Laryngectomy Health Dictionary

Obstruction of the larynx is potentially dangerous in adults but can sometimes be life-threatening in infants and children. Stridor – noisy, di?cult breathing – is a symptom of obstruction. There are several causes, including congenital abnormalities of the larynx. Others are in?ammatory conditions such as acute laryngitis (see below), acute EPIGLOTTITIS and laryngo-tracheo-bronchitis (croup – see below); neurological abnormalities; trauma; and inhalation of foreign bodies.

Laryngitis In?ammation of the mucous membrane of the larynx and vocal chords may be acute or chronic. The cause is usually an infection, most commonly viral, although it may be the result of secondary bacterial infection, voice abuse or irritation by gases or chemicals. ACUTE LARYNGITIS may accompany any form of upper-respiratory-tract infection. The main symptom is hoarseness and often pain in the throat. The voice becomes husky or it may be lost. Cough, breathing diffculties and sometimes stridor may occur. Acute airway obstruction is unusual following laryngitis but may occasionally occur in infants (see laryngotracheo-bronchitis, below).

Treatment Vapour inhalations may be soothing and reduce swelling. Usually all that is needed is rest and analgesics such as paracetamol. Rarely, airway intervention – either ENDOTRACHEAL INTUBATION or TRACHEOSTOMY – may be necessary if severe airway obstruction develops (see APPENDIX 1: BASIC FIRST AID). A?ected patients should rest their voice and avoid smoking.

Chronic laryngitis can result from repeated attacks of acute laryngitis; excessive use of the voice – loud and prolonged, singing or shouting; tumours, which may be benign or malignant; or secondary to diseases such as TUBERCULOSIS and SYPHILIS.

Benign tumours or small nodules, such as singer’s nodules, may be surgically removed by direct laryngoscopy under general anaesthetic; while cancer of the larynx may be treated either by RADIOTHERAPY or by SURGERY, depending on the extent of the disease. Hoarseness may be the only symptom of vocal-chord disturbance or of laryngeal cancer: any case which has lasted for six weeks should be referred for a specialist opinion.

Laryngectomy clubs are being established

A laryngoscopic view of the interior of the larynx.

throughout the country to support patients following laryngectomy. Speech therapists provide speech rehabilitation.... larynx, disorders of

These may be of physical or psychological origin – or a combination of both. Di?culties may arise at various stages of development: due to problems during pregnancy; at birth; caused by childhood illnesses; or as a result of delayed development. Congenital defects such as CLEFT PALATE or lip may make speech unintelligible until major surgery is performed, thus discouraging talking and delaying development. Recurrent ear infections may make hearing dif?cult; the child’s experience of speech is thus limited, with similar results. Childhood DYSPHASIA occurs if the language-development area of the BRAIN develops abnormally; specialist education and SPEECH THERAPY may then be required.

Dumbness is the inability to pronounce the sounds that make up words. DEAFNESS is the most important cause, being due to a congenital brain defect, or acquired brain disease, such as tertiary SYPHILIS. When hearing is normal or only mildly impaired, dumbness may be due to a structural defect such as tongue-tie or enlarged tonsils and adenoids, or to ine?cient voice control, resulting in lisping or lalling. Increased tension is a common cause of STAMMERING; speech disorders may occasionally be of psychological origin.

Normal speech may be lost in adulthood as a result of a STROKE or head injury. Excessive use of the voice may be an occupational hazard; and throat cancer may require a LARYNGECTOMY, with subsequent help in communication. Severe psychiatric disturbance may be accompanied by impaired social and communication skills. (See also VOICE AND SPEECH.)

Treatment The underlying cause of the problem should be diagnosed as early as possible; psychological and other specialist investigations should be carried out as required, and any physical defect should be repaired. People who are deaf and unable to speak should start training in lip-reading as soon as possible, and special educational methods aimed at acquiring a modulated voice should similarly be started in early childhood – provided by the local authority, and continued as required. Various types of speech therapy or PSYCHOTHERAPY may be appropriate, alone or in conjunction with other treatments, and often the ?nal result may be highly satisfying, with a good command of language and speech being obtained.

Help and advice may be obtained from AFASIC (Unlocking Speech and Language).... speech disorders

A cancerous tumour of the larynx. The exact causes of this cancer are not known, but smoking and high alcohol consumption may be associated factors. Hoarseness is the main symptom, particularly when the tumour originates on the vocal cords. At an advanced stage, symptoms may include difficulty in breathing and swallowing, and coughing up blood.

If laryngoscopy reveals a tumour on the larynx, a biopsy is carried out.

If the tumour is small, radiotherapy or laser treatment may be used.

For unresponsive and large tumours, partial or total laryngectomy may be considered.... larynx, cancer of

A technique for producing speech after surgical removal of the larynx (see laryngectomy).

Air is trapped in the oesophagus and is gradually expelled while the tongue, palate, and lips form distinguishable sounds.... oesophageal speech

An operation in which an opening is made in the trachea and a tube is inserted to maintain an effective airway. A tracheostomy is used for the emergency treatment of airway problems involving the larynx. A planned tracheostomy is most commonly performed on a person who has lost the ability to breathe naturally and is undergoing long-term ventilation or is unable to keep saliva and other secretions out of the trachea. Permanent tracheostomy is needed after laryngectomy.... tracheostomy

n. a battery-powered electrical vibrator that helps people to speak after *laryngectomy.... electrolarynx

Professionally trained speech therapists assist, diagnose and treat the whole spectrum of acquired or developmental communication disorders. They work in medical and education establishments, often in an advisory or consultative capacity. The medical conditions in which speech therapy is employed include: dysgraphia, DYSLEXIA, DYSARTHRIA, DYSPHASIA, DYSPHONIA, DYSPRAXIA, AUTISM, BELL’S PALSY, CEREBRAL PALSY, DEAFNESS, disordered language, delayed speech, disordered speech, DOWN’S (DOWN) SYNDROME, LARYNGECTOMY, LEARNING DISABILITY, MACROGLOSSIA, MOTOR NEURONE DISEASE (MND), malformations of the PALATE, PARKINSONISM, STAMMERING, STROKE and disorders of voice production.

Speech therapists form a small independent profession, most of whom work for the National Health Service in community clinics, general practices and hospitals. They may also work in schools or in units for the handicapped, paediatric assessment centres, language units attached to primary schools, adult training centres and day centres for the elderly.

A speech therapist undergoes a four-year degree course which covers the study of disorders of communication in children and adults, phonetics and linguistics, anatomy and physiology, psychology and many other related subjects. Further information on training can be obtained from the College of Speech Therapists.

If the parents of a child are concerned about their child’s speech, they may approach a speech therapist for assessment and guidance. Their general practitioner will be able to give them local addresses or they should contact the district speech therapist. Adults are usually referred by hospital consultants.

The College of Speech Therapists keeps a register of all those who have passed a recognised degree or equivalent quali?cation in speech therapy. It will be able to direct you to your nearest NHS or private speech therapist.... speech therapy

n. the implantation of an organ or tissue (see graft) from one part of the body to another or from one person (the donor) to another (the recipient). Success for transplantation depends on the degree of compatibility between donor and graft: it is greatest for *autografts (self-grafts), less for *allografts (between individuals of the same species), and least for *xenografts (between different species; see xenotransplantation). Skin and bone grafting are examples of transplantation techniques in the same individual. A kidney transplant involves the grafting of a healthy kidney from a donor to replace the diseased kidney of the recipient: renal transplantation is the second commonest example of human transplant surgery using allografts (after corneal grafts – see keratoplasty). Bone-marrow, blood-stem-cell, heart, heart–lung, pancreatic, and liver transplants are also very successful. Patients have undergone laryngeal transplantation following *laryngectomy. Transplanting organs or tissues between individuals is a difficult procedure because the recipient’s immune system perceives the transplant as a foreign object and rejects it. Special treatment (e.g. with *immunosuppressant drugs) is needed to prevent transplant rejection, and the less common but equally devastating effects of an attack by the graft’s immune cells on the host.

Ethical questions arise over donated organs. If the donor is living, is the organ properly a *gift? If the donor has recently died, how has the death been judged and has *consent been given explicitly by the patient or surviving relatives (opting in) or is it assumed if the donor has not forbidden it (opting out)?... transplantation