Tracheoesophageal speech in a developing world community
Tracheoesophageal speech in a developing world community
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DOI：
10.1001/archotol.128.1.50
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发表时间：
2002-01-01
影响因子：
--
通讯作者：
Sellars, SL
中科院分区：
文献类型：
--
作者：
Fagan, JJ;Lentin, R;Sellars, SL
目标：确定第三世界医疗实践中的气管食管言语结果；检查社会经济地位、识字率和与专家服务的接近程度对气管食管言语的影响；评估这些因素是否会影响患者对瘘管言语的选择；设计：回顾性分析。地点：南非开普敦 Groote Schuur 医院，为第三世界社区提供服务。患者：1996 年 1 月 1 日至 1998 年 10 月 1 日期间连续接受全喉切除术的 97 名患者。接受全喉切除术的患者通常会留有用于讲话的原发性气管食管瘘。主要结果指标：全喉切除术后的言语结果；气管食管言语与社会阶层、识字率和与专家服务的接近程度有关；以及可拆卸和留置瓣膜的经验。结果：73 名患者中的 59 名 (81%) 获得了有用的言语。言语结果不受就业状况或与专家服务的接近程度的影响。尽管言语受到识字率和住房的影响，但一些不识字的棚屋居民却获得了良好的言语能力。可拆卸假体的平均装置寿命为 16 周 0（35% 的患者 >4 个月 [64/183]）。留置假肢的平均寿命为 28 周。结论：第三世界社区的气管食管言语结果与发达国家的结果相同。所有接受喉切除术并具有足够的手动灵活性和认知功能的患者都应进行瘘管言语试验。可拆卸发声假肢可以成功地用作留置假肢。
Objectives: To determine the tracheoesophageal speech results in a Third World medical practice; to examine the impact of socioeconomic status, literacy, and proximity to specialist services on tracheoesophageal speech; to assess whether these factors should affect patient selection for fistula speech; and to determine guidelines for voice prosthesis selection.Design: Retrospective analysis.Setting: Groote Schuur Hospital, Cape Town, South Africa, which serves a Third World community.Patients: Ninety-seven consecutive patients who underwent total laryngectomy between January 1, 1996, and October 1, 1998. Patients who undergo total laryngectomy routinely have a primary tracheoesophageal fistula created for speech.Main Outcome Measures: Speech outcomes after total laryngectomy; tracheoesophageal speech in relation to social class, literacy, and proximity to specialist services; and experience with removable and indwelling valves.Results: Fifty-nine (81%) of 73 patients acquired useful speech. Speech outcome was not affected by employment status or proximity to specialist services. Although speech was affected by literacy and housing several illiterate shack dwellers acquired good speech. Average device life of removable prostheses was 16 weeks 0 (>4 months in 35% [64/183]). Indwelling prostheses had an average life of 28 weeks.Conclusions: Tracheoesophageal speech results in a Third World community equate with those in the Developed World. All patients who undergo laryngectomy and have adequate manual dexterity and cognitive function should be given a trial of fistula speech. Removable voice prostheses can successfully be used as indwelling prostheses.