1. Etiology of Laryngeal Cancer
 a. Associated with smoking
 b. Use of tobacco with alcohol increases risk
 c. Incidence

2. Symptoms of Laryngeal Cancer
 a. Hoarseness
 b. Dyspnea and stridor
 c. Dysphagia, weight loss, neck swelling, blood discharge and pain
 d. Signs include lump in neck, lumps at base of tongue, tenderness in laryngeal area

3. Laryngeal Tumors
 a. Usually squamous cell carcinoma
 b. Located supraglottic, glottic and subglottic
 c. Stage indicates severity of cancer (I - IV)
 d. Based on tumor size (T), node involvement (N) & metastasis (M)

4. Treatment Options
 a. Radiation
 b. Chemotherapy
 c. Surgery
  i. Hemilaryngectomy
  ii. Supraglottic laryngectomy
  iii. Near total laryngectomy
  iv. Total laryngectomy

5. Other Related Surgeries
 a. Radical neck dissection (resection)
 b. Pharyngo-laryngectomy
 c. Esophageal resection & Gastric pull-up
 d. Glossectomy

6. Permanent Changes Following Total Laryngectomy
 a. Tracheal stoma
 b. Inability to produce voice for speech
 c. Disruption in ability to smell, sniff, taste, sip
 d. Disruption in ability to whistle, sneeze, blow nose, gargle and spit, sigh or cry
 e. Risk of aspiration of water and foreign bodies into lungs is high

7. Pre-Op Counseling & Post-Op Visits
 a. Provide pt and family with information to help them face adjustments after the surgery
 b. Convey confidence to those concerned that pt will talk again - just in a different way
 c. Refer to handout
 d. Show video

8. Methods of Alaryngneal Speech
 a. Speech aids/artificial larynx
 b. Esophageal speech
 c. Tracheoesophageal (TE) speech using a voice prosthesis

9. Artificial Larynx Devices
 a. Pneumatic
 b. Intraoral electronic
 c. Neck-type electronic
 d. Mouth type interdental electronic

10. Therapy for Users of an Artificial Larynx
 a. See notes and handouts on website

11. Esophageal Speech
 a. Air from pharynx is moved into upper esophagus and the forced out under pressure
 b. Tissues of pharyngo-esophageal (PE) segment are forced into vibration
 c. Vibration is shaped by articulators into speech
 d. Anatomy of the esophagus

12. Advantages/Disadvantages of Esophageal Speech
 a. No additional surgery
 b. No investment in equipment, maintenance, repair cost
 c. No external devices that need cleaning or changing
 d. Both hands free to perform other functions
 e. Difficulty for some to learn
 f. Time and financial commitment to learn
 g. Pitch, loudness and intelligibility problems

13. Fundamentals of Esophageal Speech
 a. The esophagus serves as the reservoir for air for voice production
 b. The PE segment is the neoglottis
 c. Air pressure is positive above and negative below the neoglottis
 d. 2 process for loading the esophagus
  i. Injection method
  ii. Inhalation method
 e. Once air is in the esophagus - pt must tighten thoracic and abdominal muscles and force it out

14. Tips for Teaching Esophageal Speech
 a. Introduce all 3 methods
 b. Begin as soon as physician gives release
 c. Short frequent therapy sessions
 d. No eating prior to session
 e. Intersperse relaxation into session
 f. Frequent practice - short sessions 10-12 times a day at beginning

15. Tracheoesophageal Speech
 a. Small puncture made into posterior tracheal wall providing opening into esophagus
 b. Heals for minimum of 48 hours
 c. Voice prosthesis inserted into puncture
 d. Unidirectional valve tip on portion inserted into esophagus
 e. Protects airway during swallowing; opens when tracheostoma is occluded diverting air into esophagus
 f. PE segment again serves as neoglottis

16. Advantages
 a. Improvements over traditional esophageal speech
  i. Expanded dynamic range
  ii. Increased pitch variation
  iii. Extension of duration of sound
  iv. Quicker to learn
 b. Better sound quality than either esophageal or electrolarynx speech

17. Determining Candidates for TE Puncture
 a. Guidelines for choosing candidates
 b. Esophageal insufflation test
  i. Catheter passed transnasally through hypopharynx and into esophagus
  ii. Air introduced into esophagus to test vibratory capability of the PE segment
  iii. Successful test includes ability to sustain vowel for 8 sec without strain or strangled voice; count from1-15 on single inspiration

18. Therapy for Pts with Voice Prosthesis
 a. Treatment for pharyngeal constrictor spasm include:
  i. Selective myotomy
  ii. Pharyngeal plexus neurectomy
  iii. Injections of Botox
 b. Prosthesis fitting
 c. Reduce effort, reduce speech rate, fine tune articulation
 d. Troubleshooting

19. Swallowing Problems Associated with Laryngeal Cancer
 a. Supraglottic laryngectomy
 b. Hemilaryngectomy
 c. 3/4 laryngectomy
 d. Total laryngectomy
 e. Radiotherapy

20. Swallowing Problems Associated with Oral & Oropharyngeal Cancer
 a. Radiation therapy
 b. Surgical therapy
  i. Partial tongue resection
  ii. Anterior floor of the mouth resection
  iii. Lateral floor of the mouth/Base of tongue resection