Rehabilitation Program for Laryngectomees, Illustrated by Four Case Reports

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Audiology and Speech Pathology Section

LARYNGECTOMIZED patients, known as “laryngectomees,” are confronted with two interrelated problems: the acquisition of a substitute for speech, and economic and social rehabilitation. The basic problem is, of course, the acquisition of a substitute for speech.

Since the first laryngectomies were performed about 100 years ago, many artificial devices have been designed and recommended to enable the patient to communicate again. However, in 1909 Gutzmann1 first described the development of natural esophageal speech in patients who had had their larynges removed. Further studies considered the various factors involved in the acquisition of that form of speech by laryngectomized patients.2–13 It was fully realized that the psychologic aspects of the operation greatly influenced the patient's chances of learning to talk again. Stern3 urged that a patient who had had his larynx removed, be encouraged and reassured during the immediately postoperative period by a visit from a former patient who had mastered esophageal speech. Kallen4 advised that speech therapy be instituted immediately after healing in order to prevent social maladjustment and psychologic depression. Schall6 and Morrison9 emphasized the importance of combatting the depression that overwhelms the patient when he realizes that his speech will not be the same as it was preoperatively, and that social and economic readjustment may be difficult. McCall11 advocated preoperative training for esophageal speech. Yet, despite these recommendations, Pitkin13 has found that in a group of 65 laryngectomized patients: 87 per cent had not been given adequate speech instruction before operation; 46 per cent had not received hospital . . .



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