[Rehabilitative methods for the laryngectomized patient - new orientation for the practice]

The rehabilitation of the laryngectomee has not only a functional aspect, i.e. restoration of voice and treatment of physical complaints, but also requires social readjustment and mastering of psychological problems. The most important part of functional rehabilitation is the acquisition of an effective substitute voice. A critical review of the various methods of voice restoration reveals that esophageal speech is still to be preferred, because it is independent of any aids. The Singer-Blom voice prosthesis appears to be superior to the vocal fistula of Staffieri because of its smaller aspiration risk and less complications. Regarding electromechanical speech aids some recent publications by several authors have outlined probable improvements in this field. For the treatment of physical complaints a suction pump, an inhalor and a humidifier are necessary in every case as well as gauze aprons for the protection of the tracheostoma, an ointment for skin care and (for patients wearing a tracheostomy tube) a set-up for cleaning the tube. This indispensable basic equipment may be complemented by a shower shield, a swimming tube, an alarm bell and a respiration tube for emergencies. Efforts at social rehabilitation have two directions: (1) Support of social reintegration by eliminating ignorance, prejudices and anxieties of relatives and friends; (2) preservation of employment or procurement of a new job. The task of psychological rehabilitation is to cope with the abnormal depressive reaction which is to be expected in about half of the patients; psychological rehabilitation begins with intensive counselling before surgery and goes hand in hand with a quick and complete functional and social rehabilitation; its main goal is the restoration of selfconfidence in the patient. These multiple rehabilitation tasks can only be accomplished by close cooperation with the speech therapist, the social services, the employment office and the employer, the insurance companies and possibly with the psychotherapist. The laryngectomee associations and special rehabilitation centers offer valuable help, but the ENT-specialist does have a key position as an advisor and coordinator within the rehabilitation process.