Introduction to Standard Esophageal Speech. Texas Laryngectomy Association 2018

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Jody Wells
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1 Introduction to Standard Esophageal Speech Texas Laryngectomy Association 2018

2 Disclosure

4 Objectives At the end of this presentation the participant will be able to: Describe the production of standard esophageal speech (SES) State the pros and cons of esophageal speech Describe methods of producing esophageal speech State appropriate treatment goals

5 Definition Standard esophageal speech (SES) is a method of speech production that involves vibration of the pharyngoesophageal (P-E) segment. Air is injected into the upper esophagus and then released in a controlled manner to create sound/voicing used to produce speech.

7 SES - Pros Hands FREE Calls minimal attention to the speaker No device No battery No trips to the ENT/SLP

8 SES - Cons Not every SLP knows how to teach it Extensive therapy Takes time Difficult to produce when eating Difficult to produce when ill Re-construction issues

9 When Can You Start? Esophageal speech training may begin when the NGT is out and the physician has determined there is no fistula or any other condition that might interfere with air intake.

10 First Steps Explain the anatomy and physiology Explain the process Notice any sounds that are voiced How did that feel? Do you know how you produced that? Have the patient feel the neck Insufflation test? Start sessions with relaxation exercises Use visualization (open, yawning)

11 Important Practice Tips Don t eat immediately before practice Short, frequent practice periods Sips of water throughout practice NO SODA!

12 Goals Esophageal Quality of voicing Consistency of voicing Latency Articulatory Precision Rate Non-verbal behaviors Klunking, stoma noise, facial grimacing, extraneous head movements, poor eye contact.

13 Activity Hierarchy Level 1: 2-4 syllable phrases and sentences Level 2: 5-7 syllable phrases and sentences Level 3: 8+ syllable phrases and sentences Level 4: oral reading of paragraphs Level 5: structured conversation Level 6: spontaneous and extended conversations

14 Methods of Air Intake Inhalation Glosso-pharyngeal press Consonant injection Combination

15 Inhalation Short, rapid inhalation thoracic pressure doubling the negative pressure in the esophagus. Positive pressure within the nasal and oral cavity moves toward the esophagus to equalize the pressure The oropharynx and esophageal musculature relax, the esophagus distends Air moves easily into the upper esophagus

16 Inhalation Two possible methods Open mouth, tongue down, inhale as if you are scared Exhale, occlude the stoma, open your mouth and inhale Relax and say ah Don t force or push!

18 Glosso-pharyngeal Injection (Tongue Pumping) Four possible combinations All start with the same instruction - Imagine a ball of air. Capture the ball of air in the middle of the mouth and hold it against the hard palate. Place the tongue in the t position. The tip and sides of the tongue should be held firmly against the roof of the mouth.

19 Glosso-pharyngeal Injection (Tongue Pumping) All end with the same instruction. As you feel the ball of air go down your neck, quickly and gently push the air back up. Open your mouth and say ah

20 Glosso-pharyngeal Injection The Four Possibilities Lip seal tongue pump Close lips tightly and pump the ball to the back of the mouth Lip seal tongue sweep Close the lips tightly and with an anterior to posterior rocking motion roll or sweep the ball to the back of the throat No lip seal tongue pump Pump the ball of air to the back of the throat No lip seal tongue sweep Anterior to posterior rocking motion roll or sweep the ball back of the throat

22 Consonant Press Start with voiceless consonants /p/ /t/ /k/ Air is moved anterior to posterior in the oral cavity during the production of the consonant.

24 Ideally the patient will utilize all methods to produce fluent SES. Combination

25 Objectives At the end of this presentation the participant will be able to: Describe the production of standard esophageal speech (SES) State the pros and cons of esophageal speech Describe methods of producing esophageal speech State appropriate treatment goals

Slide 1. Slide 2. Slide 3. Introduction to the Electrolarynx. I have nothing to disclose and I have no proprietary interest in any product discussed.

Slide 1. Slide 2. Slide 3. Introduction to the Electrolarynx. I have nothing to disclose and I have no proprietary interest in any product discussed. Slide 1 Introduction to the Electrolarynx CANDY MOLTZ, MS, CCC -SLP TLA SAN ANTONIO 2019 Slide 2 I have nothing to disclose and I have no proprietary interest in any product discussed. Slide 3 Electrolarynxes