Electrolarynx

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Different brands of electrolarynges

List of electrolarynges:

Electrolarynges are speech technologies and medical devices. They were developed for laryngectomy patients who lost their capacity to speak. 'Larynx' in the title of the device means that it is supposed to replace a patient's lost or damaged larynx.

Electrolarynges are electronic devices, mainly powered by battery. They produce a vibration that the user can modulate to words by his or her jaws, tongue, and lips.

Main Characteristics

Electrolarynges are battery-powered devices that replace the sound-vibrating capabilities of the larynx. There are two types of electrolarynges; the first neck-type usually resembles a small hand-held tube that the user operates with one hand, while the second intra-oral type consists of two parts—a pulse generator with a battery and the tone generator.[1] One specific type of intra-oral electrolarynx is UltraVoice, which is an intra-dental electrolarynx. It is activated by a remote switch.[2] The former type of devices is put against the tissue of the throat or under the chin.[3] The latter contains a plastic tube that is inserted into the patient's mouth,[4] or in the case of UltraVoice, is placed in a dental plate and can be used hands-free.[2] The neck-type of electrolarynx is more widely used than the intra-oral type.[5]

The usage of an electrolarynx

The sound of a patient's voice is produced by the electromagnetic vibration of the device.[6] The vibrations the device generates are then carried over to the inside of the oral cavity. The user can then use the rest of the vocal tract to shape the sound and speak.[5] This allows people who have lost either a part or the entire larynx due to cancer to be able to produce speech and to communicate again.

Electrolarynx is just one of the options for laryngectomees and tracheostomees. After the loss of their voice, they could also develop pharyngeal, buccal or oesophageal voice production. However, not every patient is able to develop any of these voices. The voice can also be restored by surgery and the use of silicone prostheses, which is widely discussed in the section Speech prostheses.[7] Patients can also use speech synthesizers.

Historical overview

The current electrolarynges are hand-held electromechanical devices that use a small vibrator to vibrate the inside of the oral cavity. However, pneumatic external larynges were used before miniaturization allowed such devices to be battery-powered and of portable size. The first laryngeal prosthesis was described by Czech physiologist Jan Nepomuk Czermak in 1859. This device was not electrical, however, but it was powered by air. The voice was conducted through a vibrating tube in the patient's mouth. Based on the ideas of Czermak, Ernst Brucke actually made a speech prosthesis that allowed patients to pronounce single syllables. A great many artificial larynges were developed in the end of 19th century and the beginning of 20th century. Although the majority of the devices was powered by air, certain developers also tested electrical devices.[1]

Pneumatic larynx

In the beginning of the 20th century, artificial larynges were still unreliable and the quality of sound was not sufficient. These features discouraged many possible patients from purchasing any of these devices. The disadvantages were overcome in 1924 by J. E. Mackenty, who found out that a soft rubber mouth piece could improve the quality of a patient's speech. In order to allow shipping of his invention, he cooperated with the Western Electric Company.[1] Therefore, the first available pneumatic artificial larynx was introduced by the Western Electric Company as the Western Electric No° 2 type larynx.[8] It was available on the market from 1930 to 1959.[9] These devices were attached to the tracheostoma of the patient. The device was shaped in such a way that the exhaled air produced a humming noise. It was then carried via a small tube to the inside of the patient's mouth, where it served as a base for speech much like the vibrations produced by a modern electrolarynx.[10]

Western Electric Electrolarynx No. 5

The first battery-powered electrolarynx was introduced by G. M. Wright in 1942. After development of his first device, Wright joined Aurex Corporation and later Kett Engineering Corporation, which developed the first electrolarynges Aurex Model M 410 resp. Kett Mark I. These devices contained a vibrator connected by the battery with a cord; consequently they were the intra-oral type of electrolarynx. The further models of both companies, the Aurex Model M 520 and the Kett Mark II, however, had a battery included in the devices; thus they were the neck-types of electrolarynx.[1] An example of the former type of device is the Cooper-Rand electrolarynx, while the latter type is represented by Nu-Vois, Romet R, Servox, SolaTone, and TruTone.

Purpose

Electrolarynges are directed towards patients who have lost their ability to produce speech. The usage of an electrolarynx is one of the options that allow them to communicate.

Important Dates

  • 1859: Czermak suggested the first pneumatic laryngeal prosthesis
  • 1873: Billroth conducted the first successful total extirpation of the larynx
  • 1924: Mackenty, in cooperation with Western Electric Company, developed the first available pneumatic larynx[1]
  • 1942: Wright's first electrolarynx Sonovox was introduced[5]

Enhancement/Therapy/Treatment

The main achievement of electrolarynx is that the device enables speech for patients who have lost their voice. In addition, it is easier to learn how to use an electrolarynx than to learn oesophageal voice production. An electrolarynx is also an option for patients who cannot learn oesophageal voice production at all. As a fast and easy way to relearn how to speak, it is also used by patients who intend to return to their job promptly and when voice is essential, in order to manage their job properly.[11] The speech produced by an electrolarynx is also faster and louder than oesophageal speech.[5]

In addition, the acquisition of speech by an electrolarynx can also be an important factor in a patient's psychological health. Gardener and Harris report:
Patients have reported that they get a "lift" by using such an aid; they know at once that they will talk again, somehow. Furthermore, they feel more socially acceptable because they can communicate intelligibly and maintain their "speech personality."[11]

Ethical & Health Issues

In comparison with oesophageal speech, electrolarynges are costly. The price of a device could be covered by health insurance, but this is not always the case. In addition, the device contains several components, such as a battery or plastic tube, which sometimes have to be removed, which further increases the investment.[12]

Several researchers have pointed out that the quality of the voice produced by an electrolarynx is not as good as other options for people who lost their voice.[12] Hanjun Liu and Manwa Ng argue that the voice produced by an electrolarynx is considered monotonic and robotic, primarily due to limited control of the pitch. However, there are devices such as TruTone or Servox that allow the user to control the pitch.[5]

The use of a neck-type electrolarynx could be limited by the post-surgery state of the patient. Conditions such as edema, scarring or radiation could cause that this type of electrolarynx to not work properly or hurt the patient's tissue. While edema usually disappears after weeks or months after surgery, patients with scarred and irradiated tissue must entirely avoid the use of a neck-type electrolarynx.[3]

Although there is a possibility that the weight of electrolarynges will be reduced in the future,[13] the weight of current electrolarynges usually exceeds 100 grams. This could limit patients who are weakened by surgery or other health complications.[4]

The intra-oral types of electrolarynx are more demanding from a hygienic point of view. Bethann Moffet and Rebekah Pindzola point out that more cases of infection have been reported in this type of electrolarynx.[14]

Public & Media Impact and Presentation

Users of electrolarynges have only rarely been featured in the media. Judy Siegel-Itzkovich reports in her article, which was published in The Jerusalem Post, that a Holocaust victim in Israel has to use an electrolarynx. His larynx was damaged during medical experiments in a concentration camp by Josef Mengele.[15]

The BBC has made videos presenting the lives of people who use an electrolarynx.[16] They point out that electrolarynx users could have problems with phone calls[17] and that the voice produced by an electrolarynx is not always sufficiently loud.[18]

Jake Polden in the Daily Mail reports Brazilian social experiment, where cigarettes were sold by Joao Candido, the man who lost his voice due to cigarette consumption. Jake Polden points out that customers were considerably affected by Candido's story:
Joao then drops the biggest bombshell yet and reveals to a curious man what the device is he is holding, allowing him to speak. He tells the man that it is an electronic larynx - something he has had to use since his vocal cords were removed due to larynx cancer. Joao says: 'I had already stopped smoking for 14 years when I had the cancer. But either way it was because of the cigarettes.' The revelation is met with many shocked looks from the customers attempting to buy cigarettes from the man. Later a customer states that the experience scared him slightly, while a woman says that this is the time to stop.[19]

A man who uses an electrolarynx was also a part of an anti-smoking campaign in the U.S. He conducted a video in which he sang with which his electrolarynx a song with the refrain 'You don't always die from tobacco'.[20]

Characters who use electrolarynx, have appeared in several series or films. These have included Charlie from Mad Max,[21] Ned Gerblansky from South Park,[22] and Electrolarynx Guy from My Name is Earl.[23]

Public Policy

As medical devices, electrolarynges must be listed by the FDA and have to comply with European Commission Council directive 93/42/EEC when their manufacturers intend to distribute them in the American or European market.[24][25]

Related Technologies, Projects, or Scientific Research

Several components such as adapters, tubes, batteries, chargers, cords,[26] and hands-free holders[27] can be purchased.

References

  1. 1.0 1.1 1.2 1.3 1.4 KEITH, Robert L., SHANKS, James, Laryngectomee Rehabilitation: Past and Present. In: Speech and Language: Advances in Basic research and Practice. New York: Academic Press, 1983. Available online at: https://books.google.cz/books?id=0C60BQAAQBAJ&pg=PA126&lpg=PA126&dq=Cooper-Rand+electrolarynx&source=bl&ots=or27eudDf2&sig=22heagC08Fpk57qGILvufHxwCyM&hl=cs&sa=X&ved=0ahUKEwi1--bt3r7RAhWGuxQKHbrFCC04ChDoAQgdMAE#v=onepage&q=Cooper-Rand%20electrolarynx&f=false (Retrieved 13th January, 2017).
  2. 2.0 2.1 BLOM, Eric D. Current Status of Voice Restoration Following Total Laryngectomy. Oncology [online]. 2000, Jun 1. Available online at: http://www.cancernetwork.com/head-neck-cancer/current-status-voice-restoration-following-total-laryngectomy (Retrieved 19th January, 2017).
  3. 3.0 3.1 SHUTE, Brian. There's Nothing Like the Sweet Spot: Placement of the Artificial Larynx. DrShute.com [online]. 1997, Oct. Available online at: http://www.drshute.com/archives/2004/08/theres_nothing.html (Retrieved 16th January, 2017).
  4. 4.0 4.1 Advance Health Network. Industry News: Cooper-Rand Electronic Speech Prosthesis. Advance Health Network [online]. Available online at: http://speech-language-pathology-audiology.advanceweb.com/Article/Cooper-Rand-Electronic-Speech-Prosthesis.aspx (Retrieved 13th January, 2017).
  5. 5.0 5.1 5.2 5.3 5.4 LIU, Hanjun, NG, Manwa L. Electrolarynx in voice rehabilitation. Auris Nasus Larynx, 2007, 34.3: 327-332.
  6. UEMI, Norihiro, et al. Design of a new electrolarynx having a pitch control function. In: Robot and Human Communication, 1994. RO-MAN'94 Nagoya, Proceedings. 3rd IEEE International Workshop on. IEEE, 1994. p. 198-203. Available online at: http://ieeexplore.ieee.org/document/365931/?arnumber=365931&tag=1 (Retrieved 18th January, 2017).
  7. BROWN, Dale H. et al. Postlaryngectomy Voice Rehabilitation: State of the Art at the Millennium, World Journal of Surgery [online]. 2003, 14 May. DOI: 10.1007/s00268-003-7107-4 Available online at: http://link.springer.com/article/10.1007/s00268-003-7107-4 (Retrieved 16th January, 2017).
  8. RIESZ, R. Description and demonstration of an artificial larynx. Journal of the Acoustical Society of America 1929; 1: 273-9.
  9. VAN DER TORN, Marein. A sound-producing voice prosthesis. Ph. D. Thesis. Amsterdam. VU Medical Center: VU Medical Center, 2005.
  10. National Cancer Institute. Pneumatic larynx. NCI Dictionary of Cancer Terms [online]. Available online at: http://www.cancer.gov/publications/dictionaries/cancer-terms?CdrID=46223 (Retrieved 16th January, 2016).
  11. 11.0 11.1 GARDNER, Warren H., HARRIS, Harold E. Aids and Devices for Laryngectomees. Arch Otolaryngol 73(2) [online]. 1961: 145-152. Doi: 10.1001/archotol.1961.00740020151003 Available online at: http://jamanetwork.com/journals/jamaotolaryngology/article-abstract/1766151 (Retrieved 17th January, 2017).
  12. 12.0 12.1 BALASUBRAMANIAN, T. Voice Rehabilitation following Total Laryngectomy. Drbalu.com [online]. 2006. Available online at: http://drtbalu.com/Voice_rehab.html (Retrieved 18th January, 2017).
  13. SHUTE, Brian. Current Trends in Electronic Larynges. DrShute.com [online]. 1994, Jul 25. Available online at: http://www.drshute.com/archives/2004/08/current_trends.html (Retrieved 18th January, 2017).
  14. MOFFET, Bethann, PINDZOLA, Rebekah H. Acustic Properties of Artifical Larynx Speech. ASHA [online]. 1988. Available online at: http://www.asha.org/uploadedFiles/asha/publications/cicsd/1988AcousticProperties.pdf (Retrieved 16th January, 2017).
  15. SIEGEL-ITZKOVICH, Judy. Voice of the people. The Jerusalem Post [online]. 2015, Apr 26. Available online at: http://www.jpost.com/Israel-News/Health/Voice-of-the-people-399185 (Retrieved 17th January, 2017).
  16. WebWhispers.org. Electrolarynx: What Do The Various EL Devices Sound Like?. WebWhispers.org [online]. Available online at: http://www.webwhispers.org/library/Electrolarynx.asp (Retrieved 19th January, 2017).
  17. CULLING, Bert. Video Nation: Man from Mars. BBC [online]. 2003, Jul. Available online at: http://www.bbc.co.uk/tyne/videonation/stories/man_from_mars.shtml (Retrieved 19th January, 2017).
  18. CULLING, Bert. Video Nation: Cat. BBC [online]. 2003, Jul. Available online at: http://www.bbc.co.uk/tyne/videonation/stories/cat.shtml (Retrieved 19th January, 2017).
  19. POLDEN, Jake. When smoking does not kill: Smokers receive powerful wake-up call when buying cigarettes from a man with an electrolarynx. Daily Mail [online]. 2015, Sep 2. Available online at: http://www.dailymail.co.uk/news/article-3219431/When-smoking-does-not-kill-Smokers-receive-powerful-wake-call-buying-cigarettes-man-electrolarynx.html#ixzz4W0g49sAC (Retrieved 17th January, 2017).
  20. mylexisdhose. Truth singing cowboy. Youtube [online]. 2008, Apr 10. Available online at: https://www.youtube.com/watch?v=eshSlxe9qd0 (Retrieved 17th January, 2017).
  21. The Mad Max Wiki. Charlie. The Mad Max Wiki [online]. Available online at: http://madmax.wikia.com/wiki/Charlie (Retrieved 17th January, 2017).
  22. South Park Wiki. Ned Gerblansky. South Park Wiki [online]. Available online at: http://southpark.wikia.com/wiki/Ned_Gerblansky (Retrieved 17th January, 2017).
  23. My Name Is Earl Wiki. Electrolarynx Guy. My Name Is Earl Wiki [online]. Available online at: http://mynameisearl.wikia.com/wiki/Electrolarynx_Guy (Retrieved 17th January, 2017).
  24. U.S. Food and Drug Administration. What does FDA regulate?. U.S. Food and Drug Administration [online]. Available online at: http://www.fda.gov/AboutFDA/Transparency/Basics/ucm194879.htm (Retrieved 17th January, 2017).
  25. European Commission. Medical devices. European Commission [online]. Available online at: https://ec.europa.eu/growth/single-market/european-standards/harmonised-standards/medical-devices_en (Retrieved 17th January, 2017).
  26. Luminaud Inc. Luminaud: Speech, Voice and Communication Products. Luminaud Inc. [online]. Available online at: http://u.b5z.net/i/u/10204675/f/CF0615pdfbw_c.pdf (Retrieved 17th January, 2017).
  27. Griffin Laboratories, Inc. HandsFree Electrolarynx Holder. Griffin Laboratories, Inc. [online]. Available online at: http://www.griffinlab.com/Products/HandsFree-Electrolarynx-Holder.html (Retrieved 17th January, 2017).