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Voice Prosthesis for Voice Rehabilitation Following …
Chemoradiation treatment for advanced, inoperable head and neck cancer is increasingly successful in eradicating disease. However, despite the fact that organ preservation is highly likely, function preservation is often still quite poor. The main issues are the development or persistence of trismus and swallowing problems, whereas voicing also can remain impaired. There are indications that early rehabilitation, i.e. starting even before the onset of the therapy can diminish and even prevent some are most of the treatment related problems. Therefore, a prospective, randomized trial is carried out, in which standard speech pathology exercises are compared with a dedicated trismus-treating device, to study the possibilities to prevent post treatment trismus, swallowing, and communication sequels. Funding Atos Medical AB, Sweden (unrestricted research grant). Co-investigators are Dr. Maya van Rossum and Dr. Ludi Smeele. AIO is Lisette van der Molen , MA. Duration 2006-2011 (Netherlands Cancer Institute project N05TSP).
This program, since 2003 embedded in the program Speech Communication and Phonetic Sciences (Prof. Louis Pols), aims at increasing our understanding of the pathophysiology of oncology related voice and speech disorders, potentially leading to improved rehabilitation and/or intervention strategies. Modern advances in the treatment of head and neck cancer have resulted in improved control rates, although often at the expense of impairment of functions of mouth, throat, and/or voice box. One of these advances is the application of special combined chemotherapy and radiotherapy protocols, which has also resulted in a higher likelihood of preservation of the treated organ. Unfortunately, preservation of an organ does not necessarily mean that its function remains unaffected. Loss of function is even more self-evident in case of surgical procedures, where all or part of an organ has to be removed for cure. Total laryngectomy (complete removal of the voice box) is the mostobvious example of a surgical procedure, that has significant functional side effects, and, besides other consequences, leads to changes in voice and speech. Presently the program focuses on the perceptual and acoustic determinants of speech intelligibility in laryngectomized individuals, who use a special implanted prosthesis for voice rehabilitation. Other oncology related voice and speech disorders as a result of head and neck cancer treatment also are aimed at in this program, which is carried out in close collaboration with the Netherlands Cancer Institute. With the appointment of Prof. Dr. Michiel WM van den Brekel in 2011 as the second ordinarius on the chair for "Oncology-related voice and speech disorders", who is involved in all projects listed below, the continuity of this research program is warranted for many years to come. Currently the following (partly externally-funded) research projects are carried out
Atos Medical Provox Vega Voice Prosthesis | …
Vocal rehabilitation after total laryngectomy with the help of an implanted voice prostheses is presently the gold standard to re-establish oral communication after this (often successful) cancer operation. In the Netherlands, there are currently approximately 2500 laryngectomized individuals. The majority of them are using voice prostheses, which act as one-way valves to allow pulmonary air to be used for voicing and at the same time prevent aspiration of fluids into the trachea. These devices have no 'eternal life' and need to be replaced, when the one-way valve function deteriorates, leading to insufficient closing and thus to aspiration of fluids. Furthermore, deterioration of the valve may also impair voicing. Therefore, current research is focusing on improvement of durability and physical properties of the present generation voice prostheses. This project is funded by an unrestricted research grant by Atos Medical AB, Sweden . This project is carried out in close collaboration with Dr. Annemieke Ackerstaff, Dr. Irene Jacobi, and staff members of the Department of Head and Neck Surgical Oncology of the Netherlands Cancer Institute. Duration since 1987, ongoing (Netherlands Cancer Institute projects N98VOX, N00VOX, M01VOX). The results of Phase I and II trials evaluating the recently developed 3rd generation Provox Vega prostheses have beenpublished/are in press. The main outcome was that the re-designed voice prosthesis shows a significant improvement in voice quality and that the innovative insertion device further eases the replacement of these prostheses. Since the device-life so far has not improved, further projects aiming atthisaspect will be carried out.
Total laryngectomy not only affects communication, but inevitably also leads to pulmonary problems. Breathing is possible only through a permanent stoma at the base of the neck, which precludes the normal air-conditioning in the nose. Restoration of lost nose functions (partly) can beachieved by the peri- or intrastomal application of so-called Heat and Moisture Exchangers (HME's). The beneficial influence of these devices on pulmonary problems in laryngectomized individuals is established in several clinical trials, we carried out in the past. Interestingly,in allthese studies significant correlations between pulmonary improvement and improvement in perceived voice quality were found. However, the underlying physiology of HME's was not yet well understood, and the goal of this project, therefore, was to improve our understanding in this respect. This might lead to technical improvements and efficiency of the present generation HME's, not only resulting in a further increase in pulmonary health, but also in better voice quality and thus better quality of life of laryngectomized individuals. This project originally was funded by the Michiel Keijzer Foundation, which is related to the Netherlands Society of Laryngectomees (NSvG). Other funding was received form the Maurits en Anna de Kock Foundation and (as an unrestricted reseach grant) from Atos Medical, Sweden. This project is carried out in close collaboration with Dr. Saar Muller of the Department of Medical Physics of the Netherlands Cancer Institute, the Department of Otolaryngology of the Academic Medical Center (AMC; Prof. Dr. Wytske Fokkens) and the Departments of MTO and Neonatology (Dr. Ir. Frans de Jongh) of the AMC. AIO was J.K. Zuur, MD. The duration of the project was from 2003 to 2007 (Netherlands Cancer Institute projects N04LFV, N04OXY, N05HME). In this project a special Airway Climate Explorer (ACAE) was developed, which now for the first time enables the reliable assessment of the climate (humidity and temperature) in the respiratory tract. Karel Zuur defended his Thesis "Postlaryngectomy pulmonary physiology and tracheal climate and the influence of a heat and moisture exchanger (HME)", based on the development of and first clinical studies with the ACE on April 4, 2008. The projects is still ongoing withanew AIO, Renske Scheenstra (2007-2009), who will expand the clinical ACE studies and assess newly designed HME's. This part of the project is in its final stages and the Thesis defense is expected at the end of 2010. The 3rd AIO on this project is Cindy van den Boer, MD, who currentlyisworkingonthe further evaluation of the patho-physiology of the postlaryngectomy respiratory tract (duration of the project 2009-2013).
[The Costs for Different Voice Prostheses Depending on …
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