الفهرس 
Esophageal SpeechOnly 14 pages are availabe for public view
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Abstract
Disadvantage:- Electrolarynx produce a mechanical sound quality and hence can be unacceptable during communication in public. The device is not hands free, although they can be made hands free with use of a suitable collar but sometimes can be cumbersome to the patient. Using an electrolarynx can pose problems in some daily activities for example, while speaking, driving, cooking, or holding the telephone. Another disadvantage is the need to charge or replace the batteries frequently. Successful use:- ~100% Tracheoesophageal puncture Mechanism:- tracheal air exhaled into pharynx through fistulous tract. Advantage:-the advantage of TEP include: 1.Possible after laryngectomy, neck dissection and/or radiotherapy. 2. The fistula is a convenient route for oesophagogastric feeding in the immediate postoperative period. 3. Easily reversible if desired by the patient. 4. More quickly attained than oesophageal speech. 5. High success rate for prosthetic vocal rehabilitation (close to 95% in long-term users) 6. Fair-to-excellent voice quality in close to 88%. 7. Similar to laryngeal speech on a range of voice parameters such as fundamental frequency, jitter, shimmer, words per minute and maximum phonation time as compared to oesophageal speech. 8. More intelligible, natural sounding, and has improved intensity and duration of speech. Disadvantage:- the disadvantage of TEP include: 1. Need to manually cover the stoma when voicing; although, in many, this has been relieved by the creation of hands-free valves. 2. Adequate pulmonary reserve is necessary. 3. Additional surgery for secondary punctures. 4. Violation of the posterior oesophageal wall. 5. Inadvertent passage of the catheter through a false passage, and oesophageal perforation. Successful use:- 40-90% LARYNGEAL TRANSPLANTATION The future of reconstructive surgery lies in advances in composite tissue transplantation. Although there has been a considerable amount of research and interest in laryngeal transplantation, it remains a controversial topic with several obstacles impeding large clinical trials. It is a complex procedure that would involve at least anastomosis of the superior thyroid artery, jugular vein, and four nerves (two recurrent and two superior laryngeal nerves). In addition, tracheostomy, gastrostomy, and stenting are required. The first laryngeal transplant was performed in Cleveland, Ohio, in 1988. The patient, who underwent laryngectomy for trauma, suffered early acute rejection episodes but then later achieved normal speech and swallowing function.In general, the future of transplantation lies in research to decrease rejection and encourage immunogenicity. Although immunosuppressive medications have improved significantly, many long-term and some short-term side effects have not been eliminated. With proper clinical trials and medical advances, laryngeal transplantation could indeed revolutionize the way we treat laryngectomy patients and voice reconstruction.