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Tracheoesophageal Speech in a Developing World Community
Johannes J. Fagan, MD, FCS(SA), MMed(Otol);
Roslyn Lentin, BSc(Log);
Manuel F. Oyarzabal, MD, FRCS;
Sedick Isaacs, PhD, FSS, MBCS;
Sean L. Sellars, MD, FRCS
Arch Otolaryngol Head Neck Surg. 2002;128:50-53.
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 (>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.
From the Departments of Otolaryngology (Drs Fagan, Oyarzabal, and Sellars)
and Logopedics (Ms Lentin), University of Cape Town School of Medicine, Groote
Schuur Hospital, and Medical Informatics (Dr Isaacs), Groote Schuur Hospital,
Cape Town, South Africa.
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