Govorna rehabilitacija nakon totalne laringektomije

master's thesis

• Title (english): Voice restoration after total laryngectomy
• Author: Ivona Jerković
• Mentor: Mario Bilić (mentor)
• Committee member: Drago Prgomet (predsjednik povjerenstva)
• Committee member: Mirko Ivkić (član povjerenstva)
• Committee member: Mario Bilić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

Totalna laringektomija je opsežan kirurški zahvat, indiciran kod bolesnika s uznapredovalim karcinomom larinksa, stadija T3 i T4 prema TNM klasifikaciji. Grkljan, anatomski složen organ, povezuje gornji i donji dišni put i time osigurava tri glavne funkcije: štiti donji respiratorni trakt, omogućuje respiraciju i sudjeluje u fonaciji, tj. stvaranju glasa. Nakon potpunog uklanjanja grkljana i okolnih struktura, bolesnik se suočava s brojnim promjenama u načinu života: udisaj i izdisaj se odvija na traheostomi (trajnom otvoru na prednjoj strani vrata), zrak bez prethodne pripreme direktno ulazi u traheju i pluća, bolesniku je poremećen osjet mirisa i okusa, i najvažnije, ne može govoriti. Gubitak glasa značajno utječe na komunikaciju i odnose s ljudima, te rezultira bolesnikovim povlačenjem, psihološkim smetnjama i smanjenjem kvalitete života. Još od kada je 1873. Theodor Billroth izveo prvu totalnu laringektomiju, uloženi su značajni napori u istraživanje i razvoj najboljeg načina govorne rehabilitacije kod laringektomiranih bolesnika. Uspješnu rehabilitaciju danas je moguće postići s tri najvažnije metode: učenjem ezofagealnog govora, upotrebom elektrolarinksa i traheoezofagealnim glasom i govorom uz govornu protezu (GP). Ezofagealni glas nastaje tako što bolesnik ubaci zrak u gornji dio jednjaka, te prilikom njegovog propuštanja prema usnoj šupljini dolazi do vibracije faringoezofagealnog segmenta (PES). Elektrolarinks je govorni aparat koji zahvaljujući elektro bateriji stvara vanjski izvor vibracija. Prislanjanjem uređaja na kožu vrata, one se prenose u usnu šupljinu gdje artikulacijom nastaje glas i govor. Traheoezofagealni govor s GP nastaje prolaskom zraka iz pluća prema gornjem dijelu jednjaka, kroz GP postavljenu u traheoezofagealnu fistulu. Zadnjih nekoliko desetljeća, traheoezofagealni govor s GP je zlatni standard govorne rehabilitacije u svijetu.

Abstract (english)

Total laryngectomy (TL) is an extensive surgical procedure, reserved for patients with advanced laryngeal carcinoma, staged as T3 and T4 by the TNM classification. The larynx, an anatomically complex organ by its structure, connects the upper and lower respiratory tract, and therefore it serves three important functions in humans: protection of the lower airways, facilitation of respiration and voice production. Following complete removal of the larynx and nearby structures, the patient has to adapt to new forms of living; breathing trough a stoma (permanent aperture in the neck), inhaling unprepared air directly into the trachea and lungs, loss of smell and taste, and most importantly, being voiceless. The loss of vocal communication severely disrupts interactions with others and leads to social withdrawal, psychological changes and a decrease in the quality of life. Since the first TL was described by Theodore Billroth in 1873, great effort has been put in finding the best option for voice resuscitation and improvement in the quality of life in laryngectomized patient. Successful voice restoration can be attained with one of three speech options: esophageal speech, electrolarynx, and, most recently, tracheoesophageal speech using an artificial valve. Esophageal speech is produced after the air has been drawn into the upper esophagus and then released in a controlled manner to vibrate the pharyngoesophageal segment (PES). An electrolarynx is an artificial, mechanical device which creates an external buzzing vibrations. By placing it on the neck, vibrations reach the throat and mouth of the user so he can convert this energy into the voice and speech. Tracheoesophageal speech with voice prosthesis is produced after expiratory air from the lungs has been drawn into the upper esophagus, directed through the voice prosthesis inserted into the fistula. The last method has become the most preferred speech method in the past decade in the world.

• Keywords: totalna laringektomija; govorna rehabilitacija; govorna proteza
• Keywords (english): total laryngectomy; voice restoration; artificial valve
• Language: croatian
• URN:NBN: urn:nbn:hr:105:118518
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-11-02 09:06:13