In vitro evaluation of a double‐membrane–based voice‐producing element for laryngectomized patients

Despite state of the art tracheo-esophageal (TE) voice-rehabilitation after laryn-gectomy, some patients are unable to produce voice of sufficient quality, because of hypotonicity or atonicity of their pharyngoesophageal (PE) segment. Furthermore, the TE voice is low pitched, which presents a problem especially for female laryngectomized patients. A voice-producing element (VPE) is developed, based on the doublemembrane concept, to supply the laryngectomized patients with a better substitute voice.The VPE is comprised of two elastic membranes inside a circular housing that can be inserted in a shunt valve. Four identical prototypes were manufactured and tested in-vitro under physiological conditions. Prototypes were also tested in 17 female laryngectomised patients. An aerodynamic and acoustical analysis was performed, the maximum phonation time, speech rate and intonation capability determined. Finally the voice was perceptual evaluated.Basic sound, containing multiple harmonics, was successfully produced under physiologic air pressure and airflow conditions. The fundamental frequency and sound pressure level could be controlled by changing the driving pressure, thus enabling sufficient intonation. The obtained frequency range (190 -350 Hz) is appropriate for producing a female voice. The VPE produced a sound with a low noise-to-harmonics ratio (mean 0.15), the efficiency of sound production (5.5⋅10 -5 ) is comparable to normal vocal folds.The clinical study clearly showed that the pitch and sound intensity were increased without an unacceptable increase in driving lung pressure. The flow rates were lower than normal, leading to significantly longer phonation times. Accumulation of mucus did not interfere with speech production.In conclusion, functional restoration of the voice after laryngectomy with a VPE, based on the double-membrane concept, appears a feasible concept for female laryngectomized patients or patients with a hypo-or atonic PE segment.

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“…The model represented the acoustical load of the lungs and trachea. The following aero-acoustic parameters were measured [16]:…”

Section: Experimental Set-upmentioning

confidence: 99%

A voice-producing prosthesis for laryngectomized patients

Tack

Marres

Meeuwis

et al. 2009

International Conference on Instrumentation, Communication, Information Technology, and Biomedical Engineering 2009

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“…Previous attempts have been made at introducing sound generating devices to address many of these issues 14,16,17 . Various systems including metal reeds, silicone lips, and membrane based devices have been described 18‐21 . However, many of these recent attempts have been limited by their use of the tracheo‐esophageal puncture site as a conduit for the sound generating mechanism.…”

Section: Introductionmentioning

confidence: 99%

“…14,16,17 Various systems including metal reeds, silicone lips, and membrane based devices have been described. [18][19][20][21] However, many of these recent attempts have been limited by their use of the tracheoesophageal puncture site as a conduit for the sound generating mechanism. This small area limits the airflow across the sound generation source, heightens the impact of secretions on the prosthesis, and creates a close proximity to the neo-pharyngeal mucosa-vibrations of which can result in interference.…”

Section: Introductionmentioning

confidence: 99%

Novel voice prosthesis after total laryngectomy with laryngoplasty reconstruction

2020

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Background: Although many patients achieve serviceable speech after total laryngectomy (TL), others are limited by unnaturally low pitch. We describe a cadaveric study to provide proof of concept for a novel voice prosthesis after TL with free tissue laryngoplasty. Methods: Devices were implanted into fresh frozen cadavers after TL and free tissue laryngoplasty. Phonation pressures were measured using a custom Blom-Singer Manometer (InHealth Technologies, Carpinteria, CA) and acoustic files were analyzed using Praat, a speech analysis software. Results: Two fresh frozen cadavers were implanted with the voice prosthesis. Both prostheses demonstrated appropriate stenting of the laryngoplasty. Successful sound production was achieved after airflow generation at the proximal trachea. An average phonation pressure of 3.5 cmH 2 O (SD 1.7 cmH 2 O) was necessary to generate a sound intensity of 80.6 dB (SD 0.2 dB) at an average fundamental frequency of 299.5 Hz (SD 112.6 Hz). Conclusions: The novel voice prosthesis described herein offers a feasible voice generation mechanism.

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“…However, both produce only monotonous voices, and it is reported that their functions deteriorate as secretions adhere to the surface of the material (4) . Tack et al succeeded in changing the pitch of the voice by an average of 5.1 semitones according to the expiratory pressure at a stable and appropriate pitch by placing two elastic resin membranes parallel inside the shunt valve such that they act as a vibrating valve (5), (6) .…”

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confidence: 99%

An Artificial Larynx Built in TE Shunt Valve That Produces Substitute Voice by Only Patient's Own Expiration (Preliminary Study for Suitable Tone Pitch and Its Controllability)

Kourakata

Sakamoto

Nakao

2013

JAMDSM

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A large portion of patients of larynx cancer tekes total laryngectomy and loses their original voice consequently. Some ways to obtain substitute voice for total laryngectomees have been presented, however, each of them cannot conquer inconveniences, tone quality, extremely low tone, monotonousness etc. We invented very simple, small enough to be built in TE (tracheaesophageal) shunt valve but functional substitute voice that is driven by patient's own expiration and its tone pitch can be controlled by expiratory pressure simultaneously. The new device has an outward-striking membrane as an oscillating valve and a set of piston-cylinder mechanism, which controls oscillator's tension and alters pitch of sound. As results of performance experiments applied to the prototype model made as twice scale as an actual dimension, the device produces the lowest sound frequency of 205 Hz and pitch range of 374 cent being approximately proportional to driving air pressure between 0.8 and 2.2 kPa. It is said that normal pitch of female voice is around 210 Hz, thus we consider the possibility of the device as a new substitute voice was shown that contributes to improvement of total laryngectomees' QOL particularly to female patients.

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In vitro evaluation of a double‐membrane–based voice‐producing element for laryngectomized patients

Abstract: Functional restoration of the voice after laryngectomy with a double-membrane VPE appears to be a feasible concept for female laryngectomized patients with a hypotonic, or atonic pharyngoesophageal segment.

Cited by 12 publications

References 23 publications

A voice-producing prosthesis for laryngectomized patients

A voice-producing prosthesis for laryngectomized patients

Novel voice prosthesis after total laryngectomy with laryngoplasty reconstruction

An Artificial Larynx Built in TE Shunt Valve That Produces Substitute Voice by Only Patient's Own Expiration (Preliminary Study for Suitable Tone Pitch and Its Controllability)

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