Diagnosis of Voice Disorders Among University Teachers: Hygiene, Prevention and Recovery

Voice is a unique means of communication and socialization of a person, the formation of a vast human multicultural space. It is used in a wide variety of professions and is a function with an interdisciplinary affiliation, therefore hygiene, health preservation, and voice restoration have a systemic convergent (interdisciplinary) nature. This problem is dealt with by specialists of pedagogical and medical profiles (speech therapists, phonopedists, phoniatrists, otolaryngologists). Higher school teachers have excessive voice and psychoemotional stress, recently complicated by distance learning. In the course of their work, they must meet the requirements for their voice quality in the process of performing teaching. The object of the research is the state of vocal abilities among teachers of higher education. Subject – generalization of methods of voice restoration among teachers of higher education, actualization of the importance of preventive and hygienic work to prevent professional voice disorders. The working hypothesis of the study consists of the assumption that timely diagnosis and systematic use of selected speech therapy and phonopedic measures will optimize the process of restoring laryngeal functions among university teachers. This paper describes an empirical study of the characteristics of the voice in high school teachers (Pacific State University), identifies the main factors affecting voice health and the causes of their occurrence. Based on the analysis of the survey data obtained from the survey and previously conducted theoretical and practical research, materials (brochures) and videos (master classes) on hygiene and prevention of voice disorders were prepared for university teachers. The scientific contribution of the research consists in obtaining empirical results in the designated problem field, combining speech therapy and phonopedic scientific and methodological materials for practical use by persons with voice-speech professions. The direction of future research will be to expand the group of respondents (teachers, educators, students) for diagnostic measurements and subsequent comparative analysis of the data obtained.

919 Surgical Voice Restoration – Improving Out of Hours Management: A Multidisciplinary Quality Improvement Project

Aim Swansea Bay University Health Board have a caseload of 37 surgical voice restoration (SVR) laryngectomies. These patients are excellently managed during working hours, by a SALT-led service. Concerns were raised regarding the quality of out of hours management: the aim of this project was to identify and address the factors contributing to the difference in care received. Method A questionnaire was sent to current junior doctors to assess knowledge and confidence when managing SVR patients. Phone interviews were conducted with SVR patients to discuss the issues from a patient’s perspective. The junior doctor team and SALT team liaised to identify contributing logistical issues. Results The junior doctor survey indicated both experience and confidence were low, including amongst senior trainees. 58.3% were unfamiliar with equipment used to change a speech valve. Patient interviews revealed several issues, such as delays to treatment and unnecessary admissions. Logistical concerns included inability to access equipment out of hours and an absence of departmental guidelines. Conclusions This project demonstrates a collaborative approach between junior doctors and SALT, to improve the quality of care for a sub-set of patients with highly specialised needs. We identified the contributing factors for the disparity in services and tailored interventions to provide the junior doctors responsible for out of hours care, with the knowledge and skills to provide a better standard of care.

Voice rehabilitation with phonatory prosthesis after total laryngectomy and pharyngolaryngectomy: comparison of functional outcomes between primary and secondary puncture

<p><strong>Background:</strong> Tracheoesophageal puncture (TEP) with voice prosthesis (VP) placement is considered the standard for vocal rehabilitation after total laryngectomy (TL). This study aimed to compare the success rate of primary and secondary TEP and to evaluate the impact of clinical factors on functional outcome.</p><p><strong>Methods:</strong> A retrospective medical chart review was conducted in patients who underwent TL or pharyngolaryngectomy (PLT) and TEP. Variables collected included age, gender, comorbidities, tumor location and stage, extension of surgical resection, reconstruction, neck dissection, radiation therapy, salvage surgery, device lifetime, postoperative complications and successful voice restoration.</p><p><strong>Results:</strong> A total of 186 patients were enrolled in this study, 164 patients (88.2%) underwent primary TEP and 22 (11.8%) secondary TEP. Successful voice rehabilitation was achieved in 76.9% of patients and there was no difference between primary and secondary TEP groups (76.2% vs. 81.8%, p=0.76). A poorer voice restoration outcome was found in patients who underwent radiation therapy (p=0.01) or salvage surgery (p=0.03). Adjuvant radiation was the only independent prognostic factor for functional success (OR=4.7, IC 95%= 1.4-15.9, p=0.04). VP related complications occurred in 65.7% of patients, with higher incidence in secondary TEP group (90.9% vs. 67.7%, p=0.03). Overall device lifetime was similar between primary and secondary groups (9.2 vs. 8.7 months, p=0.89).</p><p><strong>Conclusions:</strong> Voice rehabilitation outcome was similar with primary and secondary TEP. However, TEP related complications were more common in secondary procedures. Primary TEP allows earlier voice restoration, avoiding a second surgical intervention. Functional success rate was poorer for patients who underwent radiation therapy.</p>

Management of the Embedded Tracheoesophageal Prosthesis: Retrograde Removal and Replacement

Objective: To describe the retrograde removal of a tracheoesophageal (TE) prosthesis embedded in the common wall between the trachea and esophagus with preservation of the original tracheoesophageal puncture (TEP) tract with subsequent placement of new tracheoesophageal prosthesis for voice restoration. Methods: The Blom-Singer TEP Set (InHealth Technologies, Carpinteria, CA) was used to facilitate this procedure. The coated wire leader cable was threaded through the small opening in the posterior tracheal wall and into the lumen of the old TE prosthesis. The wire was pulled through the mouth in retrograde fashion - bringing the old TE prosthesis out with it and dilating the existing TEP tract. A new prosthesis was then placed over the end of the wire and returned through the stoma, delivering the prosthesis through the TE tract and into the stoma. Results: Safe, voice restoration with avoidance of need for multiple procedures. Conclusion: Removal of an embedded prosthesis and simultaneous replacement of a new prosthesis was safely and efficiently achieved using a retrograde technique which maintained the patency of the prior TE tract and restored voice.

VOICE RESTORATION IN PATIENTS WITH ORAL CAVITY AND OROPHARYNGEAL CANCERS USING INNOVATIVE TECHNOLOGIES

Currently, voice restoration in patients with oral cavity and oropharyngeal cancers after organ-preserving and reconstructive surgeries is relevant and socially significant. Materials and methods. From 2014 to 2019, a total of 110 patients with oral cavity and oropharyngeal cancers (Tj 3N0 2M0) were treated at the Department of Head and Neck Tumors of Cancer Research Institute. Organ-preserving surgeries with a flap reconstruction following hemiglossectomy or glossectomy with horizontal plane resection of the mandible, and hemiglossectomy or glossectomy with resection of the mandibular and muscles of the floor of the mouth were performed. In the postoperative period, violation of speech, swallowing and chewing processes were observed. After removal of the nasophageal probe and sutures, all patients underwent speech rehabilitation to restore speech function using innovative technologies. Together with scientists from Tomsk University of Control Systems and Radioelectronics, we have developed and introduced into clinical practice OnkoSpeech v1.0 software package that allows us to apply a personalized approach to planning speech rehabilitation based on a sound spectrum spectral analysis for patients with oral cavity and oropharyngeal cancers after organ-preserving surgery. Results. The software package allows us to evaluate the quality of speech and work with a database of records of speech therapy sessions. A positive result of voice restoration was observed in all 110 patients in the period from 18 to 30 days. We have received objective confirmation of the assumption that in most cases after the rehabilitation, the acoustic characteristics approach the speech indices in comparison with the preoperative period. Conclusion. Our technique makes it possible to increase the effectiveness of the restoration of speech function, reduce the time of speech rehabilitation, and significantly increase the social status and quality of life of cancer patients.