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International practice of laryngectomy rehabilitation interventions: a perspective from South Africa

Fagan, Johan J.a; Lentin, Roslynb; Quail, Gavina

Current Opinion in Otolaryngology & Head and Neck Surgery: June 2013 - Volume 21 - Issue 3 - p 199–204
doi: 10.1097/MOO.0b013e328360c3c1

Purpose of review This review reflects on the experience of speech rehabilitation of laryngectomees at the Groote Schuur Hospital in Cape Town and expands on ways of dealing with the challenges that practising in a developing world setting presents.

Recent findings Postlaryngectomy speech rehabilitation is unavailable in most African countries because of a profound shortage of speech and language therapists, otolaryngologists, and trained head and neck surgeons, as well as fiscal limitations. This article presents our recent tracheoesophageal speech results; discusses the employment of early postlaryngectomy feeding, selection criteria for patients for tracheoesophageal speech, the choice of voice prosthesis, follow-up care of patients coming from afar; and presents the results of a comparative study of the efficacy of different methods of airway humidification.

Summary Our data and experience illustrate that excellent postlaryngectomy speech results can be achieved in a developing world setting by a dedicated team comprising speech and language therapists and otolaryngologists, that early postlaryngectomy feeding is well tolerated, and that a simple cotton cloth stoma cover is as effective as more expensive heat moisture exchange devices.

aDivision of Otolaryngology, University of Cape Town

bSpeech Therapy, Groote Schuur Hospital, Observatory, Cape Town, South Africa

Correspondence to Professor Johan J. Fagan, MBChB, FCS (SA), MMed (Otol), Division of Otolaryngology, University of Cape Town, H-53 OMB, Groote Schuur Hospital, Observatory, 7925, Cape Town, South Africa. Tel: +27 21 406 6420; fax: +27 21 448 8865; mobile: +27 82 897 3473; e-mail:

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