Acceptance of Artificial Larynx Among Total Laryngectomy Patient: Case Studies 

Introduction

The human voice is remarkable instrument as voice is work as the unique identification for each individual. A speaker can evoke a wide range of emotion and mental images by slight changes of vocal timbre, loudness, or subtle nuances in inflections. A person’s voice is also a sensitive barometer of physical and emotional health. Any damage and lesion to the larynx will also hamper the voice. As an example laryngeal cancer which may lead to the surgery to save persons’ life and in some cases need to removal of complete voice box which is known as total laryngectomy. Before going to the procedure of surgery pre-laryngectomy counseling by voice pathologist plays a significant role. This will provides the rehabilitation option after surgery and help the client and his family to prepare mentally, physically and emotionally for surgery and after surgery. Total laryngectomy results in physical and functional changes that can affect the emotional well-being and some of the most basic functions of life, including breathing, swallowing, and communication. Patient who undergoes total laryngectomy experience a decreased quality of life compare to patients after partial laryngectomy or healthy individuals.

Therefore, voice rehabilitation is one of the most difficult challenges that these patients must overcome. Voice pathologist should explain about the most appropriate method for voice rehabilitation to the client and his family which can help client to keep realistic expectation from the device. If client fails to keep realistic expectation or have over-expectation than it may de-motivates the client to use rehabilitation method and will have negative impact quality of life. Need of the Study:In our experience most of the client get de-motivate to use voice rehabilitation method after total laryngectomy due to many issues. As many studies reported that artificial larynx is one of the best and easy rehabilitation options after the total laryngectomy but still after that many clients refuse to use the same so there is a dearth of study to explore the various factors for refusing the artificial larynx as voice rehabilitation option. AIMPresent study aims to explore the acceptance level of artificial larynx among two cases of total laryngectomy. Methods:In this paper we are presenting the two cases of laryngectomy that underwent total laryngectomy but refused to use artificial larynx as a voice rehabilitation option. To assess their self perception and quality of life we conducted a detailed case history of client & medical outcomes study questionnaire (McHorney et al. , 1994). Client was also provided with the questionnaire which consists of 10 questions related to the pre-operative, post-operative counseling. This questionnaire was developed by authors and validated by 2 SLPs working in the same area from last 10 years. Clinician also interviewed the client family member to assess the emotional and psychological impact of clients’ problem in family. Same was also discussed with their surgeon to assess surgeons’ perception.

Case Studies: Case A:Geriatric male client of age 63 years reported to the client with the complaint of not able to speak due to total laryngectomy. Client was diagnosed in 2016 with the carcinoma of larynx (T4aN2bM0) including B/L aryepiglotc fold, B/L false vocal fold (VF), reaching upto B/L true VF and also erosion of thyroid cartilage seen. Client underwent total laryngectomy with total thyroidectomy with B/L sagital neck dissection with nasopharyngeal reconstruction by primary closure in 2016. According to client and his family he didn’t underwent pre-operative counseling and he further reported that he didn’t as familiarized by voice rehabilitation option prior to the counseling. Client further reported that he was informed and explained about the artificial larynx post-surgically but no professional was unable to train him for same. He also reported that voice produced by artificial larynx was not intelligible and consists of more noise component, he also no able to handle the instrument adequately. He further reported that maintenance and price of electro-larynx device was too high which he could not afford. After refusal of artificial larynx no health professional counsel him for other voice rehabilitation options. Due to that still his completely rely on writing mode of communication due to that he is very emotional unstable and get irritate easily. As per report by oncologist no speech language pathologists are available in the hospital due to that client and his family was not counsel and trained with voice rehabilitation option adequately.

Case B: Adult non diabetic male of age 45 years reported to institute with the complaint of not able to speak due to laryngectomy. Client underwent total laryngectomy in 2012 and was advised to go for artificial training. Client refused to for artificial larynx due to same factors as explained by Case A. Client was further provided with the other option of alaryngeal speech by oncologist but no professional was available in the hospital to demonstrate and explained the client about other options.

Conclusion: Both cases had refused to accept artificial larynx as a voice rehabilitation option due to unavailability of experienced voice pathologist, poor voice quality, unable to handle and high price and maintainace charges. Due to uavailability of speech language pathologist, the clients were not provided with pre and post-operative counseling, so they experienced difficulties. They were also unaware of the possibilities and opportunities by which they can modify their voice. At last we can conclude that most of the time clients suffer in the process of voice rehabilitation after head and neck cancer surgery due to unavailability of SLPs. In some cases where SLPs are available than also due to high price of device and poor voice quality clients refused to use artificial larynx. We all come together a long way but still need to go far as still after so many advanced technologies client not able to get benefitted.