Speech-Language Pathologist, Part 15

Question 1: Describe laryngeal papillomas, including their etiology, symptoms, treatment, and prognosis.

Answer 1: Laryngeal papillomas are benign epithelial tumors affecting the larynx and respiratory tract. They are caused by the human papilloma virus, which also causes warts. Although a majority of the population is infected with this virus, these growths occur in only some people. Onset can be in childhood or adulthood, and symptoms include hoarseness and/or noisy breathing. Laryngoscopy routinely is used to diagnose the disease; treatment is to remove the papillomas. Avoiding scarring, which can permanently affect the voice, is crucial. Advances in pulsed-dye lasers allow painless removal in a doctor’s office. The procedure requires no anesthesia, takes only a few minutes, and needs no recovery time. This “smart” laser targets the papilloma without damaging normal epithelium. Recurrence is frequent because the virus lives in normal tissue surrounding the papilloma. Some children need excision once or twice a month, some for life; for others, puberty brings spontaneous regression. Chemotherapy, radiation, and other traditional treatments are available for more aggressive cases but are rarely needed since the advent of PDL.

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Question 2: Discuss laryngeal carcinoma, its etiology, treatment relative to time of detection, and consequences of radical treatment.

Answer 2: Laryngeal carcinoma is malignant cancer and the most common cancer of the upper respiratory/digestive tract. It correlates highly with tobacco smoking. Six times as many smokers develop head and neck tumors as nonsmokers. The heaviest smokers are 20 times more likely to die of laryngeal cancer than nonsmokers are. Laryngeal cancer can be treated with radiation or chemotherapy, but survival rates are comparable to those of surgery in stages I through III only. With earlier detection, chemotherapy is more effective than radiation. With detection at stage IV, one recent study found a 49 with chemotherapy.

Question 3: Discuss some pros and cons of various post-laryngectomy voice rehabilitation techniques.

Answer 3: The electrolarynx has the advantage of allowing immediate speech without a long learning process. Disadvantages are that it occupies one of the user’s hands; it must be carried around and needs batteries, and it has a robotic sound quality. Advantages of indwelling prosthetic devices such as the Blom-Singer, ProVox, or VoiceMaster are comparatively good voice quality and high success rates without long learning periods. Some disadvantages include requiring tracheoesophageal puncture, an insertion process, and periodically replacing parts and supplies; expense; usually needing to block the tracheostoma with one hand; leakage around the prosthesis from puncture enlargement; granulomatous tissue formation around the prosthesis, and aspiration of the prosthesis. The latter three conditions do not occur frequently. Esophageal speech has advantages of needing no surgery, procedures or equipment, and the patient has more control over his or her speech. Disadvantages are a longer learning curve, lower voice pitch, and reduced loudness, though this improves with strengthening over time.

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