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Fingerfreies Sprechen mit dem Provox-HME-Freehands®-Tracheostomaventil

Klinische Langzeiterfahrungen

Finger-free speech with the Provox FreeHands HME Automatic Tracheostoma Valve® system

Clinical long-term experience

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Zusammenfassung

Hintergrund

Stimmprothesen ermöglichen eine ausgezeichnete Stimmrehabilitation bei laryngektomierten Patienten. Viele Betroffene empfinden es jedoch als stigmatisierend, dass das Tracheostoma zum Sprechen mit dem Finger verschlossen werden muss. Dadurch kommt es zu Einschränkungen beim Gestikulieren und beidhändigen Arbeiten. Abhilfe können hier automatische Tracheostomaventile schaffen.

Material, Methoden und Patienten

Bei 17 laryngektomierten Patienten, die bereits mit einem Provox-HME-Freehands®-Tracheostomaventil versorgt waren, erfolgte 18 Monate nach dessen Anpassung eine Evaluation per Fragebogen zur Zufriedenheit, Stimmqualität (hier u. a. Stimmdynamik, Frequenzumfang), Tragekomfort, Fixation, aufgetretenen Problemen und der Wirksamkeit des HME-Filters.

Ergebnisse

Bei 4 Patienten musste die Studie wegen Fixationsproblemen des Tracheostomaventils (2) bzw. einer Leckage durch die tracheoösophageale Fistel (2) abgebrochen werden. Sieben der verbliebenen 13 Patienten trugen das Ventil täglich und nutzten es durchschnittlich 6 h. 76% der Patienten empfanden es als sehr vorteilhaft, fingerfrei sprechen zu können. Mit dem Provox-HME-Freehands-Tracheostomaventil® lag die Phonationsdauer bei 8,5(±6,8) s, der Dynamikumfang der Stimme bei 21,7(±5,6) dB.

Schlussfolgerung

Die Ergebnisse zeigen, dass die Verwendung des Provox-HME-Freehands®-Tracheostomaventils ein fingerfreies Sprechen bei hoher Langzeitcompliance und guter phonatorische Rehabilitation ermöglicht.

Abstract

Introduction

The use of voice prostheses allows excellent rehabilitation of laryngectomized patients but it is considered a disadvantage that the tracheostoma must be closed manually for speech production. This limits their ability to simultaneously communicate by gestures or to work with both hands. An automatic tracheostoma valve helps patients to overcome this problem.

Patients, material and methods

A total of 17 laryngectomized patients were asked to join a long-term study 18 months after having been fitted with a Provox FreeHands HME Automatic Tracheostoma Valve® system. The patients completed a questionnaire in order to assess satisfaction, voice quality, wearing comfort, fixation, potential problems and the effectiveness of the HME cassette.

Results

Of the 17 patients 4 discontinued the study due to problems of securing the valve to the skin (n=2) or fistula leakage (n=2). Of the remaining patients 7 wore the valve daily for an average of 6 h. Of the patients 76% considered it a great advantage to be able to speak without using their hands. With the Provox FreeHands HME Automatic Tracheostoma Valve® system, maximum phonation time was 8.5 s (±6.8) and the dynamic range was 21.7 decibels (±5.6).

Conclusion

The results show that the Provox FreeHands HME Automatic Tracheostoma Valve® system not only allows hands-free speech but is also associated with excellent long-term compliance and good voice rehabilitation.

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Literatur

  1. Ackerstaff AH, Hilgers FJM, Aaronson NK et al (1993) Improvements in respiratory and psychosocial functioning following total laryngectomy by the use of a heat and moisture exchanger. Ann Otol Rhinol Laryngol 102:78–83

    Google Scholar 

  2. Ackerstaff AH, Hilgers FJM, Aaronson NK et al (1995) Heat and moisture exchangers as a treatment option in the post-operative rehabilitation of larvngectomized patients. Clin Otolaryngol 20:504–509. doi:10.1111/j.1365-2273.1995.tb01589.x

    Google Scholar 

  3. Ackerstaff AH, Hilgers FJM, Balm AJM, Tan IB (1998) Long term compliance of laryngectomized patients with a specialized pulmonary rehabilitation device, Provox Stomafilter. Laryngoscope 108:257–260. doi:10.1097/00005537-199802000-00018

    Google Scholar 

  4. Blakely BW, Podraza BL (1987) Acoustic and perceptual assessment of speech using a voice prosthesis with valvular and manual occlusion. Otolaryngol Head Neck Surg 97:552–557

    Google Scholar 

  5. Blom ED, Singer MI, Hamaker RC (1982) Tracheostoma valve for postlaryngectomy voice rehabilitation. Ann Otol Rhinol Laryngol 91:576–578

    CAS  PubMed  Google Scholar 

  6. Doyle PC, Grantmyre A, Myers C (1989) Clinical modification of the tracheostoma breathing valve for voice restoration. J Speech Hear Disord 54:189–192

    CAS  PubMed  Google Scholar 

  7. Ehrenberger K, Wicke W, Piza H et al (1985) Jejunal grafts for reconstructing a phonatory neoglottis in laryngectomized patients. Arch Otorhinolaryngol 242:217–223. doi:10.1007/BF00454424

    Google Scholar 

  8. Fujimoto PA, Madison CL, Larigan LB (1991) The effects of a tracheostoma valve on the intelligibility and quality of tracheoesophageal speech. J Speech Hear Res 34:33–36

    CAS  PubMed  Google Scholar 

  9. Gerwin J, Culton G (1993) Prosthetic voice restoration with the tracheostomal valve. A clinical experience. Am J Otolaryngol 14:432–439. doi:10.1016/0196-0709(93)90119-R

    Google Scholar 

  10. Grolman W, Schouwenburg PF, Boer MFD et al (1990) First results with the Blom-Singer adjustable tracheostoma valve. Laryngoscope 100:290–293

    Google Scholar 

  11. Hagen R (2005) Surgical voice restoration following total laryngectomy. HNO 53:602–611. doi:10.1007/s00106-005-1271-9

    Google Scholar 

  12. Hammer S (2007) Stimmtherapie mit Erwachsenen. Was Stimmtherapeuten wissen sollten. Praxiswissen Logopädie, 3. Aufl. Thiel MW (Hrsg) Springer, Berlin Heidelberg New York

  13. Herrmann IF, Koss W (1986) In (Hrgs) Experience with the Eska-Hermann tracheostoma valve. Springer, Berlin Heidelberg New York

  14. Hilgers FJM, Ackerstaff AH (2006) Development and evaluation of a novel tracheostoma button and fixation system (Provox LaryButton and LaryClip adhesive) to facilitate hands free tracheoesophageal speech. Acta Otolaryngol 1218–1224. doi:10.1080/00016480600702126

  15. Hilgers FJM, Ackerstaff AH, Aaronson NK et al (1990) Physical and psychosocial consequences of total laryngectomy. Clin Otolaryngol 15:421–425. doi:10.1111/j.1365-2273.1990.tb00494.x

    Google Scholar 

  16. Hilgers FJM, Ackerstaff AH, van As CJ et al (2003) Development and clinical assessment of a Heat and Moisture Exchanger with a multi-magnet automatic tracheostoma valve (Provox FreeHands HME) for vocal and pulmonary rehabilitation after total laryngectomy. Acta Otolaryngol 123:91–99. doi:10.1080/0036554021000028083

    Google Scholar 

  17. Lorenz KJ, Groll K, Ackerstaff A et al (2007) Hands-free speech after surgical voice rehabilitation with a Provox® voice prosthesis- Experience with the Provox FreeHands HME tracheostoma valve® system. Eur Arch Otorhinolaryngol 264:151–157. doi:10.1007/s00405-006-0155-2

    Google Scholar 

  18. Maddalena H, Pfrang H, Schohe R, Zenner HP (1991) Sprachverständlichkeit und psychosoziale Anpassung bei verschiedenen Stimmrehabilitationsmethoden nach Laryngektomie. Laryngorhinootologie 70:562–567. doi:10.1055/s-2007-998098

    Google Scholar 

  19. Maier H, Weidauer H (1994) Surgical voice rehabilitation after laryngectomy by a modification of the Asai procedure. HNO 42:99–103

    CAS  PubMed  Google Scholar 

  20. McRae D, Young P, Hamilton J, Jones A (1996) Raising airway resistance in laryngectomees increases tissue oxygen saturation. Clin Otolaryngol 21:366–368. doi:10.1111/j.1365-2273.1996.tb01089.x

    Google Scholar 

  21. Op de Coul BMR, Hilgers FJM, Balm AJM et al (2000) A decade of postlaryngectomy vocal rehabilitation in 318 patients: a single institution experience with consistent application of indwelling voice prostheses (Provox). Arch Otolaryngol Head Neck Surg 126:1320–1328

    Google Scholar 

  22. Op de Coul BNR, Ackerstaff AH, van As-Brooks CJ et al (2005) Compliance, quality of life and quantitative voice quality aspects of hands-free speech. Acta Otolaryngol 125:629–637

    Google Scholar 

  23. Remmert S, Ahrens KH, Sommer K et al (1994) Voice rehabilitation with the jejunum speech siphon: the biventer rein, a modification for prevention of aspiration. Laryngorhinootologie 73:84–87. doi:10.1055/s-2007-997085

    Google Scholar 

  24. Schwarz C, Cirugeda M, Hagen R (2004) Tracheostomaventil mit integrierter Hustenklappe (Window) zur Verbesserung der fingerfreien Sprache des Laryngektomierten – klinische Langzeitergebnisse. Laryngorhinootologie 83:173–179. doi:10.1055/s-2004-814266

    Google Scholar 

  25. Tervonen H, Bäck L, Juvas A et al (2005) Automatic speaking valve in speech rehabilitation for laryngectomized patients. Eur Arch Otorhinolaryngol 262(10):816–820

    Article  PubMed  Google Scholar 

  26. Tisch M, Lorenz KJ, Störrle E, Maier H (2003) Lebensqualität laryngektomierter Patienten nach chirurgischer Stimmrehabilitation. Erfahrungen mit der Provox Prothese. HNO 51:467–472. doi:10.1007/s00106-002-0736-3

    Google Scholar 

  27. Van As CJ, Hilgers FJM, Koopmans-van Beinum FJ, Ackerstaff AH (1998) The influence of stoma occlusion on aspects of tracheoesophageal voice. Acta Otolaryngol Stockh 118:732–738. doi:10.1080/00016489850183278

    Google Scholar 

  28. Van den Hoogen FJA, Meeuwis C, Oudes MJ et al (1996) The Blom-Singer tracheostoma valve as a valuable addition in the rehabilitation of the laryngectomized patient. Eur Arch Otorhinolaryngol 253:126–129. doi:10.1007/BF00615108

    Google Scholar 

  29. Verkerke GJ, Veenstra A, Schutte HK et al (1994) Design and test of a hands-free tracheostoma valve to improve the rehabilitation process after laryngectomy. Int J Artif Organs 17:175–182

    CAS  PubMed  Google Scholar 

  30. Williams SE, Scanio TS, Ritterman SI (1989) Temporal and perceptual characteristics of tracheoesophageal voice. Laryngoscope 99:846–850. doi:10.1288/00005537-198908000-00013

    Google Scholar 

  31. Williams SE, Scanio TS, Ritterman SI (1990) Perceptual characteristics of tracheoesophageal voice produced using four prosthetic/occlusion combinations. Laryngoscope 100:290–293

    CAS  PubMed  Google Scholar 

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Interessenkonflikt

Die Studie wurde im Rahmen eines Drittmittelprojekts mit Unterstützung der Fa. Atos Medical Deutschland und des Verteidigungsministeriums durchgeführt.

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Authors and Affiliations

  1. Abteilung für Hals-Nasen-Ohren-Heilkunde, Kopf-Hals-Chirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland

    K.J. Lorenz OFA, K. Huverstuhl & H. Maier

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  1. K.J. Lorenz OFA
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  2. K. Huverstuhl
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  3. H. Maier
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Correspondence to K.J. Lorenz OFA.

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Lorenz, K., Huverstuhl, K. & Maier, H. Fingerfreies Sprechen mit dem Provox-HME-Freehands®-Tracheostomaventil. HNO 57, 1090–1098 (2009). https://doi.org/10.1007/s00106-009-1937-9

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