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Review of Prognostic Factors for Esophageal Voice Christine G Loma Linda University TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works Loma Linda University Electronic Theses, Dissertations & Projects 6-1980 Review of prognostic factors for esophageal voice Christine G. Bravos Follow this and additional works at: https://scholarsrepository.llu.edu/etd Part of the Biostatistics Commons, and the Speech Pathology and Audiology Commons Recommended Citation Bravos, Christine G., "Review of prognostic factors for esophageal voice" (1980). Loma Linda University Electronic Theses, Dissertations & Projects. 541. https://scholarsrepository.llu.edu/etd/541 This Thesis is brought to you for free and open access by TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. It has been accepted for inclusion in Loma Linda University Electronic Theses, Dissertations & Projects by an authorized administrator of TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. For more information, please contact [email protected]. ABSTRACT Plan A of this study was completed. Plan B of the study is the subject for future research. A review of _the laryngectomy literature, from the earliest mention of the laryngectomy surgical procedure to the present was conducted; with specific emphasis upon factors pertinent to laryngectomee rehabilitation and esophageal speech development. Psychological, idiosyn­ cratic, social, therapeutic and physiological factors were reported as affecting esophageal voice development. There were a great diversity of variables that might be predictive in judging acquisition of esophageal voice. However, much of the information regarding predictive variables was based on subjective reports, poorly controlled statistical research, or insignificant correlations. A Preliminary Esophageal Voice Checklist was developed to provide a systematic survey of variables frequently reported in the literature as affecting esophageal voice development. A proposal for experimental study, Plan B, was made for d~velopment of a pre~interven­ tion assessment tool. Such a tool would allow the clinician to judge a laryngectomee's potential for esophageal development or an alternate form of conmunication. LOMA LINDA UNIVERSITY Graduate School REVIEW OF PROGNOSTIC FACTORS FOR ESOPHAGEAL VOICE by Christine G, Bravos A Thesis in Partial Fulfillment of the Requirements for the Degree Master of Science in the Field of Speech Pathology June 1980 Each person whose signature appears below certifies that this thesis in his opinion is adequate, in scope and quality, as a thesis for the degree Master of Science. Chai rrna n rel v1n Cohen, Associate Professor_Of_____ _ Speech Pathology (ii) ACKNOWLEDGEMENTS I am indebted to Dr, Maurice Hodgen for his trust and ongoing support that enabled me to complete this paper, I acknowledge the participation of my committee members, Dr, Melvin Cohen, Mr. Jack Hartley and Dr. Grenith Zimmerman for their direction and valuable assistance in the completion of this paper; and for their enthu­ siastic support for future research in this area of study. I wish to thank Dr. Jean Lowry, in the Department of Speech Pathology, for her concern that completion of this paper be accomplished in accord­ ance with Graduate School guidelines. I am deeply appreciative of my Chairman, Dr. Melvin Cohen's ongoing support during the research stage of this paper. His timely and inspiring counsel continuously motivated the undertaking of this study, I acknowledge the generosity of Robin Miller, my associate and dear friend, for making it possible that I could devote long hours needed to complete this paper. I extend special thanks to my parents, Lucas Bravos and to my late mother, Helen Bravos, for raising me to know the value of knowledge and to strive for excellence fo my acade.mi.c pursuits, And to my uncle, Nick Diacos, I the\nk hi.m for his genui_ne interest and philanthropy during my academic life. I recognize the indelible contribution of my sister, Annette Bravos, for being a positive model throughout my academic career. I will always (iii ) remember the endless devotion of her time in the typing and preparation of this manuscript. I am most grateful to Lucy Beck for preparing the final manuscript. Lastly, I wish to acknowledge the laryngectomee patients who I have had the privilege to know and to treat. I thank each one for making me aware of the urgent need for this study, (iv) TABLE OF CONTENTS Page CHAPTER I INTRODUCTION , r ! ' r ! ! ' ' • 1 • t Statement of the Problem , '! ' • • t t .. ' ' , f t ! « ,. ' 7 Importance of· Study t ! t f • • I • t '- 8 Purpose of Study ! ~ . ' . ' . ~ ' 12 Hypothesis ... ~ • t . i 3 ' ~ ! . ' ~ CHAPTER II LITERATURE REVIEW ~ . ~ .... ,,.,,,. ... ,., . 14 Psychological Factors ~ 14 ' . ' ~ •t!!•·~·· Fear .... ' ~ ... t • ' ' • ! t .. .. ' • • • • 19 I)') /\nxi:ety • t • • ' . ' • l. l. Depression ' • • ' • • ~ • ' f ': ' , ' • ' • • • 24 Motivation . ' . ' ..... • t ! • , . t • ! 28 c>i osyncra tic Factors ( . 30 Personality Traits .. • t . ' 30 Home Environment . ' . 37 Attitude Toward Esophageal Speech .. 39 Social Factors . ' . , .. , !' t ' • ' • • 41 Employment . ~ . • 42 • • • • • t • • Type of Employment . ' ~ ! ' • •. 44 Early or Late Return to Work , ' . ' • 45 Age ·······~!•tt,t• t ~ ' t • 4! ! ' • ' ' 46 (vi) Page ! , • • , , • Therapeuttc Factors ~ !'~•·•t•!'9'~· 47 Pre-operati,ve Tra i,ni,ng . ,.,!,,~.,~~t•tt!"• 47 Pre-operative Visttatton of Speech Pathologist . ,. ~ 50 Pre~operative Visitation by Esophageal Speaker$ 51 Post~operattve Visitation by Esophageal Speakers ... , • ! • 53 Speech Pathologist Versus Lay Laryngectomee tn Voice ! • ,, • , ! Tra tni ng , . • , • . , . , t ~ • ' t 53 Speech Pathologist • • ! t • t • • • ' 53 Lay Laryngectomee • I 54 • • t • ' ' " ~ t t • ! . ' . Speech Pathologist With Supportive Assistance From Lay Laryngectomees . , , . , . 55 Early/Late Speech Therapy Intervention 57 Group Versus Individual Voice Training 58 Esophageal Voice Techniques Used by Speaker . 58 Facilitory Voice Techniques . 61 Participation in Laryngectomee Associations . , . 63 Physiological Factors . 65 Natural Ability 65 Alcohol ism . ' 68 Radiotherapy • • t ~ 69 Fistula Formation . 71 CHAPTER III METHODS AND PROCEDURES 74 Methods . •••••t•tttt•!rt••t••••• 74 Materials . ' ' . • • • '! • 74 (vii) Page Population Sample • ,,!'•tt!~•!I t • 76 Instrumentation . , .... ,,., .. 77 Judging , , . .. ' . ' 79 CHAPTER IV SUMMARY • • , • • • • • • • •f'!'••f•f.•tt ! • ' 81 RESULTS AND DISCUSSION . ' . ' . ' 87 Pre1 iminary Esophageal Voice Check1 i st ,. ' . " . ' . 89 CHAPTER V FUTURE RESEARCH . ' • ! , , ... ~,, .. 99 BIBLIOGRAPHY . , . • t ~ . ' ' ' . ' ' 101 APPENDIX . ' • ' • • t. • ' .. ' • ' . 117 (_viii} KEY TERMS A1 arynge?l___3Eeech_: speech produced without use of the larynx Esophageal _?_Reech or voice; When this adjective is applied to 11 voice 11 or "speech," it refers to a method of producing sound from air in the esophagus. Esophagus: a food passage from the mouth to the stomach LaryQ_gect9me~: the person who has had a 1 aryngectomy performed upon him Laryngectomy: the surgical removal of the larynx Larynx: a structure containing the vocal cords situated at the top cf the trachea and below the root of the tongue (y) CHAPTER I INTRODUCTION At the end of the nineteenth and beginning of the twentieth century survival of the patient after laryngectomy was the prime consideration. The loss of the natural voice was a moot point to rehabilitation workers. Surgical and medical triumphs have shown ary increase in longevity for the laryngectomee. A great many laryngectomees will live-out the remaining decades of their lives with this unique disability and its many physical, psychological, social and economic complications. Today, laryngectomy must be thought of as the beginning of the rehabilitation process, restora­ tion of usable speech must follow. Re-learning of communication skills may_ facilitate the return to a 0 normal'' lifestyle. Cleopedias in 100 A.O. was the first to record cancer of the larynx {Winsor Morrison, M.D., Personal Communication). Progress in treatment of carcinoma of the larynx is due to the work of many men in several countries. In 1866, Patrick Watson of Edinburgh removed a non-functioning syphilltic larynx from a 36-year-old male" "Patient rallied from the operation but died some weeks after from pneumonia'~ (Watson, 1881). In 1873, Christian Theordore Billroth performed the first laryngectomy for cancer of the larynx. The tragic loss of his first twenty patients is documented (Thomason, 1939}, Laryngeal cancer was regarded as an uncommon disease and was described as P..xtremely rare by Cornil and Ranvier as late as 1876 (Thomson, 1939}. In 1887, the case of Crown Prince Fredrich of Gennany, a laryngectomee, brought the whole subject of laryngeal cancer and its surgical treatment into the world-wide prominence. By modern standards the disease in most of these early cases was far advanced and the surgical 1 2 mortality was high. Progress remained slow until 1900. Gluck and Soerensen in Berlin contributed greatly to surgical technique (Jesberg, 1960). The name.s of Si.r St, Clair Thomson, Tapta, Solis-Cohen, MacKenty, and Buckley stand out as milestones that mark the ~long and hazardous journey from the early disheartening failure to what today we call our most complete success i.n the treatment of cases of cancer o( the. larynx" (Cunntng, 1943). The number of patients. that survived laryngectomy prior to 1920 was few (Struben,
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