented as sound waves, which are then perceived by the human auditory system as sound.

Vocal cord nodules are bilaterally symmetrical benign white masses that form at the midpoint of the vocal folds. Although diagnosis involves a physical examination of the head and neck, as well as perceptual voice measures, visualization of the vocal nodules via laryngeal endoscopy remains the primary diagnostic method. Vocal fold nodules interfere with the vibratory characteristics of the vocal folds by increasing the mass of the vocal folds and changing the configuration of the vocal fold closure pattern. Due to these changes, the quality of the voice may be affected. As such, the major perceptual signs of vocal fold nodules include vocal hoarseness and breathiness. Other common symptoms include vocal fatigue, soreness or pain lateral to the larynx, and reduced frequency and intensity range. Airflow levels during speech may also be increased. Vocal fold nodules are thought to be the result of vocal fold tissue trauma caused by excessive mechanical stress, including repeated or chronic vocal overuse, abuse, or misuse. Predisposing factors include profession, gender, dehydration, respiratory infection, and other inflammatory factors.

Swallowing, sometimes called deglutition in scientific contexts, is the process in the human or animal body that allows for a substance to pass from the mouth, to the pharynx, and into the esophagus, while shutting the epiglottis. Swallowing is an important part of eating and drinking. If the process fails and the material goes through the trachea, then choking or pulmonary aspiration can occur. In the human body the automatic temporary closing of the epiglottis is controlled by the swallowing reflex.

Burping is the release of gas from the upper digestive tract of animals through the mouth. It is usually audible.

<span class="mw-page-title-main">Laryngectomy</span> Surgical procedure

Laryngectomy is the removal of the larynx and separation of the airway from the mouth, nose and esophagus. In a total laryngectomy, the entire larynx is removed. In a partial laryngectomy, only a portion of the larynx is removed. Following the procedure, the person breathes through an opening in the neck known as a stoma. This procedure is usually performed by an ENT surgeon in cases of laryngeal cancer. Many cases of laryngeal cancer are treated with more conservative methods. A laryngectomy is performed when these treatments fail to conserve the larynx or when the cancer has progressed such that normal functioning would be prevented. Laryngectomies are also performed on individuals with other types of head and neck cancer. Post-laryngectomy rehabilitation includes voice restoration, oral feeding and more recently, smell and taste rehabilitation. An individual's quality of life can be affected post-surgery.

<span class="mw-page-title-main">Tracheoesophageal fistula</span> Medical condition

A tracheoesophageal fistula is an abnormal connection (fistula) between the esophagus and the trachea. TEF is a common congenital abnormality, but when occurring late in life is usually the sequela of surgical procedures such as a laryngectomy.

An electrolarynx, sometimes referred to as a "throat back", is a medical device about the size of a small electric razor used to produce clearer speech by those people who have lost their voice box, usually due to cancer of the larynx. The most common device is a handheld, battery-operated device pressed against the skin under the mandible which produces vibrations to allow speech; other variations include a device similar to the "talk box" electronic music device, which delivers the basis of the speech sound via a tube placed in the mouth. Earlier non-electric devices were called mechanical larynxes. Along with developing esophageal voice, using a speech synthesizer, or undergoing a surgical procedure, the electrolarynx serves as a mode of speech recovery for laryngectomy patients.

<span class="mw-page-title-main">Inferior pharyngeal constrictor muscle</span> Skeletal muscle of the pharynx

The inferior pharyngeal constrictor muscle is a skeletal muscle of the neck. It is the thickest of the three outer pharyngeal muscles. It arises from the sides of the cricoid cartilage and the thyroid cartilage. It is supplied by the vagus nerve. It is active during swallowing, and partially during breathing and speech. It may be affected by Zenker's diverticulum.

Esophageal dysphagia is a form of dysphagia where the underlying cause arises from the body of the esophagus, lower esophageal sphincter, or cardia of the stomach, usually due to mechanical causes or motility problems.

Vocal cord paresis, also known as recurrent laryngeal nerve paralysis or vocal fold paralysis, is an injury to one or both recurrent laryngeal nerves (RLNs), which control all intrinsic muscles of the larynx except for the cricothyroid muscle. The RLN is important for speaking, breathing and swallowing.

<span class="mw-page-title-main">Carl Gussenbauer</span> Austrian surgeon (1842–1903)

Carl Gussenbauer was an Austrian surgeon.

Puberphonia is a functional voice disorder that is characterized by the habitual use of a high-pitched voice after puberty, hence why many refer to the disorder as resulting in a ‘falsetto’ voice. The voice may also be heard as breathy, rough, and lacking in power. The onset of puberphonia usually occurs in adolescence, between the ages of 11 and 15 years, at the same time as changes related to puberty are occurring. This disorder usually occurs in the absence of other communication disorders.

A tracheo-esophageal puncture is a surgically created hole between the trachea (windpipe) and the esophagus in a person who has had a total laryngectomy, a surgery where the larynx is removed. The purpose of the puncture is to restore a person’s ability to speak after the vocal cords have been removed. This involves creation of a fistula between trachea and oesophagus, puncturing the short segment of tissue or “common wall” that typically separates these two structures. A voice prosthesis is inserted into this puncture. The prosthesis keeps food out of the trachea but lets air into the esophagus for oesophageal speech.

Alaryngeal speech is speech using an airstream mechanism that uses features other than the glottis to create voicing. There are three types: esophageal, buccal, and pharyngeal speech. Each of these uses an alternative method of creating phonation to substitute for the vocal cords in the larynx. These forms of alaryngeal speech are also called "pseudo-voices".

<span class="mw-page-title-main">Voice therapy</span> Used to aid voice disorders or altering quality of voice

Voice therapy consists of techniques and procedures that target vocal parameters, such as vocal fold closure, pitch, volume, and quality. This therapy is provided by speech-language pathologists and is primarily used to aid in the management of voice disorders, or for altering the overall quality of voice, as in the case of transgender voice therapy. Vocal pedagogy is a related field to alter voice for the purpose of singing. Voice therapy may also serve to teach preventive measures such as vocal hygiene and other safe speaking or singing practices.

<span class="mw-page-title-main">Voice prosthesis</span>

A voice prosthesis is an artificial device, usually made of silicone that is used in conjunction with voice therapy to help laryngectomized patients to speak. During a total laryngectomy, the entire voice box (larynx) is removed and the windpipe (trachea) and food pipe (esophagus) are separated from each other. During this operation an opening between the food pipe and the windpipe can be created. This opening can also be created at a later time. This opening is called a tracheo-esophageal puncture. The voice prosthesis is placed in this opening. Then, it becomes possible to speak by occluding the stoma and blowing the air from the lungs through the inside of the voice prosthesis and through the throat, creating a voice sound, which is called tracheo-esophageal speech. The back end of the prosthesis sits at the food pipe. To avoid food, drinks, or saliva from coming through the prosthesis and into the lungs, the prosthesis has a small flap at the back. There are two ways of inserting the voice prosthesis: through the mouth and throat with the help of a guide wire, or directly through the tracheostoma (anterograde) manner. Nowadays, most voice prosthesis are placed anterograde, through the stoma.

<span class="mw-page-title-main">Heat and moisture exchanger after laryngectomy</span>

Heat and moisture exchangers (HME) are used after laryngectomy to help reduce breathing restrictions and compensate nasal functions.

References

  1. "What is Esophageal Speech? (with pictures)". wisegeek.com. Retrieved 2016-08-10.
  2. "Mr.Tsuchida Esophageal speech to Provox プロヴォックス シャント発声 - YouTube". YouTube . 2012-12-12. Archived from the original on 2021-12-22. Retrieved 2016-08-20.
  3. Pawar, P. V., Sayed, S. I., Kazi, R., & Jagade, M. V. (2008). Current status and future prospects in prosthetic voice rehabilitation following laryngectomy.