METHOD FOR RESTORING VOICE FUNCTION AFTER SUBTOTAL LARYNECECTOMY AND FORMATION OF TRACHEAE-PHARYNGEAL SHUNT

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, oncology, otorhinolaryngology, concerns the restoration of the voice function of patients with laryngeal and laryngopharyngeal cancer after subtotal laryngectomy and the formation of a tracheae-pharyngeal shunt. Set of measures is proposed, including rational psychotherapy, talks, a story about the possibility of voice rehabilitation, showing a video recording of a patient who speaks well after the operation, physical therapy, breathing exercises aimed at forming a powerful forced exhalation by the patient, with the direction of airflow from the lungs through the remaining part of the larynx and the trachea-pharyngeal shunt into the pharynx and oral cavity. Breathing exercises are performed in a sitting or lying position, controlling the movements of the diaphragm. To do this, put your hand on your chest, put the other hand on your stomach, raise your abdomen when inhaling. Lower abdomen when exhaling, the thorax is motionless. Each exercise is performed 5 times in a row, the complex – 2–3 times a day. First breathing exercise: inhalation is short, vigorous - exhalation is long, smooth, with a single stream. Second: inhalation is short, exhalation is forced, fast. Third: inhalation is short, vigorous - exhalation with resistance, closing the tracheostoma. Fourth: inhalation with resistance, closing the tracheostoma - exhalation is long, smooth, with a single stream. Fifth: inhalation is short, vigorous, noiseless - exhalation with short pushes. Next, the patient is taught to produce a voice: in the sitting position, slightly tilting the head forward and down, take a deep breath, tightly close the tracheostoma hole with a napkin, make a strong exhalation, try to say a short word, prolonging the vowel. Perform 2–3 times, then break for 1–1.5 minutes, the patient breathes quietly, restoring breathing. Repeat 8–9 times in one session. Once the patient has learned to produce a voice, improve the quality of the voice: first, the patient repeats short words with a vowel in the middle of the word, then phrases of 2 short words, slightly prolonging a vowel so that the voice does not interrupt when vowels are spoken. Patient speaks calmly, without increasing the pace of speech; as they master, complicate the speech material, increasing the number of sounds in words and the duration of the phrase to 4–5 words. Choose well-known words and expressions to be used by the patient when communicating in everyday life, make sure that he/she pronounces the phrase without pauses, in one exhalation, gradually extending the phrase. Next, the exercises are performed to give intonation expressiveness to the voice, pronouncing phrases of 4–5 words with narrative, interrogative and exclamation intonation. Vary the power of the voice, pronouncing phrases of 4–5 words, beginning with a whisper and adding the volume to the voice, and conversely, starting with a loud voice, gradually turn into a whisper. Sessions are held with a speech therapist 3 times a day for 12–15 minutes with a break of 25–30 minutes and 3–4 times a day unassisted.;EFFECT: method allows in a short time to restore the voice function of patients who underwent the above surgical manipulations.;1 cl, 1 ex