- Facts and Figures
- Acronyms and Definitions
- What is Larynx Cancer (Links)
- Free for the Asking
- SLP Information
lary abbreviations - categorized
CPT CODE - Current Procedural Terminology - A code used on an insurance billing code to denote what procedure was carried out by the provider. These codes are also universal and specific to providers such as therapists, MD’s etc.
DME - Durable Medical Equipment - This type of medical equipment refers to items that are used over and over again. Such as nebulizers, braces, crutches, stoma devices. The code is used for billing insurance companies for this equipment
ICD-9 - International Classification of Diseases - The ICD is designed as a health care classification system, providing a system of diagnostic codes for classifying diseases, including nuanced classifications of a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. A somewhat universal term used to signify the diagnosis of the patient on the insurance form. This code is taken from a code book and is a necessity to allow billing to an insurance provider. The ICD is revised periodically and is currently in its tenth revision. The ninth version, ICD-9 is used in the United States.
GERD - Gastroesophageal reflux disease (GERD) _ This is a chronic digestive disease. GERD occurs when stomach acid or, occasionally, stomach content, flows back into your food pipe (esophagus). The backwash (reflux) irritates the lining of your esophagus and causes GERD.
LPR - Laryngeal Pharyngeal Reflux disease - A back flow of the acidic contents of the stomach up the esophagus to the larynx and pharynx. Can be silent or signaled by other signs and symptoms as in GERD
SCC laryngeal cancer - Squamous Cell Carcinoma of the Larynx - Most laryngeal cancers are squamous cell carcinomas, reflecting their origin from the squamous cells which form the majority of the laryngeal epithelium.
SmCC - Small cell carcinoma (SmCC) – SmCC generally occurs in the lung and extrapulmonary. Approximately 99% of laryngeal cancers are primary squamous cell carcinomas. The primary small cell carcinoma of larynx is a rare tumor representing less than 0.5% of all laryngeal cancers. This is one of the most lethal of malignancies associated with frequent and early widespread metastases and dismal prognosis.
An enteral tube can be passed through the nose and into the stomach or it may be placed directly into the stomach or intestine through a small opening or stoma which is made for it.
G-Tubes - Gastrostomy Tubes (g-tubes) – These are made by many different companies and are good for long term nutritional support. They, however, require that the stomach be working properly.
J-Tubes - Jejunosotmy Tubes (j-tubes) – These are used for a number of reasons: aspiration problems, GERDS, poor gastric emptying, etc. There is a valve between the stomach and the intestines which in theory prevents the back flow from intestine to stomach
NG Tube - Nasogastric Tube - A tube that passes through the nose and on into the gastric system is called a Nasogastric Tube (an NG Tube).
PEG - Percutaneous Endoscopic Gastrostomy - PEG is an endoscopic medical procedure in which a tube (PEG tube) is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate (for example, because of dysphagia or sedation).
DTMJDI - Don’t Tell Me Any More, Just Do It.
HAMPT - How Am I Paying For This.
ICH - I Can Hear ( I just cant speak).
IKITLV - Yes I Know I Sound Like Vadar.
IYOK - If You Only Knew.
WIEE - Will This Ever End.
WLYG - Where Did Last Year Go?
YDKHI - You Don’t Know The Half Of It.
YGTDW - You’re Going To Do What To Me?
PRN - Pro Re Nata - A Latin phrase meaning in the circumstances or as the circumstance arises. It is commonly used in medicine to mean as needed or as the situation arises.
QD - Once a day; q.d. stands for "quaque die" (which means, in Latin, once a day).
BID - Seen on a prescription, b.i.d. means twice (two times) a day. It is an abbreviation for "bis in die" which in Latin means twice a day.
TID - three times per day.
QID - four times per day.
Fr – French – This is an outer diameter measurement used for TEP voice prosthesis. A diameter of 1 French has an external diameter of 1⁄3 mm. It is most often abbreviated as Fr, but can often be seen abbreviated as Fg, Ga, FR or F. It may also be abbreviated as CH or Ch (for Charrière, its inventor). D (mm) = Fr / 3 or Fr = D (mm) * 3. For example, if the French size is 9, the diameter is 3 mm. An increasing French size corresponds to a larger external diameter.
HME - Heat/Moisture Exchange filter - Heat and Moisture Exchanger (HME) filter dust and other larger airborne particles, HMEs preserve some of the moisture and heat inside the respiratory tract and prevent their loss.
IAL – International Association of Laryngectomees - The International Association of Laryngectomees (IAL) is a non-profit voluntary organization composed of approximately 250 member clubs and recognized regional organizations. These clubs are generally known as "Lost Chord" or " New Voice" clubs. Clubs are composed of from 10 to more than 300 Laryngectomees. The purpose of the IAL is to assist these local clubs in their efforts towards the total rehabilitation of the Laryngectomee.
IU – International Unit - Standard measure of the biological activity (biological effect) of manufactured medicinal drugs and vitamins. For every substance to which this unit is assigned, there is an internationally accepted biological effect expected with a dose of 1 IU
OTC Medications – Over the Counter medications- no prescription required, bought over the counter at your local pharmacy or online.
QOL - Quality-of-Life (QOL) - In general, quality of life (QoL or QOL) is the perceived quality of an individual's daily life, that is, an assessment of their well-being or lack thereof. This includes all emotional, social, and physical aspects of the individual's life. In health care, health-related quality of life (HRQoL) is an assessment of how the individual's well-being may be affected over time by a disease, disability, or disorder.
RFS or RF- Radiation Fibrosis Syndrome (RFS) - Radiation therapy is a mainstay of cancer treatment. The reason radiation is used to treat cancer is that it is usually toxic to the fast growing cancer cells. Unfortunately, normal cells are often affected by radiation in a variety of ways, especially over time. One of these changes is the abnormal production of the protein, fibrin, which accumulates in and damages the radiated tissue. This process is known as radiation fibrosis (RF).
TSP - Tobacco Smoke Pollution - TSP is the smoke emitted from a cigarette sitting in an ashtray and the smoke that is exhaled by a smoker.
WW – Webwhispers - WebWhispers was started in 1996 for those who had questions about larynx cancer treatments, surgery, recovery, and what life is like after laryngectomy surgery. They are now the largest support group for individual laryngectomee survivors of larynx and other throat cancers. They offer advice from those who have been there and education at the time it is needed.
Procedures, Treatment and Doctor Speak
ENT – Ear, Nose and Throat Doctor - Otolaryngology is the medical specialty that deals with disorders and conditions of the ear, nose, and throat (ENT) region, and related areas of the head and neck. If you have a problem that is related to your ear, nose, or throat, you may need to see an ENT specialist, who is also called an ear, nose, and throat doctor or an otolaryngologist.
F.A.C.S. - The doctor is a member of the American College of Surgeons, which refers to its members as "Fellows." The letters FACS (Fellow, American College of Surgeons) after a surgeon's name mean that a surgeon must be board certified in his or her specialty, have practiced a minimum of one year after board certification, and passed a review of clinical work, academic work and ethics in running his or her practice.
HBO – Hyperbaric Oxygen treatment - Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room or tube. Hyperbaric oxygen therapy is used for treating serious infections, bubbles of air in your blood vessels, and wounds that won't heal as a result of diabetes or radiation injury.
IMRT - Intensity-Modulated Radiation Therapy (IMRT) - IMRT is an advanced type of radiation therapy used to treat cancer and noncancerous tumors. IMRT uses advanced technology to manipulate beams of radiation to conform to the shape of a tumor.
LP - Larynx Preservation (LP) - Larynx preservation therapy refers to treatment that maintains the function of the larynx. Examples of larynx preservation therapies include: Radiation therapy, Chemoradiation therapy (giving radiation therapy along with chemotherapy) and Partial laryngectomy (surgery that removes part of the larynx).
NED – No Evidence of Disease - When diagnostic tests show that cancer is no longer present, the cancer is in remission. Some doctors use this term and NED (no evidence of disease) interchangeably. While cancer cells may remain, they’re undetectable.
PL - Partial Laryngectomy - Smaller cancers of the larynx often can be treated by removing only part of the voice box. There are different types of partial laryngectomies, but they all have the same goal: to remove the entire cancer while leaving behind as much of the larynx as possible.
RT - Radiation Therapy (RT) - Radiation therapy, radiotherapy, or radiation oncology, often abbreviated RT, RTx, or XRT, is therapy using ionizing radiation, generally as part of cancer treatment to control or kill malignant cells. Radiation therapy may be curative in a number of types of cancer if they are localized to one area of the body. It may also be used as part of adjuvant therapy, to prevent tumor recurrence after surgery to remove a primary malignant tumor (for example, early stages of breast cancer). Radiation therapy is synergistic with chemotherapy, and has been used before, during, and after chemotherapy in susceptible cancers.
SCPL - Supracricoid Partial Laryngectomies (SCPL) - In numerous European countries, the supracricoid partial laryngectomy (SCPL) was developed in the late 1950s as an alternative to TL. SCPL has the advantages of preservation of speech and swallowing function without a permanent stoma and a very high local control rate for selected glottic and supraglottic cancers.
SLP – Speech and Language Pathologist - Speech-language pathologists (sometimes called speech therapists) assess, diagnose, treat, and help to prevent communication and swallowing disorders in patients. Speech, language, and swallowing disorders result from a variety of causes, such as a stroke, brain injury, hearing loss, developmental delay, a cleft palate, cerebral palsy, or emotional problems.
TL-Total laryngectomy (TL) - Total laryngectomy removes the whole larynx. Part of your pharynx may be taken out as well. Your pharynx is the tube air moves through from your nose. It connects with your larynx.
TNM - Tumor, Node, Metastasis (TNM) – Staging system for Cancer. Staging describes the severity of a person’s cancer based on the size and/or extent (reach) of the original (primary) tumor and whether or not cancer has spread in the body.
Skin Flaps for reconstructing the esophagus
DP - Deltopectoral Flap – The DP is thinner and more closely approximates the thin tissue of the pharynx. There is little donor site morbidity, but the flap may need to be completed in stages, and sometimes the amount of tissue that can be given by this type of flap is limited. It works very well as a patch.
JFF - Jejunal Free Flap – The JFF comes already formed as a conduit or cylinder, and there is plenty of intestines that can be harvested. This is particularly helpful when much of the esophagus must be removed, more than can be reasonably replaced with the RFFF or another flap. Swallowing is usually good, but voice may not be as good as with the RFFF. Also, because we are harvesting intestine an incision into the abdomen must be made.
PMC - Pectoralis Myocutaneous Flap - The PMC is a time-honored and reliable flap based on the muscle of the chest and the overalying skin. The blood supply is robust, the amount of tissue that can be borrowed is significant, and its close location to the neck makes this a favorite for patching defects or providing coverage. The flap is hardy and its blood supply reliable. Its disadvantages include its bulk, the cosmetic deformity of transposing this under the neck skin, and in some cases weakness of the arm.
RFFF - Radial Forearm Free Flap - When all of the pharynx is removed, or even some of the esophagus, then a larger, more pliable flap is required. They often turn to the radial forearm free flap (RFFF) which is taken from the inside surface of the arm near the wrist. Because it is a free flap, the artery and vein will need to be sewn to an artery and vein in the neck (called a microvascular anastomosis). Once healed, voice and swallowing are usually excellent.
STSG - Split Thickness Skin Graft - A top layer of skin is moved from one part of the body to another.
Social Security Administration
CDR - Continuing Disability Review - Social Security periodically reviews your disability or blindness to decide if you are still disabled or blind. If you are no longer disabled or blind, they will stop your benefits. The law requires them to perform a medical CDR approximately every 3 years, unless they determine you have a condition that they expect will improve sooner than that. However, if you have a condition that is not expected to improve, they will still review your case, but not as often as every 3 years.
CE - Consultive Examination - If the evidence provided by the claimant's own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by recontacting the treating source for additional information or clarification, or by arranging for a CE. The type of examination and/or test (s) purchased depends upon the specific additional evidence needed for adjudication. If an ancillary test (e.g., X-ray, etc.) will furnish the additional evidence needed for adjudication, the DDS will not request or authorize a more comprehensive examination. If the examination indicates that additional testing may be warranted, the medical source must contact the DDS for approval before performing such testing.
CMS - Centers for Medicare & Medicaid Services (CMS) - The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards.
DDS - Disability Determination Services – Most Social Security disability claims are initially processed through a network of local Social Security Administration (SSA) field offices and State agencies (usually called Disability Determination Services or DDSs)
EHR - Medicare Electronic Health Record (EHR) Incentive Program - The EHR Incentive Program provides incentive payments for certain healthcare providers to use EHR technology in ways that can positively impact patient care. An electronic health record (EHR)—sometimes called an electronic medical record (EMR)—allows healthcare providers to record patient information electronically instead of using paper records.
PFS- Medicare Physician Fee Schedule (PFS) - Medicare Part B pays for physician services based on the Medicare PFS, which lists the more than 7,400 unique covered services and their payment rates.
PQRS - Physician Quality Reporting System (PQRS) - PQRS is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals (EPs). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries.
SSA – Social Security Administration
SSDI - Social Security Disability Insurance (SSD or SSDI) - A payroll tax-funded, federal insurance program of the Social Security Administration and is designed to provide income supplements to people who are physically restricted in their ability to be employed because of a notable disability, usually a physical disability. SSD can be supplied on either a temporary or permanent basis, usually directly correlated to whether the person's disability is temporary or permanent.
SSSI - Social Security Supplemental Income - An additional monthly amount added to social security benefits when need is proven to go beyond the allotted amount.
Tests or Results
EKG – Electrocardiogram - Records the electrical activity of the heart.
TSH numbers - Thyroid Stimulating Hormone numbers - The thyroid gland produces thyroid hormone. When it functions properly, the thyroid is part of a feedback loop with your pituitary gland. First, the pituitary senses the level of thyroid hormone that the thyroid has released into the bloodstream. The pituitary then releases a special messenger hormone, known as "Thyroid Stimulating Hormone" (abbreviated as TSH). The role of TSH is to stimulate the thyroid to release more thyroid hormone. When the thyroid, for whatever reason -- illness, stress, surgery, obstruction, for example -- does not produce enough thyroid hormone, the pituitary detects this reduction in thyroid hormone, and it moves into action. The pituitary then makes More TSH, to help trigger the thyroid to produce more thyroid hormone. This is the pituitary's effort to return the system to "normal" and normalize thyroid function.
CAT scan or CT/PET scan– Computer Aided Tomography scan or a CT (computed tomography) and/or PET (positron emission tomography) - Today, almost all PET scans are performed on instruments that are combined PET and CT scanners. The combined PET/CT scans provide images that pinpoint the anatomic location of abnormal metabolic activity within the body. The combined scans have been shown to provide more accurate diagnoses than the two scans performed separately.
MRI – Magnetic Resonance Imaging - Magnetic resonance imaging (MRI), nuclear magnetic resonance imaging (NMRI), or magnetic resonance tomography (MRT) is a medical imaging technique used in radiology to investigate the anatomy and physiology of the body in both health and disease. MRI scanners use strong magnetic fields and radiowaves to form images of the body. The technique is widely used in hospitals for medical diagnosis, staging of disease and for follow-up without exposure to ionizing radiation. (And it is very loud).
Types of Voice
EL or AL – Electro Larynx or Artificial Larynx - An electrolarynx is a handheld device which is held against the throat, and provides vibrations to allow speech. Electrolarynges may be used immediately post surgery with an oral adapter (the neck being too tender immediately post surgery). Esophageal and electrolaryngeal speech (speech with an electrolarynx) may take weeks or months of training to achieve functional voicing).
ES – Esophageal speech - is a method of speech production that involves oscillation of the esophagus. Instead, air is injected into the upper esophagus and then released in a controlled manner to create sound used to produce speech. Esophageal speech is a learned skill that requires speech training and much practice
HF - Hands-Free Valve (HF) - Adjustable Tracheostoma Valve, when used in conjunction with a voice prosthesis, allows hands free operation of the stoma, eliminating the need to use a finger or thumb to control the air passage. It enables hands-free, conversational speech.
SGD – Speech Generating Device - refers to any computer that is used for communication by allowing its user to input a message that the computer then speaks aloud.
TE or TEP - Tracheoesophageal Speech or Tracheoesophageal Puncture – A voice prosthesis is an artificial device, usually made of silicone that is used to help laryngectomized patients to speak. In this simple surgical procedure, a small puncture is made between the trachea and the esophagus, and a one-way air valve is inserted. This air supply can be used to cause vibrations in a similar manner to esophageal speech. This surgical procedure may occur during the laryngectomy (primary TEP) or after a period of time (secondary TEP).
VP - Voice Prostheses (VP) - A voice prosthesis (plural prostheses) is an artificial device, usually made of silicone that is used to help laryngectomized patients to speak. The two main categories voice prosthesis can be divided into are ‘non-indwelling’ and ‘indwelling’ voice prostheses. ‘Non-indwelling’ voice prostheses can be replaced by the patients themselves, whereas ‘indwelling’ prostheses have to be replaced by a medical professional.
Voice Institute of the IAL
VI – Voice Institute - The IAL Voice Institute trains laryngectomees and prospective instructors of speech in an intensive 5-day course that emphasizes speech restoration as the central component to multidisciplinary total rehabilitation.
VIP - Voice Institute Pupil (VIP) - If you are a laryngectomee and would like assistance to develop or improve your speech, you should register for the IAL Voice Institute as a Voice Institute Pupil (VIP).
LT - Laryngectomized Trainee (LT) - If you have been a laryngectomee for at least two years, have good speaking skills, and would like indepth instruction in communication methods and related topics in order to serve as a peer-counselor to other laryngectomees, register for the IAL Voice Institute as a Laryngectomee Trainee (LT).
ST - Speech Pathology Trainee (ST) -
GS - Graduate Student (GS) -
The above abbreviations were gathered and organized by Scott Sysum and Madlyn Walton. They considered this a draft but I am putting it on the web as it is needed now and we will make corrections and additions any time.. P.S.
Acronyms and Definitions
In the world of laryngectomees, you will hear a number of terms used, most of them new to you and your caregivers, so it is easy to become confused. Our glossary will help you to understand some basic terms, acronyms, and definitions.
ACS (American Cancer Society): With chartered divisions throughout the country and over 3,400 local offices, the American Cancer Society (ACS) is committed to fighting cancer through balanced programs of research, education, patient service, advocacy, and rehabilitation. For further information contact www.cancer.org .
Advanced Directives: are documents signed by a competent person giving direction to health care providers about treatment choices in certain circumstances. There are two types of advance directives.
- Durable power of attorney for health care ("durable power") allows you to name a "patient advocate" to act for you and carry out your wishes.
- A living will allows you to state your wishes in writing, but does not name a patient advocate.
Alaryngeal: Without a larynx, vocal cords, or “voice box”.
Artificial larynx (ALD or AL): A manufactured instrument that makes a tone or vibration, which is used to produce speech. Types of artificial larynges include: pneumatic, intraoral and neck type.
Aspiration: Entry of food, liquid or other material into the lungs.
Augmentative or Artificial Communication Device (AAC): A device used to augment or assist with communication. This can be as simple as a pencil and paper or as complex as a computerized speech generating device.
Baseplate: Also known as a “housing”, is a device which adhers to the skin with adhesive or silicone glue. An HME and/or hands free type valve is then inserted into the baseplate.
Back Pressure: Back pressure is a phenomena experienced by tracheoesophageal speakers who are attempting to force too much air through their voice prosthesis. A voice prosthesis is a relative small tube and can only accept a small flow of air. When excessive air is produced the air will leak around the occlusion of a laryngectomee who is manually occluding the stoma or will push from the inside against the housing of a laryngectomee who is using a hands free valve.
Barrett's Esophagus: Barrett's esophagus is a condition that develops in some people who have chronic gastroesophageal reflux disease (GERD) or inflammation of the esophagus (esophagitis). Barrett's esophagus is a precancerous condition. At the present time, no one can predict which patients with Barrett's esophagus will develop cancer. It is, therefore,
recommended that all patients who have Barrett's esophagus see their doctors and be periodically checked.
Barton Mayo Button: A Barton-Mayo button is a silicone tube which can be used to prevent stoma shrinkage. This device has a lip or rim which helps to hold it in place without the use of a neck strap or skin adhesives. The Barton Mayo Button is compatible with most tracheostoma valves and voice prostheses. An HME and/or a hands free valve can be inserted into the button.
Barium Swallow: A barium swallow, or upper GI series, is an x-ray test used to examine the upper digestive tract (the esophagus, stomach, and small intestine). Because these organs are normally not visible on x-rays, you need to swallow barium, a liquid that shows up on x-rays. The barium temporarily coats the lining of the esophagus, stomach, and intestine, making the outline of these organs visible on the xray pictures. This test is useful for diagnosing cancers, ulcers, problems that cause narrowing of the esophagus, some causes of inflammation in the intestine, and some swallowing problems.
Benign tumor: Non cancerous growth
Biopsy: The process of taking a sample of tissue for examination to determine if cancer cells are present.
Botox: Botulinum toxin used as an injection to inhibit muscle spasm that sometimes affects voicing.
Bougie: A thin cylinder, usually rubber, plastic, or metal, that a physician inserts into or though a body passageway, such as the esophagus, to diagnose or treat a condition. A bougie may be used to widen a passageway, as in a dilation, guide another instrument into a passageway, or dislodge an object.
Carcinoma/ Cancer (CA): A cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells. In most parts of the body, cells continually divide and form new cells to supply the material for growth or to replace worn-out or injured cells. For example, when you cut your finger, certain cells divide rapidly until the tissue is healed and the skin is repaired. They will then go back to their normal rate of division. In contrast, cancer cells divide in a disorganized manner. Cancer cells pile up into a non-structured mass or tumor with the ability to invade other tissues, either by direct growth into adjacent tissue (invasion) or by migration of cells to distant sites (metastasis).
- Squamous Cell (SCCA or SCC): Squamous cell carcinoma develops in the epithelial layer of the skin and in various mucous membranes of the body. It represents more than 90% of all head and neck cancers.
- Adenocarcinoma: Cancer that begins in cells that line certain internal organs and that have gland-like (secretory) properties. This type of cancer is a relatively rare and particularly aggressive form of cancer.
- Chondrosarcomas: Chondrosarcomas or synovial sarcomas develop from connective tissues of the larynx or hypopharynx. These are extremely rare forms of laryngeal cancer.
Candida albicans: A fungal infection of the oral cavity commonly seen in patients who have undergone radiation therapy for the treatment of head and neck cancer. Candida may result in pain or difficulty swallowing as well as voice prosthesis failure. Candida is commonly treated with a topical antifungal such as Nystatin.
Caries: Decay or demineralization of the tooth surface caused by bacteria.
Catheter: Plastic, rubber or silicone tube which can inserted into a body cavity to stent or prevent closure, stretch the diameter of an opening or to deliver medication or drain/remove fluids.
Chemotherapy: The use of chemical agents to destroy cancerous cells and tissue.
Chronic obstructive pulmonary disease (COPD): Chronic disease of the lungs such as asthma, bronchitis and emphysema which can make breathing challenging.
CT scan: Computerized tomography sometimes called CAT scan which uses special x-ray equipment to generate three dimensional images of the body which results in greater clarity than ordinary x-rays.
Dehydration: Dehydration means your body does not have as much water and fluids as it should. Dehydration can be caused by losing too much fluid, not drinking enough water or fluids, or both. Vomiting and diarrhea are also common causes. Severe dehydration is a life-threatening emergency.
Delirium Tremens (DT's): Delirium tremens is a life-threatening form of alcohol withdrawal that involves sudden and severe mental or neurological changes.Delirium tremens may be triggered by infection or illness in people with a history of heavy use of alcohol. It is most common in people who have a history of alcohol withdrawal, especially in those who drink the equivalent of 7 - 8 pints of beer (or 1 pint of "hard" alcohol) every day for several months. Delirium tremens also commonly affects those with a history of habitual alcohol use or alcoholism that has existed for more than 10 years.This is a condition that requires immediate medical attention.
Diagnostic Laryngoscopy (DL): A procedure which allows the physician to examine and biopsy suspicious areas in the upper airway and secondary structures. This procedure requires general anesthesia and can usually be done on an outpatient basis.
Dietician: An individual who has had special training in diet and nutrition.
Dilator: A device used to stretch or enlarge a passageway.
Direct Laryngoscopy: Direct visualization of the larynx.
Dysarthria: A speech disorder that is due to a weakness or incoordination of the speech muscles. Speech is slow, weak, imprecise or uncoordinated.
Dysphagia: Difficulty swallowing.
Dysplasia: A precancerous condition.
Edema: Accumulation of fluid into tissue resulting in swelling.
Esophagogastroduodenoscopy (EGD): A procedure usually performed by a gastroenterologist (GI or intestinal doctor), which involves passing an endoscope, a long, flexible black tube with a light and video camera on one end, through the mouth to examine the esophagus, stomach and the first part of the small intestine called the duodenum.
Epiglottis: A structure in the larynx that protects the airway while swallowing.
ENT: A physician who specializes in the diagnosis and treatment of diseases of the ears, nose and throat.
Enteral feeding: Nutrition delivered directly to the stomach via a feeding tube.
Esophagus: a tube shaped structure, which allows food to empty from the back of the throat into the stomach.
Esophageal Dysmotility: A condition in which the ability of the esophagus to contract and transport food and saliva from the mouth to the stomach has been diminished.
Esophageal insufflation test: A test in which air is passed into the esophagus via a catheter to determine the ability to generate esophageal sound.
External Beam Therapy (EBT): See radiation therapy
False cords: Structures in the larynx, which acts as a valve to protect the airway.
Fenestrate: To make an opening. For example a Speech Pathologist may fenestrate or cut a hole in a laryngectomy tube to allow air to pass through the tube into a voice prosthesis.
Fiberoptic Endoscopic Evaluation of Swallowing and Sensory Testing (FEEST): a test in which a flexible scope is passed through the nose into the larynx to assess swallowing ability and laryngeal sensation.
Fiberoptic Laryngoscopy: The use of a flexible scope with a camera attached to examine the nasal, oral, pharyngeal and laryngeal passages and structures.
Fine Needle Aspiration (FNA): A procedure used to obtain cells or fluid from tissue using a needle with an empty syringe to be examined by a pathologist.
Fine Needle Biopsy (FNB): A procedure in which a needle is introduced into tissue to obtain a core sample of tissue, which will be evaluated by a pathologist.
Fistula: An unwanted opening along a surgical incision, which allows food or saliva to drain to the outside of the body or into the surrounding tissue.
Forearm free flap: The transfer of tissue and vessels from the forearm, rolled into a tube and used to reconstruct the pharynx.
Free flap: The transfer of healthy tissue and vessels from one part of the body to another part of the body, which has been surgically removed.
Gastric pull-up: An extended type of surgery in which the pharynx and the esophagus are removed and the stomach is “pulled up” to substitute for the removed structures.
Gastroesophageal reflux disease (GERD): A condition in which food or liquid travels backwards from the stomach to the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.
Glossectomy: Surgical removal of the tongue.
Glottic cancer: Cancer of the vocal folds.
Gray: A measure of absorbed radiation dose.
Granulation tissue: The term granulation tissue is derived from the appearance of small, red, granular cells which bleed easily. Granulation tissue is commonly seen within freshly healing tissue. Granulation tissue can also result from chronic irritation. Some laryngectomees with TEP’s develop granulation tissue around the flange of their voice prosthesis.
Heat Moisture Exchanger HME: A filtration device placed over the tracheostoma, which captures heat and moisture as air is exhaled from the lungs and then returns the captured heat and moisture to the lungs when air is inhaled.
Hemiglossectomy: Surgical removal of a portion of the tongue.
Hemilaryngectomy: Surgical removal of a portion of the larynx.
Hiatal Hernia: A condition in which a portion of the stomach protrudes upward into the chest, through an opening in the diaphragm. Increasing age, obesity,and smoking are known risk factors in adults. This condition may cause reflux (backflow) of gastric acid from the stomach into the esophagus
Hospice: A special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.
Hyperparathyroidism: See parathyroid
Hyperbaric Oxygen Treatment HBO: Hyperbaric oxygen treatment is used to substantially increase oxygen flow within tissues to improve healing. Patients undergoing hyperbaric treatment are placed in a chamber where 100% oxygen is circulated. The oxygen is pressurized so that air pressure may be 2-3 times greater than normal. This allows the lungs and skin to absorb more concentrated oxygen in a shorter period of time.
Hyper-tonicity: In the laryngectomee community hyper-tonicity generally relates to the PE segment and the ability to produce fluent standard esophageal speech or tracheoesophageal speech. The effects of excessive PE segment tightness can range from a harsh and/or strained vocal quality to complete inability to produce “voice”. Hyper-tonicity can be treated in a variety of ways including Botox, myotomy or dilation.
Hypo-tonicity: In the laryngectomy community hypo-tonicity generally relates to the PE segment and the ability to produce esophageal speech or tracheoesophageal speech with enough intensity to be heard in a conversational speech setting. An excessively loose or relaxed PE segment results in a breathy vocal which may be difficult to be heard. Hypo-tonity can be treated by increasing pressure to the PE segment manually, by changing ones posture or utilization of a pharyngeal-esophaegeal segment pressure prosthesis.
Indirect laryngoscopy: The use of a mirror and a light to indirectly visualize the larynx.
Indwelling prosthesis: A voice prosthesis, which must be inserted by professional, such as a speech language pathologist or a physician.
International Association of Laryngectomees (IAL): A non-profit organization whose purpose is to provide information and education to Laryngectomees and professionals who work with Laryngectomees in order to help them achieve total rehabilitation and reintegration into the community.
Insufflation Test: A test given after laryngectomy and before TEP puncture to determine the voicing ability.
Intensity Modulated Radiation Therapy (IMRT): See radiation therapy
Jejunum: A section of the small intestine, which is sometimes used to reconstruct the pharynx.
Laryngectomee: A person whose larynx has been surgically removed.
Laryngectomy: Surgical removal of the larynx.
Larynx: The “voice box” or the organ responsible for sound generation.
- Supraglottis: the area above the vocal cords, including the epiglottis, which closes off the larynx when you swallow to keep food from going into your lung.
- Glottis: The vocal folds.
- Subglottis: The area below the vocal folds.
Laryngectomy Tube: A flexible silicone tracheostomy tube designed to prevent stoma shrinkage in a laryngectomee. This type of tube is generally held in place using a neck strap.
Laser: a surgical instrument, which produces a powerful beam of heat and light used to vaporize tissue.
Local Spread: Local spread means that a growing cancer extends beyond the organ in which it developed, into nearby organs and tissues. For example, the esophagus is adjacent to the larynx. Very large tumors of the larynx may extend into the esophagus.
Lost Chord Club: A support group for laryngectomees and their family and friends.
Low pressure voice prosthesis: See Voice Prosthesis
Lymph nodes: Also sometimes referred to as lymph glands, lymph nodes are small rounded or bean-shaped structures surrounded by a capsule of connective tissue. Lymph nodes are located in many places throughout the body. However, the majority of the lymph nodes in our body are concentrated in the head and neck region. Lymph nodes filter lymphatic fluid and store special cells that can trap cancer cells or bacteria which are traveling through the body in lymph fluid.
Lymphedema: Lymphedema is a buildup of lymph fluid (a fluid which helps fight infection and disease) in the fatty tissues just under the skin. This buildup of lymph fluid causes swelling, inflammation and eventual thickening and scarring of the tissue under the skin. Lymphedema is a common complication of head and neck cancer and can result in long-term difficulties including disfigurement, difficulty swallowing and difficulty finding appropriate electrolarynges device placement. Although lymphedema is not curable it is treatable. Assessment and treatment of lymphedema should be done by a Certified Lymphedema Therapist. To find a Certified Lymphedema Therapist in your area contact the National Lymphedema network at www.lymphnet.org .
LT - Laryngectomee Trainee: Trainee at the IAL's Voice Institute
Magnetic Resonance Imaging (MRI): Uses radio waves and a strong magnetic field rather than x-ray to provide detailed images of internal organs and tissue. It is important to remove metal objects prior to the procedure and to inform the technicians if you have tattoos or metal implants in your body.
Malignant tumor: A tumor made up of cancer cells.
Malnutrition: Malnutrition is a condition that occurs when a person's body is not getting enough nutrients. The condition may result from an inadequate or unbalanced diet, digestive difficulties, absorption problems, or other medical conditions. Malnutrition can be life threating. General symptoms can include fatigue, dizziness, weight loss and decreased immune response.
Margins: also known as "margins of resection," refer to the distance between a tumor and the edge of the surrounding tissue that's removed along with it. When a tumor is removed, some tissue surrounding it is also removed. A pathologist checks the tissue under a microscope to see if the margins are free of cancer cells. Depending upon what the pathologist sees, the margins of a tumor are described as:
- Positive margins: Cancer cells extend out to the edge of the tissue, where the ink is.
- Negative margins: No cancer cells are found in the ink.
- Close margins: Any situation that falls between positive and negative is considered "close." Knowing how close cancer cells are to the edge of the removed tissue helps in making the right treatment decisions.
Maxillofacial Prosthodontist: A dentist who has had additional training, which allows him/her to make dental and facial prosthetics used to restore and/or reconstruct the oral cavity and/or face.
Metastatic: Metastasis involves spread of cancer cells through the bloodstream, or the lymph system.
MRI: See Magnetic Resonance Imaging
Mucositis: Mucositis occurs when cancer treatments break down the rapidly divided epithelial cells lining the GI tract, particularly in the oral cavity, leaving the mucosal tissue open to ulceration and infection. Oral mucositis is probably the most common, debilitating complication of chemotherapy and radiation. It occurs in 20-40% of patients treated with chemotherapy alone and up to 50% of patients receiving combination radiation and chemotherapy, especially those with head and neck cancer.
Myotomy: A myotomy is any surgical procedure in which muscle is cut. A laryngectomee who suffers from spasms in a portion of their esophagus may undergo a myotomy to improve swallowing function and/or to improve standard esophageal speech or tracheoesophageal speech production.
Microstoma: Stenosis or shrinking of the stoma which may result in difficulty breathing and/or caring for or changing a voice prosthesis. Microstoma may be treated by stenting/stretching the stoma with a laryngectomy tube. In some circumstances surgery may be needed to revise the stoma, i.e. make the stoma larger.
Mucous Plug: Thick or dried secretions which occlude the airway.
Nasogastric feeding tube (NG Tube): A flexible tube inserted into the nose, down the back of the throat, through the esophagus and into the stomach. This tube is used to provide temporary nutritional support to patients who are unable to eat and drink in a normal way.
Neoglottis: A glottis created by suturing the pharyngeal mucosa over the superior end of the transected trachea above the primary tracheostoma and making a permanent stoma in the mucosa; done to permit phonation after laryngectomy.
Neophonation: standard esophageal or tracheoesophageal voice.
Nurse Practitioner: A registered nurse who has completed advanced education (generally a minimum of a master's degree and training in the diagnosis and management of medical conditions. Nurse practitioners provide a broad range of health care services including prescribing medications.
Occupational Therapist: A professional trained to help people learn or re-learn to perform routine activities people need to do on a dialy basis to live independently.
Odynophagia: Odynophagia is a medical term which means pain when swallowing.
Oncologist: A physician who specializes in the study and treatment of cancer with chemotherapy.
Oropharynx: The area of the oral cavity behind the tongue.
Osteonecrosis: Osteonecrosis of the jaws (ONJ) is a condition whereby there is loss or destruction of the bone underneath the teeth. This loss of bone appears to be caused by a combination of poor blood supply and impaired bone remodeling or healing. Osteoradionecrosis: Osteoradionecrosis is one of the more serious complications of head and neck irradiation for cancer. Bone cells and vascularity may be irreversibly injured. When radiation osteonecrosis is progressive, it can lead to intolerable pain or fracture and may necessitate jaw resection. The risk for developing spontaneous osteoradionecrosis is related to the dose of radiation delivered (usually more than 6000 cGy) and bone volume. The mandible is at higher risk than the maxilla. The risk is increased in patients without dentures and even more if teeth within the treatment field are removed after therapy. Spontaneous bone exposure usually occurs more than one year after radiation is completed. The risk for osteonecrosis continues indefinitely following radiation therapy.
Otolarygologist: Physician/surgeon who specializes in diagnosing and treating diseases of the ear, nose and throat.
Palliative: Treatment intended not to cure cancer but to control its growth and/or reduce pain.
Parathyroids: Parathyroid glands are small glands of the endorcrine system which are located in the neck behind the thyroid. The only purpose of the parathyroid glands is to regulate the calcium level in our bodies within a very narrow range so the nervous and muscular systems can function properly. Hypoparathyroidism is a relatively rare, but serious complication of treatment for head and neck surgery. Symptoms of hypoparathyroidism include hypocalcaemia (reduced calcium levels.) Reduced calcium levels can result in an irregular heat beat and/or tingling and/or twitching around the mouth as well as spasms or cramping in the hands and feet.
Party wall: From a medical standpoint a party wall is a structure which is shared. After a laryngectomy the party wall would be the tissue which is between the trachea and the esophagus.
Pathologist: A medical doctor who specializes in the diagnosis of disease by studying cells and tissue under a microscope.
Pectoral Myocutaneous Flap: The use of the chest muscle and skin to reconstruct a defect that remains after cancerous tissue has been removed.
Percutaneous Endoscopic Gastrostomy (PEG): A surgery to place a feeding tube into the stomach.
Peripherally Inserted Central Catheter (PICC): A tube inserted into a vein, which can be used to give medication, blood products or nutritional supplements.
PET: See Positron Emission Tomography Scan
Pharyngo-laryngo-esophagectomy: a surgery to remove the pharynx, larynx and esophagus.
Pharyngoesophageal Segment (PE Segment): The P-E segment separates the pharynx from the esophagus.
Pharyngeal-esophaegeal Segment Pressure Prosthesis A pharyngeal-esophageal segment pressure prosthesis includes a rigid support band having a U-shaped configuration having a pad assembly pivotably and rotatably mounted to its central portion for providing direct pressure to the pharyngeal-esophageal segment area. Connected to the ends of the band is a flexible strap mechanism for securing the device around the neck of the person.
Pharynx: The throat.
Physical therapist: A professional who provides services which restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities through a wide variety of modalities including exercise, heat/cold, massage, etc. They help restore, maintain, and promote overall fitness and health.
Plug or Valved Insert: A silicone device which is temporarily inserted into an indwelling voice prosthesis to used prevent leakage of food or fluids through the prosthesis into the trachea. This purpose of this plug is to prevent aspiration until the patient is able to return to the clinician to have their prosthesis changed.
Positron Emission Tomography Scan (PET): A diagnostic examination that involves obtaining images based on detection of radiation from the emission of positrons.
Pseudoepiglottis: a band of scar tissue at the base of tongue, with a pouch or a pocket below it. This pouch has a tendency to collect foods. A large pseudo-epiglottis can cause foods and liquids to back up into the oral or nasal cavity. A pseudo-epiglottis can be visualized during videofluoroscopic swallowing study.
Pulmonary: Involving or pertaining to the lungs.
Primary Cancer: . The primary is usually named for the part of the body or the type of tissue where the cancer originated.
Radiation Oncologist: A physician who specializes in the diagnosis of cancer and the treatment of cancer with radiation therapy.
Radiation therapy: A method of destroying cancer cells.
- External Beam Therapy: A method of delivering a beam of high energy x-rays to a tumor.
- Intensity Modulated Radiation Therapy: An advanced mode of highly precise radiotherapy that uses computer controlled x-ray accelerators to deliver precise radiation to a tumor or specific areas within the tumor while minimizing exposure to surrounding normal tissue.
Radical Neck Dissection: An operation used to remove cancerous tissue in the head and neck. The purpose of radical neck dissection is to remove lymph nodes and other structures in the head and neck that are likely or proven to be malignant. Variations on neck dissections exist depending on the extent of the cancer. A radical neck dissection removes the most tissue. It is done when the cancer has spread widely in the neck. A modified neck dissection removes less tissue, and a selective neck dissection even less. Greater tissue removal generally results in greater disfigurement and disability.
Recurrence: Recurrence is the medical term used when cancer comes back in a patient who appeared to be in remission (free of cancer) after treatment.
- Local Recurrence: Cancer can recur locally, in the same organ it developed in or, if that organ was removed by surgery, in a nearby remaining organ or tissue. For example, local recurrence of laryngeal means cancer started to grow again in the same area after laryngectomy and/or radiation therapy.
- Regional Recurrence: A regional recurrence usually means cancer has come back in nearby lymph nodes or in the area lymph nodes were had removed. After complete removal of the larynx, growth of cancer in lymph nodes of the neck would be considered regional recurrence.
- Distant Recurrence: A distant recurrence involves any other part of the body not included in local or regional recurrence. After surgery for apparently localized laryngeal cancer, the cancer might recur distantly in the lungs.
Regurgitate: Spitting up of food from the esophagus or stomach without nausea or forceful contractions of abdominal muscles. Laryngectomees are prone to regurgitate if they bend over after eating or drinking.
Referred pain: The feeling of pain in an area distant from the cause of the pain but supplied by the same nerve.
Saline Solution: a solution of sodium chloride (a substance also commonly known as table salt) in sterile water, used frequently for intravenous infusion, nasal irrigation or to clean/clear the trachea.
Silicone Glue: A medical grade adhesive which is safe to use on the skin.
Skin Prep: A liquid which when applied to the skin forms a protective barrier. This barrier help reduces irritation to the skin when using a tapes or tracheostoma baseplates.
Speech generating device (SGD): A speech generating devices include any device which uses electronically stored speech as a means of communication. Speech generating devices can contain between one and several thousand words which can be accessed in a variety of ways by people with communication impairment. The speech produced can be either digitised or synthesised. An artificial larynx is not a speech generating device.
Speech Language Pathologist (SLP): A professional specializing in the diagnosis and treatment of speech, language and swallowing disorders.
SPOHNC (Support for People with Oral and Head and Neck Cancer): is a patient-directed, self-help organization dedicated to meeting the needs of oral and head and neck cancer patients. SPOHNC, founded in 1991 by an oral cancer survivor, addresses the broad emotional, physical and humanistic needs of this population. For further details see www.spohnc.org .
Supraglottic Laryngectomy: An operation to remove the supraglottis, which is part of the larynx (voice box) above the vocal cords.
Standard Esophageal speech (SES): A method of communication in which the esophagus is used as the primary sound generator.
Stoma: A surgically created opening in the front of the neck through which a Laryngectomee breathes.
Stoma cover: A cloth or foam covering used to cover the stoma and protect the lungs from inhaling dust, dirt and other foreign substances.
Stomagastic feeding tube: A temporary feeding tube placed into the tracheoesophageal puncture site. Once the patient has been cleared to eat by mouth the feeding tube is removed and a voice prosthesis is placed within the tract.
Stricture: An abnormal narrowing of a structure.
TNM Cancer Staging System: TNM Staging a standardize method of assessing and defining solid tumors. TNM is an acronym for the words Tumor, Nodes, and Metastases. Each of these criteria is separately listed and paired with a number to define the severity of a tumor. For example a T1N2M0 cancer would be a cancer with a T1 tumor, N2 involvement of the lymph nodes, and no metastases (no spreading through the body).
Telecommunication Equipment Distribution Program (TEDP): Statewide programs which provide a variety of specialized telecommunications equipment to qualified applicants who have difficulty using a standard phone.
Thyroid Gland: The thyroid is a small, butterfly-shaped gland located at the base of your neck. Hormones produced by the thyroid gland have an enormous impact on health, affecting all aspects of your metabolism — from the rate at which your heart beats to how quickly you burn calories. The thyroid gland can easily be damaged by radiation or sometime must be removed because of cancer. The thyroid gland helps regulate metabolism. Removal of or damage to the thyroid generally results in a condition known as hypothyroidism. The signs and symptoms of hypothyroidism vary widely, depending on the severity of the hormone deficiency. Symptoms may include: Increased sensitivity to cold, constipation Pale, dry skin , A puffy face, unexplained weight gain, muscle aches, tenderness and stiffness, pain, stiffness or swelling in your joints, muscle weakness, depression and decreased sex drive. After proper testing, hypothyroidism can be successfully treated with medication.
Trachea: The air passage between the larynx and the lungs.
Tracheoesophageal puncture (TEP): A surgical procedure in which an opening is created between the trachea and the esophagus just behind the stoma. After the tract has been allowed to mature, a voice prosthesis is inserted within the tract to allow a Laryngectomee to communicate using lung powered esophageal speech. In recent years, this has sometimes been written as TE Puncture or TE Prosthesis to clarify the difference.
Tracheostoma: See stoma.
Tracheostoma Valve: A tracheostoma valve may be worn over the stoma of a tracheoesophageal speaker. The valve allows normal breathing but closes for speech by redirecting exhaled air, through the prosthesis, into the esophagus for speech production. This makes it possible for the laryngectomee to speak without manually occluding the stoma. The valve is a 2-way valve which opens during non-speech breathing (both inhalation and exhalation) but closes upon more forceful exhalation, such as with speech.
Tracheostomy: An opening in the windpipe.
Trismus: a term used to describe limited mouth opening. Trismus is a common side effect of radiation to the head and neck region. Trismus can result in pain as well as difficulty chewing and performing oral care.
Tumor: An abnormal overgrowth of cells, which can be either malignant or benign.
Tumor Board: A treatment planning approach in which a number of doctors and other professionals who are experts in different specialties review and discuss the medical condition and treatment options of a patient. In cancer treatment, a tumor board review may include that of a medical oncologist (who provides cancer treatment with drugs), a surgical oncologist (who provides cancer treatment with surgery), and a radiation oncologist (who provides cancer treatment with radiation).
Unknown Primary: Cancer of unknown primary (CUP) origin is the diagnosis when metastatic cancer is found but the place where the cancer began (the primary site) cannot be determined.
Ventilator: A ventilator is a machine which helps a critically ill patient breath.
Videofluoroscopic Swallow Study (VFSS): A videofluoroscopic swallow study (VFSS) is procedure performed by a radiologist and a speech pathologist to assess swallowing function. During the procedure the patient swallows a variety of liquids and foods mixed with barium, as a radiologist takes video X-rays of the mouth and throat. These images show how food passes from the mouth through the throat and into the esophagus. During the test, a speech pathologist may ask patients to alter their head position, such as tucking the chin, or to try various other techniques to improve swallowing.
Videostroboscopy: a state-of-the-art technique that provides a magnified, view of the vocal cords in action. It enables physicians to make an accurate diagnosis of conditions and diseases of the vocal cords.
Voice box: The common name for the larynx.
Vent: A button, tube or vent and is worn in the stoma. They come in all shapes and sizes. Curved or straight; long or short; different diameters and made of different materials. They sometimes have a place to tie a band around your neck to keep it in place and some have a ridge around the back edge to hold it in your stoma without a tie. They all have some kind of a flange or collar on the outside to keep them from slipping into the trachea. The main purposes are to keep your stoma nicely shaped and stretched out to the size they need to be for comfortable breathing.
VI - Voice Institute: The International Association of Laryngectomees (IAL) Voice Institute offers a premier, intensive training course designed to familiarize Speech Pathologists (ST's), laryngectomees with excellent speech rehabilitation (LT's), laryngectomees desiring self improvement in communication skills who enroll as Voice Institute Pupils (VIPs), and other health professionals with state-of-the-art methods of alaryngeal speech restoration, and medical/surgical treatment for individuals with laryngeal cancer. Observations and selective hands-on experience with alaryngeal speech alternatives are unique features of the course." The VI is held every year at the same time as the IAL Annual Meeting (AM) See the IAL web site for current information.
VIP - Voice Institute Pupil: Pupil at the IAL's Voice Institute
Voice prosthesis: A silicone tube, which is placed between the trachea and esophagus after total Laryngectomee and tracheal esophageal puncture. The prosthesis is open on the tracheal end and has a one-way valve on the esophageal end, which keeps foods and fluids from passing through the prosthesis and into the trachea and lungs.
- Indwelling prosthesis: A voice prosthesis, which must be inserted and/or removed by a professional such as a speech language pathologist or a physician.
- Low pressure prosthesis: a type of voice prosthesis which can be inserted and removed by a patient.
WebWhispers: WebWhispers is an International Internet support group for laryngectomees. For further details see webwhispers.org
Xerostomia: Dry mouth caused by a severe reduction in the flow of saliva. Xerostomia is a common side affect of radiation treatment to the head and neck region.
This glossary was prepared by
Tammy L. Wigginton, WebWhispers Library Advisor
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