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Voice Ch. 9

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Created by: jessicawalker

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Term	Definition
Head and Neck Cancers	head and neck cancers include cancers in the lips, mouth, nose, salivary glands, pharynx, and larynx
Epidemiology of HNC	5th most common cancer in the world (4% of all cancers) HPV positive HNCs are more amenable to treatment than HPV negative HNC Alcohol and tobacco increases risk of HNC Over 90% of HNCs fall under squamous cell carcinoma
Signs and Symptoms of Laryngeal Cancer	Hoarseness/change in voice that persists over 2wks Enlarged lymph nodes/lump in neck Airway obstruction/diff. breathing/noisy breathing Persistent sore throat or globus sensation Diff. swallow Ear pain, esp. from throat to ear Bad breath Choking
Squamous Cell Carcinoma (SCCA)	Squamous cells are thin/flat cells on surface of skin in linings of various organs SCCA is most common cancer of upper aerodigestive tract SCCA spreads in predictable ways depending on site of origin
TNM Classification	Tumor staging - most important prognostic indicator T: Tumor location, size, extent N: involvement of regional lymph nodes M: metastasis (has it spread) Numbers combined to stage cancer, higher numbers + increased severity
T: Tumor Location	T1: small tumor very localized T4: very large highly invasive tumor
N: Involvement of regional lymph nodes	N0: no spread to neck lymph nodes N3: spread to one or more lymph nodes measuring more than 6cm
M: Metastasis	M0: No evidence of distant spread M1: distant spread
Cancer Staging	Radiographic studies (CT, MRI, PET), operative, and pathologic findings are included in tumor classification and staging Presenting stage is the most important prognostic indicator
Stage I	Small tumor (T1), no spread to lymph nodes (N0) and no distant metastasis (M0)
Stage II	A tumor with spread to nearby areas (T2), but has not spread to lymph nodes (N0) or to distant parts of the body (M0)
Stage III	Any larger tumor (T3), no spread to lymph nodes (N0) or metastasis (M0) Or a smaller tumor (T1, T2), that has spread to regional lymph nodes (N1) but has no sign of distant spread (M0)
Stave IVA	Any invasive tumor (T4a) with wither no lymph node involvement (N0) or spread to only a single lymph node (N1), but no metastasis (M0). Also used for any tumor with spread to the lymph nodes (N2) but no metastasis (M0)
Stage IVB	any cancer (any T) with extensive spread to lymph nodes (N3), but no metastasis (M0)
Stage IVC	Indicates there is evidence of distant spread (any T, any N, M1)
Team Management of Laryngeal Cancer	H&N Surgeon Medical Oncologist Radiation Oncologist Anesthesiologist Nurse Dentist Dietician SLP AUD OT PT Respiratory Therapist Social Worker Psychologist/Psychiatrist Laryngectomee
Medical Workup Includes	Physical Exam Laryngoscopy Biopsy Imaging studies (x-ray, CT, MRI, bone scans, PET)
Medical Approaches to Management	Radiation therapy Chemotherapy Clinical Trials Surgery Combination of above approaches
Surgical Options	Total Laryngectomy Partial Laryngectomy (cordectomy, vertical hemilaryngectomy, supraglottic laryngectomy, subtotal laryngectomy) Composite resection
Cordectomy	Surgical procedure where part or all of the VFs are removed. Most often, this is performed when a pt has a small tumor on the glottis or VFs
Hemilaryngectomy	An operation to remove part of the larynx, but it is going to include modifiers of which specific parts were removed. Think of drawing a vertical line down the larynx.
Supraglottic Laryngectomy	Process to remove the supraglottis (everything above the VFs), sometimes referred to as a horizontal laryngectomy
Subtotal Laryngectomy	May meet requirements of adequate tumor resection in those that undergo total laryngectomy. Uninvolved column of innervated larynx thats sacrificed in total laryngectomy can be preserved in a subtotal laryngectomy. Removing everything above cricoid cart.
Composite resecton	Removal of part of the lining of the mouth and lower jaw
Potential Post-Treatment Complications	Trauma Loss of upper body strength Limited mobility: neck/shoulders Tracheostomy Aspiration pneumonia Radiation induced neoplasms of neck Stoma stenosis Pain Breathing diff. Osteoradionecrosis Infections Fistula Necrosis Coughing
Medical follow-up	Regular follow-up medical and dental examinations to check for signs of recurring cancer, second primary cancer, and to manage any side effects from treatment
Medical Outcomes	1. Survival rate 2. Pts. functional abilities which are greatly impacted by the amount of tumor resected 3. Pts. perception of their QoL
Psychosocial consideration	Acceptability Quality of relationships Financial stress Fatigue Emotional stress Altered body image Depression Job loss Anxiety Decreased self-esteem Substance abuse
Alaryngeal speech modes	Artificial larynx: provides vibration when places on pts neck or in the mouth Esophageal speech: uses the esophagus as a sound source Tracheoesophageal speech: directs air from trachea to esophagus so that sound is produced
Pneumatic Devices	Piece fits over stoma, small unit inside for sound, and tubing that carries sound to mouth. Sound is shaped by articulators Adv: non-electric sounding, easy to learn, intelligible, inexpensive Dis: bulky, requiere access to stoma, seal hard to main.
Electrolarynx	Uses electric power to drive a vibrator that provides a sound source
Electrolarynx (oral type)	Adv: easy to use, small, have loudness and pitch controls, less noisy than neck types, provides adequate loudness for noisy places, can be used right after surgery, good intell. Dis: electronic sounding, expensive, ongoing cost for batteries, practice
Electrolarynx (neck type)	Adv: easy to use for some, small, loud/pitch controls, can provide adequate loud for noisy places, good intell. can be fitted to use intraorally Dis: electronic sounding, hard for scarring/fibrosis, moderate cost, batteries
Esophageal Speech	Sound source in patient's esophagus UES intact and allows air to be trapped within PE segment Adv: non-electric sound, no external device Dis: hard to learn, not loud, gas trapping need good artic skill
Techniques for Obtaining Esophageal Air Supply	Injection method - glottal press - glossopharyngeal press inhalation method Swallowing method
Tracheoesophageal Speech (TES)	Made possible by surgical fistula &prosthesis Pt occludes stoma after inhaling, then exhales, PE vibrates Ad: non-electric sound, no external device, short learn period, flex. loudness/pitch Dis: TEP needs to be primary procedure, maintenance of valve
Tracheostomy Valves	Used in conjunction with TE voice prosthesis Valve is at level of stoma Can be inside the stoma or around it A: hands-free, air humidifier D: needs good seal, physical restrictions, remove for coughing, costly humid. replaced daily
TES	Best outcomes for fundamental frequency, max phonation, and intensity Perceptually, TES was reported to be the most pleasant and comprehensible to listeners