Resist resistance New insights and options in post-laryngectomy swallowing rehabilitation and communication

This thesis explores changes in swallowing and communication following total laryngectomy (removal of the voice box). Chapter 1 outlines the anatomy and physiology of the pharynx and larynx, along with the functional changes that occur after the surgery. Chapter 2 investigates which remaining muscles can be activated during conventional and resistance-based swallowing exercises using functional MRI. Chapter 3 presents a Clinical Phase II trial using the novel Swallowing Exercise Aid (SEA) 2.0 device, which enabled participants to perform resistance-based swallowing exercises. The trial demonstrated significant improvements in alaryngeal swallowing capacity, muscle strength, and quality of life after six weeks of intensive therapy. Chapter 4 confirms that many of these gains are maintained six months later.
Chapter 5 examines the use of pharyngeal High-Resolution Impedance Manometry (HRIM) in head and neck cancer patients through a scoping review. Chapter 6 reveals that pharyngeal HRIM detects small, non-significant changes in pharyngeal pressures following alaryngeal swallowing rehabilitation. Chapter 7 showed that tracheoesophageal voice quality on average is not affected by the resistance-based swallowing exercises. Chapters 8 and 9 focus on post-laryngectomy communication strategies, showing that participants plan their utterances more carefully, use fewer fillers, and exhibit similar co-speech gestures as controls. Finally, Chapter 10 highlights the benefits of singing therapy in improving both voice function and emotional well-being.