have traditionally had four communicative alternatives. The
first and least intrusive is any form of nonverbal communication.
. . writing, gesture/pantomime, or communication boards. While
effective, these methods are quite time consuming, tiring,
and are only effective for face-to-face situations.
In addition, other difficulties may prohibit the use of the electrolarynx including:
fourth alternative had been Tracheoesophageal Puncture (TEP).
Cost of the surgical procedure to create the puncture averages
$ 2000 to $3000, not including pre- and post-operative visits,
medications, supplies (prosthesis, French Catheters, saline
solutions, etc.) and ensuing speech therapy. Total costs can
easily exceed $6000. Many patients have successfully undergone
this procedure since its inception. Perhaps the greatest asset
of TEP is the tremendous volume that some patients are able
to achieve. Clarity is also judged to be good to excellent,
depending on the patient.
Contraindications to TEP include:
addition, the success of the TEP can be hindered by a patient's
failure to properly care for the prosthesis, improper fitting
of the prosthesis with subsequent air leakage and fungi build
up. It is not uncommon for a patient to drop the prosthesis
into the trachea or lung creating a traumatic and painful
situation for the patient until it is removed by a doctor.
Unfortunately about four people in ten (40%) are not successful
with the T.E.P. long term. This additional surgery with a
relatively low success rate can also lead to longer problems
such as infection and fistula as well as requiring admission
to the emergency room when voice proteses fall into the lung.
As a result many laryngectomees opt not to undergo this treatment.
A new device, UltraVoice Plus has been developed which presents another option enabling laryngectomees to speak.
device consists of an oral unit which is worn inside the mouth
and a controller which transmits radio waves to the oral unit.
The radio waves carry the tone of the human voice which is
reproduced in the mouth by the oral unit. Because the sound
is created within the vocal tract, it is significantly more
natural and intelligible than external units. In addition,
it has been designed to alleviate some of the contraindications
associated with the other technologies.
As the UltraVoice is worn in the oral cavity, typical considerations
such as edema, fibrosis, and placement sites are eliminated.
Worries about adequate sound transmission and skin irritation
secondary to radiation treatments are also eliminated. For
arthritic patients, the control unit can be operated with
the side of the hand or wrist, or it can be equipped with
an adaptive device, i.e. built-up button, toggle switch, etc.
The UltraVoice is worn all day like a regular denture or retainer,
including for meals. This provides the laryngectomee with
the ability to eat and talk simultaneously, a skill not attainable
with esophageal speakers. It also eliminates hygienic concerns,
such as those involved with the intraoral electrolarynxes.
In order to maximize usage of the UltraVoice, a short course
of therapy with a certified speech/language pathologist is
highly recommended. However, the laryngectomee is able to
begin speaking intelligibly with the UltraVoice from the moment
it is inserted. Clarity is judged to be excellent. Patients
incorporating esophageal speech, electrolarynxes, and sometimes
TEP's are unable to achieve independent verbal communication
until further into their course of treatment.
The only contraindication for the UltraVoice is intolerance to
an intraoral prosthesis. Age, fistulas, and cardiopulmonary
status do not affect the laryngectomee's success. Conversely,
the UltraVoice is quite helpful for those patients with cardiopulmonary
disease, as the UltraVoice serves as an energy conservation
device for these patients and provides them with the ability
to speak significantly longer without fatigue.
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