Hagen R, Berning K, Korn M, Schön F
Univ.-HNO-Klinik Würzburg.
Laryngorhinootologie. 1998 Jun;77(6):312-21. doi: 10.1055/s-2007-996980.
Following total laryngectomy the voice is produced by esophageal speech as well as with voice prostheses by vibrations of pharyngeal mucosal folds. This pharyngeal sound normally has a significantly lower fundamental frequency than the healthy voice (men about 120 Hz, women about 240 Hz, pharyngeal voice about 70 Hz), which is a handicap especially for female laryngectomy patients. In order to improve the postlaryngectomy voice, a new type of voice prostheses containing an integrated sound-producing metallic reed element was developed (ADEVA Company, Lübeck, Germany).
METHODS/PATIENTS: Thirty-five of these new sound-producing voice prostheses were tested in vitro for different prosthesis-specific physical parameters (pressure, flow, sound pressure, flow resistance, frequency range). In 15 voice prosthesis speakers, a sound-producing prosthesis was introduced during a routine outpatient visit. Besides measurement of the above mentioned physical parameters in patients with conventional and sound-producing prostheses, the resulting voice as also evaluated by means of a video recording.
In vitro all prostheses with the metallic reed element produced a clear sound. Flow resistance of the prostheses was slightly elevated by the reed element. Insertion of the prostheses was hindered by the reed element. Period of uninterrupted sound production was prolonged after insertion of a sound-producing prosthesis and patients could speak on a lower pressure level, but the sound of the reed element was permanently distinguishable only in 6 of 15 patients.
In principle a variation of the pharyngeal voice by means of a sound producing element, which is integrated into a voice prosthesis, is possible. The current design of the metallic reed element tested is not yet suitable for routine clinical use: 1. The reed element is too sensitive and is easily damaged during insertion, so the insertion device has to be improved. 2. The sound producing element is blocked by small amounts of tracheal secretions, so that this element should be replaceable separately without requiring removal of the silicone value (if possible by the patient himself). Prior to insertion of the sound producing voice prosthesis the maximum air flow through the shunt should be measured to determine if the patient can produce the necessary air flow for activation of the reed element. A further improvement for these special types of voice prostheses would be a sound producing element, which generates a variable frequency of sound. Limiting the patient to only one fundamental frequency creates a monotone, which does not sound naturally. Initial progress toward a sound-producing voice prostheses has been made. This should be followed by the necessary improvements in order to improve the feasibility of this design for routine clinical use.
全喉切除术后，语音可通过食管发音以及借助语音假体经咽黏膜皱襞振动产生。这种咽音的基频通常明显低于正常嗓音（男性约120赫兹，女性约240赫兹，咽音约70赫兹），这对女性喉切除患者尤其不利。为改善喉切除术后的语音，研发了一种新型语音假体，其包含一个集成的发声金属簧片元件（德国吕贝克的ADEVA公司）。
方法/患者：对35个这种新型发声语音假体进行了体外测试，检测不同假体特定的物理参数（压力、流量、声压、流阻、频率范围）。在15名使用语音假体的患者中，于常规门诊就诊期间植入了一个发声假体。除了测量使用传统假体和发声假体患者的上述物理参数外，还通过视频记录对所产生的语音进行了评估。
在体外，所有带有金属簧片元件的假体都能发出清晰的声音。簧片元件使假体的流阻略有升高。簧片元件阻碍了假体的植入。植入发声假体后，不间断发声的时长延长，患者能够在较低压力水平下说话，但只有15名患者中的6名能一直分辨出簧片元件的声音。
原则上，通过集成在语音假体中的发声元件改变咽音是可行的。所测试的金属簧片元件的当前设计尚不适用于常规临床应用：1. 簧片元件过于敏感，在植入过程中容易损坏，因此植入装置必须改进。2. 发声元件会被少量气管分泌物堵塞，所以该元件应能单独更换，而无需取出硅胶瓣膜（如有可能，患者自己即可操作）。在植入发声语音假体之前，应测量通过分流器的最大气流，以确定患者是否能产生激活簧片元件所需的气流。对于这些特殊类型的语音假体，进一步的改进将是一个能产生可变频率声音 的发声元件。将患者限制在仅一个基频上会产生单调的声音，听起来不自然。在发声语音假体方面已取得初步进展。接下来应进行必要的改进，以提高这种设计用于常规临床应用的可行性。
