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Biomedical subjects

E D Blom

Publications and source records attributed to E D Blom.

33 records · Page 2Linked to original sources
PubMed1985

An improved esophageal insufflation test.

Previous investigations identified that insufflation of the esophagus may elicit reflex pharyngoesophageal closure, impeding airflow and subsequent voice production. A simplified method for esophageal insufflation consistently evaluates the capacity for alaryngeal speech acquisition. Although primarily a method for predicting tracheoesophageal speech, it may also be an important prognostic indicator for traditional esophageal speech development.

Catheterization↗
PubMed1985

Pharyngeal reconstruction after total laryngectomy with preservation of phonation.

The goal of pharyngeal reconstruction after laryngectomy is to prevent fistulization and to permit rapid resumption of satisfactory deglutition. Alaryngeal speech acquisition by the traditional method of esophageal speech is effective if insufflation is rapidly learned and tolerated by the pharyngoesophageal segment. Experience with tracheoesophageal phonation revealed an incidence of pharyngoesophageal spasm in 40% of an esophageal speech failure population which prevented useful air flow for speech production. This is related to esophageal distention and reflexive upper esophageal sphincter hypertension. It is suggested that pharyngeal reconstruction after total laryngectomy may permit higher wall tension than is desirable for speech acquisition. The problem of post laryngectomy pharyngoesophageal spasm may be reduced by myotomy of the pharyngeal constrictors with resultant higher air flows in the residual vocal tract for speech. Alterations in the pharyngeal wall tonicity will affect the pitch of the speech and listener acceptability. Recently identification and division of the pharyngeal plexus has produced a similar result in improved phonatory air flows with subjective vocal pitch approximating more normal voices. The above mentioned techniques are readily applied to the laryngectomy procedure and enhance the likelihood of alaryngeal speech acquisition.

Humans↗
PubMed1985

Vocal rehabilitation after laryngectomy.

The evolution of treatment of laryngeal cancer has passed a number of milestones. The maintenance of useful communication is of paramount importance in all cases and, with the newer modalities of tracheoesophageal phonation and voice prostheses, the quality of life after laryngectomy is clearly improved. Future advances may restore continuity of the upper respiratory tract with resumption of normal nasal function, humidification of the lower respiratory tract, and elimination of the permanent tracheostoma.

Humans↗
PubMed1984

Selected acoustic features of tracheoesophageal, esophageal, and laryngeal speech.

Voice samples of 15 laryngeal, esophageal, and tracheoesophageal speakers using the Blom-Singer voice prosthesis were analyzed for intensity, frequency, and rate. Results indicate that characteristic values for tracheoesophageal speech are more similar to laryngeal speech than esophageal speech, demonstrating the powerful advantage of this pulmonary-supported method of alaryngeal voice.

Acoustics↗
PubMed1983

Effect of gastroesophageal reflux on esophageal speech.

Gastroesophageal reflux has been incriminated as a factor-inhibiting acquisition of esophageal speech after laryngectomy. Fourteen proficient esophageal speakers and 10 nonproficient speakers underwent esophageal manometry, esophageal pH probe testing, and Bernstein acid perfusion testing. Additionally, 175 laryngectomized members of Lost Chord Clubs answered mailed questionnaires about the frequency of reflux symptoms. Nonproficient and proficient esophageal speakers had a similar frequency of gastroesophageal reflux by pH probe testing, esophageal mucosal acid sensitivity by Bernstein testing, lower esophageal sphincter pressures, and gastroesophageal reflux symptoms. Gastroesophageal reflux does not appear to be a major factor in preventing esophageal speech.

Aged↗
PubMed1983

Voice rehabilitation after total laryngectomy.

More than 100 years after the first laryngectomy, voice preservation remains a remarkable challenge. A number of surgical techniques have been proposed, yet complications related to aspiration, recurrent disease, or voice failure have been frequent. Representative historical examples are described and their results reviewed. The advent of tracheo-esophageal phonation with a silicone voice prosthesis simplified the approach to this perplexing problem. The principles learned from the secondary application of this method are applied to a primary technique for vocal rehabilitation immediately after laryngectomy. The results are promising without risking alteration of the basic laryngectomy technique and expected cure rates.

Aged↗
PubMed1981

Selective myotomy for voice restoration after total laryngectomy.

Reconstruction of the pharyngoesophagus after total laryngectomy avoids the development of salivary fistulae and restores satisfactory swallowing. Successful techniques for closure include multiple layers of tissue, selected suture materials, the application of postoperative radiation therapy, and modified neck dissection. In addition, vocal rehabilitation has been traditionally associated with the formation of a pharyngoesophageal segment capable of producing sound after air insufflation. A three-year experience with 129 patients after they underwent a total laryngectomy and tracheoesophageal shunt showed that 16 patients (12%) failed to achieve satisfactory speech after tracheoesophageal puncture because of pharyngoesophageal spasm. Response to percutaneous block of the pharyngeal plexus and subsequent myotomy of the cricopharyngeus and pharyngeal constrictor muscles was assessed in 14 patients. Increased pharyngoesophageal tone after total laryngectomy seems to be an important factor in the failure to acquire esophageal voice.

Esophagus↗
PubMedDate not supplied

An endoscopic technique for restoration of voice after laryngectomy.

Reports of restoration of voice after total laryngectomy include diversion of exhaled pulmonary air though planned or spontaneous fistulae with a variety of modified tracheal cannulas and valves. Limitations of these techniques include aspiration, scar closure of the shunts, wound complications, and failure to achieve voice consistently. We report a two-year experience with an endoscopic method using a unique valved prosthesis eliminating complicated surgical reconstructions, aspiration, and stenosis. Fifty-four of 60 patients (90%) achieved fluent voices with one deglutition problem. Radiation therapy preceded voice restoration in 63% of the patients and radical neck dissection in 72%. The endoscopic procedure, hospitalization and period of speech therapy are short and constitute a cost-effective voice rehabilitation program. The results of this simple method and lack of complications are encouraging.

Adult↗
PubMedDate not supplied

Tracheostoma valve for postlaryngectomy voice rehabilitation.

Newer surgical techniques for postlaryngectomy voice rehabilitation provide a simple, effective method of communication but require manual occlusion of the tracheostoma during speech. We report the development of a unique tracheostoma valve that avoids the necessity for covering the stoma. This airflow-sensitive valve closes during speech and remains open with normal respiration. Results of a clinical trial with 50 patients over a ten-month period are encouraging. Our experience suggests that excessive vocal tract resistance to airflow is the principal limitation to effective valve use. Approaches to decreasing airflow resistance through the vocal tract to improve both voice production and tracheostoma valve use are discussed.

Clinical Trials as Topic↗
PubMedDate not supplied

Tobacco free at the Indianapolis 500.

Most children are highly impressionable and easily influenced, particularly by people they admire. Role models in sports and entertainment who publicly use or commercially promote tobacco products potentially influence children to do the same. Motorsports events are saturated with tobacco sponsorship. We describe the counter-promotion of tobacco at the famed Indianapolis 500 and suggest other venues to continue this "Tobacco Free America" theme.

Adolescent↗