Esophageal speech
Encyclopedia
Esophageal speech, also known as esophageal voice, is a method of speech production
Speech production
Speech production is the process by which spoken words are selected to be produced, have their phonetics formulated and then finally are articulated by the motor system in the vocal apparatus...
that involves oscillation of the esophagus
Esophagus
The esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...
. This contrasts with traditional laryngeal
Larynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
speech which involves oscillation of the vocal folds
Vocal folds
The vocal folds, also known commonly as vocal cords, are composed of twin infoldings of mucous membrane stretched horizontally across the larynx...
. Instead, air is injected into the upper esophagus and then released in a controlled manner to create sound used to produce speech. Esophageal speech is a learned skill that requires speech training and much practice. Because of the high level of difficulty in learning esophageal speech, some patients are unable to master the skill.
Clinical
Esophageal speech is a skill that can help patients to communicate after a laryngectomyLaryngectomy
Laryngectomy is the removal of the larynx and separation of the airway from the mouth, nose and esophagus. The laryngectomee breathes through an opening in the neck, a stoma. This procedure is usually performed in cases of laryngeal cancer...
, the most common surgery used for the treatment of laryngeal cancer. In the operation, the larynx
Larynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
and the vocal cords are removed completely. After this, the end of the trachea
Vertebrate trachea
In tetrapod anatomy the trachea, or windpipe, is a tube that connects the pharynx or larynx to the lungs, allowing the passage of air. It is lined with pseudostratified ciliated columnar epithelium cells with goblet cells that produce mucus...
is sewn onto the edge of an opening cut out at the lower part of the neck, creating a breathing hole similar to that used by a whale. This hole is called a tracheostoma and permits the patient to breathe through it after the operation.
Character
The air moves from outside the body through the tracheostoma directly to the lungs, without passing through the upper respiratory organs of the noseHuman nose
The visible part of the human nose is the protruding part of the face that bears the nostrils. The shape of the nose is determined by the ethmoid bone and the nasal septum, which consists mostly of cartilage and which separates the nostrils...
, mouth
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....
, and throat
Throat
In vertebrate anatomy, the throat is the anterior part of the neck, in front of the vertebral column. It consists of the pharynx and larynx...
. Because it bypasses the vocal folds, speech is severely impaired, and the development of an esophageal voice becomes necessary. Esophageal speech is produced without an artificial larynx, and is achieved by pumping air from the mouth into the upper esophagus. The esophagus is slightly expanded. The air is then released in a regulated manner through the mouth, with simultaneous articulation of words.
Esophageal speech is quieter and more strenuous than laryngeal speech, and fewer words can be produced successively. Good esophageal speakers can produce an average of 5 words per breath and 120 words per minute.
Because of the large, vibrating pharyngo-esophageal segment, the pitch
Pitch (music)
Pitch is an auditory perceptual property that allows the ordering of sounds on a frequency-related scale.Pitches are compared as "higher" and "lower" in the sense associated with musical melodies,...
of esophageal speech is very low--between 50 and 100 Hz. In esophageal speech, pitch and intensity
Sound intensity
Sound intensity or acoustic intensity is defined as the sound power Pac per unit area A. The usual context is the noise measurement of sound intensity in the air at a listener's location.-Acoustic intensity:...
correlate: a low-pitched voice is produced with low intensity and a high-pitched voice is produced with high intensity. The production of the latter is more exhausting.
The voice
Human voice
The human voice consists of sound made by a human being using the vocal folds for talking, singing, laughing, crying, screaming, etc. Its frequency ranges from about 60 to 7000 Hz. The human voice is specifically that part of human sound production in which the vocal folds are the primary...
of a speaker without a larynx sounds as if he or she has a cold
Common cold
The common cold is a viral infectious disease of the upper respiratory system, caused primarily by rhinoviruses and coronaviruses. Common symptoms include a cough, sore throat, runny nose, and fever...
.
Tracheoesophageal puncture
Another option for restoring speech to the laryngectomy is the tracheoesophageal punctureTracheoesophageal puncture
A tracheo-oesophageal puncture is a surgically created hole between the trachea and the esophagus in a person who has had a total laryngectomy, a surgery where the larynx is removed...
or TEP. In this simple surgical procedure, a small puncture is made between the trachea
Vertebrate trachea
In tetrapod anatomy the trachea, or windpipe, is a tube that connects the pharynx or larynx to the lungs, allowing the passage of air. It is lined with pseudostratified ciliated columnar epithelium cells with goblet cells that produce mucus...
and the esophagus, and a one-way
Check valve
A check valve, clack valve, non-return valve or one-way valve is a mechanical device, a valve, which normally allows fluid to flow through it in only one direction....
air valve is inserted. This air supply can be used to cause vibrations in a similar manner to esophageal speech. This surgical procedure may occur during the laryngectomy (primary TEP) or after a period of time (secondary TEP).
The prosthesis is placed approximately 10–14 days post operation by a certified speech language pathologist (SLP) who specializes in ENT work. During the placement of a prosthesis, the SLP measures the depth of the puncture, chooses the correct prosthesis, and inserts it with a loading device (the entire process can occur in 30-45 minutes pending complications). Patients return to be resized every few months after surgery. When the puncture site stops changing sizes, then a more permanent prosthesis can be placed that will last approximately 6-12 months (indwelling prosthesis). Patients may choose this route, in which case they will return to the SLP for placement every 6-12 months, or may choose a low pressure, or duckbill prosthesis that they can change independently at home every few months. This option has become increasingly popular in the past 10 years, as in many cases intelligible voicing may be achieved within minutes of placement of the prosthesis.
Some of the advantages to tracheoesophageal puncture are a higher success rate at about 95% of vocal rehabilitation and a much faster time frame compared to esophageal speech.(Pawar,Sayed, Kazi, Jagade,2008).
Electrolarynx
An electrolarynx is a handheld device which is held against the throat, and provides vibrations to allow speech. Electrolarynges may be used immediately post surgery with an oral adapter (the neck being too tender immediately post surgery).Esophageal and electrolaryngeal speech (speech with an electrolarynx) may take weeks or months of training to achieve functional voicing).
Modern society
In modern society, "burping the alphabet" is a common practice.External references
Esophageal speech- Mr.Tsuchida Esophageal speech to Provox
- Web Whispers esophageal sppech (Web Whispers is a support site for laryngectomy survivors)