Some of the machines have buttons to vary the pitch or tone of the sound made by the electronic larynx. This makes your voice sound more varied. Your speech and language therapist will advise you on the best type for your situation and can arrange for you to have an electrolarynx on loan.
This is the most common way to restore speech after surgery. Find out how you have it and how you can speak using a voice prosthesis. You might have surgery, chemotherapy, radiotherapy or a combination of treatments to treat laryngeal cancer.
Laryngeal cancer is cancer that starts in the voice box larynx. It is a rare type of head and neck cancer. About Cancer generously supported by Dangoor Education since Questions about cancer? In addition, the vibrational patterns are personalised for each user, based on recordings of their own, former voice.
This is possible by running these recordings through an artificial intelligence tool for audio signal processing known as linear predictive coding LPC , which can analyse how a sound is created. Although the team is currently still working on improving the algorithm behind the technology, Masaki has already received positive feedback from patients. However, there are still issues such as the noisy vibration sound and the need to adjust the position, so we will continue to develop it.
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In addition, the intraoral tubes can have sanitary issues associated with them. However, this device is not in widespread use and often the strap musculature is removed during surgical excision, thereby precluding use of this device. As mentioned earlier, the electrolarynx produces voice by emitting constant vibrations that are transmitted to the pharynx through cervical skin or directly to the intraoral mucosa.
Monotonic or robotic speech quality is produced when certain acoustic deficits are present including a flattened fundamental frequency Fo , radiating noise, and an improper source spectrum. Intonation Fo variation over time during phonation results in improved speech intelligibility 23 and is thought to be a greater contributor to intelligibility than the exact value of the Fo. As technological advances continue to improve the automation of Fo variation, we can expect speech intelligibility to improve.
The four most widely used commercially available electro-larynges are discussed below. Of note, there is considerable price variation among the different models almost a sixfold discrepancy that can impact decision making for some, especially in developing countries. It has two buttons — one that controls intensity and another that controls pitch settings. It is applied transcervically and has an oral adaptor tube. The standard model comes with two buttons, both programmable for two settings — one that controls loudness and another that controls intonation.
The electrolarynx is applied transcervically and comes with an oral adaptor tube to be used transorally. Similar to the servox and the Nu-Voice, it is a trans-cervical handheld device with an oral adaptor.
However, the TruTone allows for pitch control with direct finger pressure with pitch controlled by increasing or decreasing pressure placed on a single button — the greater the pressure, the higher the pitch. This electrolarynx consists of a denture mounted vibratory device with a handheld transmitter allowing for transoral transduction. This allows activation of the device without having to physically lift the vibratory source to place it on the neck.
After the denture is placed in the mouth, the patient has control of the device with a wireless miniature fingertip switch on a controller. As previously mentioned, there are three methods of TL vocal rehabilitation — the electrolarynx, esophageal voice, and TEP. The electrolarynx has certain advantages and disadvantages over these other methods as discussed below. Esophageal speech is achieved through a process of esophageal insufflation with swallowed air.
The air column is then funneled through the residual articulatory apparatus, where it is adapted to form intelligible voice.
Moreover, esophageal speech is more difficult to learn than electrolaryngeal speech and anatomical patient factors such as tight cricopharygeal musculature and esophageal or pharyngeal stenosis can diminish airflow strength and thus make esophageal speech difficult. Patients may find esophageal voicing to be labor-intensive with limited air reserve. Advantages of esophageal voicing over the electrolarynx include its low cost as there is no need to purchase an electrolarynx.
In fact, it is used most commonly in developing countries as it is relatively inexpensive. TEP with voice prosthesis insertion allows patients to direct tracheal air through a puncture site in the posterior tracheal wall and drive it into the esophagus.
This air column then is released from the esophagus and enters the pharynx and oral cavity where it is transformed into speech by articulatory mechanisms. As first described by Singer and Blom in , the TEP allows for excellent speech quality and sound. The prosthesis may be placed at the time of TL or as a secondary procedure and one advantage of the electrolarynx over TEP speech is the avoidance of additional surgical procedures.
Similar to the electrolarynx where poor manual dexterity can make using a handheld device difficult, patients with musculoskeletal disorders, amputations, history of cerebrovascular accidents, or other impairments of manual dexterity may have difficulty manipulating the stoma to use a TEP prosthesis. Furthermore, patients without ready access to a speech-language pathologist will have difficulty learning to use and care for the TEP prosthesis.
TEP valves need to be replaced at various time points due to obstruction, leakage, inadequate size of the prosthesis, and granulation or leakage around the fistula. An innate and distinct advantage of electrolaryngeal voicing is its intuitiveness and ease of use; in general, it is not difficult to learn how to use the electrolarynx although optimal use is attained through guidance from a speech-language pathologist.
Due to the decreased requirement for extensive training prior to initial use and ease of commercial availability although cost can vary widely , it can be utilized as a secondary or backup means of communication when the primary means of communication is unavailable. This frequently occurs as patients progress along their treatment pathway, including immediately postoperatively i.
As mentioned above, a major disadvantage of electrolaryngeal voicing is the mechanical quality of the voice which can result in greater perceived vocal handicap when compared to TEP, especially for tonal languages.
Acoustic analysis studies have confirmed that tracheoesophageal speech has a more normalized fundamental frequency, greater intensity, and longer maximum phonation time than esophageal and electrolaryngeal speech. In summary, the main disadvantages of the electrolarynx include 1 financial considerations in purchase and maintenance of the device which may be too fiscally burdensome for some, especially those in low income populations and developing countries; 33 , 34 2 the mechanical voice quality; 3 need for reasonable manual dexterity to use a hand held device although the new EMG transducer device allows for hands-free voicing and makes poor manual dexterity less of a contraindication ; and 4 the requirement for functioning articulatory musculature which can limit its usability in patients with extended laryngectomy resections.
The electrolarynx is particularly suited to patients who do not wish further surgery or the possible complications associated with a TEP, and patients who either cannot vocalize with esophageal speech or choose not to. Digital speech recognition systems have been developed that measure the spoken sound and identify the output through various methods. Preliminary results suggest that this could become a successful method of voice generation 42 and that development of a low-cost and portable articulography speech recognition program with high accuracy However, this system remains to be validated in alaryngeal patients.
Although TEP voice is the current gold standard for voice rehabilitation postlaryngectomy as noted above, there are and will remain a subset of patients who will be better suited to electrolarynx use over TEP voicing.
For these patients, future developments in the realm of the electrolarynx are necessary to enhance its usability and nuances of audibility. Such developments will likely allow for improved control of the electrolarynx in a hands free manner, thus enabling its use by patients who have impaired manual dexterity, and improved range of intonation, thus enhancing its intelligibility and comparability to natural voice.
There are several experimental electrolarynx devices that are currently not commercially available. Their model included a transcervical transducer with a sensor that can modulate frequency and intensity, allowing for changes in frequency and intensity depending on the spoken phrases. The electrolarynx is a viable and useful method of voice rehabilitation for patients who have had laryngectomies, particularly benefiting those patients for whom TEP use is not practical. Intraoral and transcervical electrolarynges are available with choice dependent on anatomical factors and patient preference.
New developments allow the electrolarynx to be utilized with greater ease in patients with poor manual dexterity as well as improve its ability to produce voice with varied intonations. Voice restoration is achieved using three speech modalities: electrolaryngeal, esophageal, and tracheoesophageal. The electrolarynx is more straightforward to learn when compared to esophageal speech, but requires patients to purchase and maintain the device.
The electrolarynx works by inducing vibrations of oral or pharyngeal mucosa by an external device, generally, at a constant fundamental frequency.
The choice of device is dependent on anatomical factors and patient preference. New technological developments will allow the electro-larynx to be utilized with increased ease in patients with poor manual dexterity and improve the ability to speak with more varied intonations. The authors wish to thank Dr Jason Gilde for his illustrations as used in this review. National Center for Biotechnology Information , U.
Journal List Med Devices Auckl v. Med Devices Auckl. Published online Jun Author information Copyright and License information Disclaimer. This work is published and licensed by Dove Medical Press Limited. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. This article has been cited by other articles in PMC. Keywords: total laryngectomy, voice restoration, electrolarynx, esophageal speech, tracheo-esophageal puncture, silent speech, electrolarynx mechanics.
History of voice restoration Voice restoration in the absence of a functional larynx has been reported for over years. Overview of voice restoration The definition of human voice is sound produced by means of the lungs and larynx or the faculty of utterance.
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