[Methods of Voice Restoration following Laryngectomy]
In Germany, approximately 950-1200 laryngectomies are performed annually due to extensive hypopharyngeal and laryngeal carcinomas. The removal of the larynx results in significant life changing functional losses, particularly in voice production and communication, resulting in psychological issues and social withdrawal. Rehabilitation requires a multidisciplinary team focusing on restoring communication skills. Methods include pseudowhispering, esophageal speech, external mechanical and electromechanical aids, and tracheoesophageal speech prostheses. Pseudowhispering uses air from the mouth and pharynx, while esophageal speech requires controlled release of esophageal air to produce sound. External aids include devices like the Electrolarynx. Tracheoesophageal speech prostheses, the current gold standard, offer superior phonation time and clarity but require frequent visits to the healthcare system to address complications due to the limited lifespan of the prosthesis. Despite high success rates with transoesophageal prostheses, some patients may face significant challenges. In conclusion, voice rehabilitation post-laryngectomy is crucial for social reintegration. Comprehensive patient education on the benefits and challenges of different methods is essential for making an informed decision tailored to their lifestyle.
[Middle Ear Malformations]
Middle ear malformations (MEMs) represent a diverse group of congenital anomalies with significant implications for auditory function. These malformations, which occur in approximately 0.5 to 3% of conductive hearing loss cases, can arise from various genetic and environmental factors. They often manifest unilaterally and may occur in isolation or as part of a syndromic condition. MEMs are closely associated with abnormalities of the external ear and less frequently with inner ear anomalies.Embryologically, the middle ear develops from the first and second pharyngeal arches, with interactions between the ectoderm and endoderm contributing to the formation of essential structures such as the tympanic membrane, ossicles and Eustachian tube. Disruptions in these developmental processes can lead to a spectrum of MEMs, ranging from minor defects to severe malformations affecting multiple middle ear components.Clinical management of MEMs requires a multidisciplinary approach, involving otolaryngologists, pediatricians, and audiologists. Early intervention with appropriate hearing aids, including conventional hearing aids and bone conduction devices, is essential to mitigate the impact of conductive hearing loss on speech and language development, particularly in children.Surgical planning involves comprehensive preoperative assessment, including high-resolution computed tomography imaging to evaluate middle ear anatomy, the facial nerve course, and vascular anomalies. Traditional surgical approaches such as stapesplasty and tympanoplasty remain mainstays for correcting specific middle ear defects, while advances in technology have expanded the role of active middle ear implants in treating special cases.In conclusion, MEMs represent a heterogeneous group of congenital anomalies with diverse etiologies and clinical implications. A thorough understanding of their embryological basis, genetic underpinnings, and surgical management strategies is crucial for optimizing outcomes in affected individuals.
[(Exercise) Inducible Laryngeal Obstruction: What to do in the attack, what to do to avoid another one?]