ENT

1. DR. GHULAM SAQULAIN
M.B.B.S., D.L.O., F.C.P.S
Head of Department of E.N.T
CAPITAL HOSPITAL, ISLAMABAD.
INTRODUCTION OF PROVOX
VOICE PROSTHESIS FOR
POST LARYNGECTOMY
SPEECH REHABILITATION.

2. INTRODUCTION OF PROVOX VOICE
PROSTHESIS IN PAKISTAN
-
A STEP TOWARDS
DEVELOPMENT OF
ASSISTIVE TECHNOLOGY
FOR POST LARYNGECTOMY
SPEECH REHABILITATION.
Key Words: Post-Laryngectomy Speech
Rehabilitation, Voice Prosthesis, T-E Fistula.

3. INTRODUCTION OF
PROVOX VOICE
PROSTHESIS IN
PAKISTAN -
A STEP TOWARDS DEVELOPMENT OF
ASSISTIVE TECHNOLOGY FOR POST
LARYNGECTOMY SPEECH
REHABILITATION.
ABSTRACT
Laryngectomy is a recognized mode of treatment offered for a
variety of laryngeal tumors all over the world including Pakistan.
The Physical changes associated with laryngectomy amount to a
complex impairment, Speech Impairment being the most dreaded.
Development and use of Assistive Technology is the only
promising chapter for these speech Impaired Individuals. This
article outlines the procedure and results of the first implants of
Provox Voice Prosthesis and subsequent speech Therapy results
in Paksitan – A ray of hope for thousands.

4. ASSISTIVE
TECHNOLOGY
DEVELOPMENT
 Laryngeal Tumors/ Cancers are on
the rise.
 Laryngectomy has proved to be a
recognized and effective mode of
treatment for advanced laryngeal
cancer.
 Laryngectomy means the removal
of the larynx or the voice box.
INTRODUCTION

5. ASSISTIVE
TECHNOLOGY
DEVELOPMENT
 The Larynx or voice box
lies behind the Adam’s
apple
 Removal of Larynx
results in there being no
connection between
patient’s mouth& nose
above and the trachea or
windpipe below.
 The Trachea opens
through a opening called
stoma which is surgically
formed at the base of the
neck during a
laryngectomy operation.
INTRODUCTION

6. ASSISTIVE
TECHNOLOGY
DEVELOPMENT
The Anatomy of
the region before
operation
INTRODUCTION
After Laryngectomy:
The top of wind pipe or
trachea is sewn to a
opening in the neck
called STOMA.

7. ASSISTIVE
TECHNOLOGY
DEVELOPMENT
 A Laryngectomee is a person who
has had this essential and life
saving operation and will result in a
group of physical Impairments,
speech impairment being the most
dreaded.
INTRODUCTION

8. ASSISTIVE
TECHNOLOGY
DEVELOPMENT
 Writing, gesture, mouthing
(Silent articulation)
 An Electrolarynx
 Oesophageal Voice
 Other Surgical Options:
Neoglottis reconstruction,
laryngoplasty, and laryngeal
transplant.
 T-E Puncture & Voice
Prosthesis Implantation.
1. Blom Singer
2. Provox voice prosthesis system.
METHODS OF
COMMUNICATION AFTER
TOTAL LARYNGECTOMY
INTRODUCTION

9. NORMAL WAY OF
PRODUCING VOICE
 For Normal voice
production we need:
 A source of air - The
Lungs
 A Vibrating source –
The vocal cords in
the Larynx
 Resonating
Chambers – The
oropharynx and the
nasopharynx.
 Articulators – the
tongue, lip, palate to
shape the sound into
words.
INTRODUCTION

10. ASSISTIVE
TECHNOLOGY
DEVELOPMENT
 Before
Layrngectomy:
the source of
air is the lungs
and the
vibrating
source is the
vocal cods
INTRODUCTION

11. ASSISTIVE
TECHNOLOGY
DEVELOPMENT
 After Laryngectomy
(For Oesophageal
speech):
1. The source of air is the
oesophagus
2. The vibrating source is
muscle fibres in wall of
upper oesophagus/
pharynx (PE segment)
(Note: In both instances,
articulators, resonators
are the same, that is
why the accent, dilect
and mannerism of
speech donot change.)
INTRODUCTION

12.  This study was undertaken as a measure
to develop assistive technology to help
the post laryngectomy speech disabled
patients.
 In this study use of Provox 2 Voice
Prosthesis was introduced in Pakistan for
rehabilitation of Post Laryngectomy
Speech Impairment.
 Two patients received these prosthesis
followed by speech therapy. The first case
was operated at NIHd and another at
Capital Hospital are presented.
ASSISTIVE
TECHNOLOGY
DEVELOPMENTMATERIAL AND METHODS

13. THE PROVOX VOICE REHABILITATION SYSTEM
 The Provox Voice Prosthesis: It is a self retaining,
indwelling, easy to manage device for prosthetic
voice rehabilitation for laryngectomized patients
with TE fistula, also when created for several other
types of prosthesis.
 It is made of medical grade silicone rubber and is
avialable in 5 lengths: 4.5,6,8,10,12. The other
dimensions are:
 Dia of Oesophageal flange: 14.5 mm
 Oval tracheal flange:12 x 16 mm
 Inner dia: 5 mm and
 outer dia of shaft:7.5 mm
 The tracheal flange includes an introductory string.
 The valve is moulded ini one piece with the prosthesis
and is supported by a radiopaque ring (20% Ba
sulphate) which increases its X-ray visibility.
ASSISTIVE
TECHNOLOGY
DEVELOPMENTMATERIAL AND METHODS

14. MATERIAL AND METHODS
 The provox voice prosthesis is inserted in a T-E fistula and
remains in situ with out replacement by the patient for long
periods.
 It can be inserted as a primary procedure or as a secondary
puncture procedure.
 Guide Wire: Each prosthesis is provided with a guide
wire to ease insertion.
 Trocar and Cannula: For creation of T-E fistula.
 Pharynx Protector: Aids primary insertion.
 Brush:
 A Special Plug: For temporary leakage.
 Heat and Moisture Exchanger (HME): Is available
for pulmonary and improved vocal rehabilitation which
contains a special valve with a spring for easy and
comfortable digital closure of stoma.

15. Stoma Vent & Filter:
Provox 2 prosthesis
inserter:
MATERIAL AND METHODS

16. MATERIAL AND METHODS

17. MATERIAL AND METHODS
CASE RECORDS:
Case No: 1
 Mr. Mohammad Sharif, a
male aged 61 years, a
resident of Rawalpindi
developed Carcinoma of
larynx and was subjected
to laryngectomy two
years back with
subsequent loss of voice.
He was admitted on
12.6.2002 in E.N.T Dept.
of NIHd for Provox-2
Voice Prosthesis
implantation and Speech
Rehabilitation.

18. MATERIAL AND METHODS
Case No: 2
 Mr. Mehboob, a male
aged 61 years, resident
of Rawalpindi, had
laryngectomy done for
supraglottic carcinoma
of larynx on 17.6.2002
with loss of voice. He
was admitted to E.N.T
department, Capital
Hospital on 25.10.2002
and received a voice
prosthesis implant on
29.10.2002, followed by
speech therapy.

19. WORKUP:
Apart from regular General, Systemic and E.N.T
examination:
 Inspection of the pharynx for stenosis or webs at
base of tongue
 Checking of stomal size
 Barium swallow to check size of PE segment.
 Speech Therapists Evaluation: Including Insufflation
test
To predict outcome of PVP Implantation
12 Fr Nasogastric cather introduced to PE segment
and air was blown to obtain speech.
 Other necessary investigations for fitness for
general anaesthesia.
MATERIAL AND METHODS

20. SURGERY:
(In both the cases secondary
implantation procedure was
planned)
Preoperative preparation
 NPO after midnight.
 Consent: Patient was
explained the procedure and
the possible hazards and
benefits.
Anaesthesia:
General Anaesthesia with
intubation through the stoma
was used.
MATERIAL AND METHODS

21. Operation
Procedure:
 With the patient in
supine postion and
drapes in place
after cleaning the
area.
 Small size scope
passed into the
pharynx.
MATERIAL AND METHODS

22.  Scope end palpated
and through
superior wall of
stoma.
 Trocar and cannula
used to make a
standard size T-E
fistula.
MATERIAL AND METHODS

23.  Size of
prosthesis to be
used assessed
using a provox
measure guage.
MATERIAL AND METHODS

24.  Provox 2 voice
prosthesis
implanted using a
guide wire.
 Post operatively
the prosthesis was
not in position on
the oesophageal
side and we had to
reimplant the
prosthesis in one of
the patients.
MATERIAL AND METHODS

25. RESULTS
 Mr. Sharif was able to
count up to 8 after 24
hrs after surgery and
speak fluently after 1
week.
 Mr. Mehboob had lot of
secretion and coughing
preoperatively and was
able to count up to 6
after 2 days and
improved significantly
afterwards.
PROVOX VOICE
PROSTHESIS
IMPLANTATION

26. CONCLUSION
Provox 2 Voice Prosthesis
implantation is a simple procedure
with excellent results.
PROVOX VOICE
PROSTHESIS
IMPLANTATION

27. THANK YOU