Location of the Vibratory Segment in Tracheoesophageal Speakers

Abstract

The Singer-Blom tracheoesophageal puncture procedure for surgical-prosthetic voice restoration has proved to be a viable option for alaryngeal speech rehabilitation. Following tracheoesophageal puncture, occlusion of the tracheostoma shunts pulmonary air through the Blom-Singer prosthesis into the cervical esophagus. The pulmonary air passing through the cervical esophagus and into the hypopharynx causes a portion of the upper alimentary tract to vibrate in a manner similar to that of the pharyngoesophageal segment during the production of esophageal speech. To study the location and shape of the vibratory segment in tracheoesophageal speakers, videofluoroscopy and simultaneous voice recording were performed with 16 patients. To analyze the vibratory segment(s), photographs were made of the videotaped image while it was stopped during the patients' production of the /a/ sound. The most frequent location of the vibratory segment was in the lower third of the neck, which corresponds to cervical vertebrae C5 through C7. Five of the subjects had two separate vibratory segments and two other subjects had long vibratory segments. The vibratory segment(s) in tracheoesophageal speakers was found to be similar to the vibratory segment(s) in esophageal speakers.

Behavior of the Cricopharyngeal Segment During Esophageal Phonation in Laryngectomized Patients

“…Different methods are used to investigate the mechanism of vibration of the pharyngoesophageal segment in esophageal speakers, each one having its own value. Videofluoroscopy is the most frequently used method, 1,2,7,8 and it is considered to be the most effective for the study of the morphology and the behavior of the cricopharyngeal segment, and for the determination of the possibility that a patient will develop this type of phonation. However, the tonus of the sphincter cannot be quantified by radiographic techniques, but only with the use of manometry.…”

Comparison of alaryngeal voice and speech

“…It is presumed that this is the result of the greater aerodynamic effect in the pulmonarily driven tracheoesophageal speech (9). Videofluoroscopic studies have shown that visual characteristics of the vibratory segment of tracheoesophageal and esophageal speakers are similar (10,11).…”

Neoglottic vibration in tracheoesophageal shunt phonation

“…Of nine patients with irregular neoglottic vibrations, two patients had incomplete neoglottic closure with breathy voices, four patients had multiple contacts of several mucosal walls with rough voices, and three patients had tight neoglottic closure with strained voices. trusion from the posterior pharyngeal wall [2,9,10]. In 1986, Traissac et al [8] described mucosal vibration of a circular bulge in the PE segment of TE shunt speakers with voice prostheses, but failed to use images to document their findings.…”

“…Fluoroscopy only provides information concerning the anatomical position and shape of the PE segment [2,9,10]. In contrast, direct observation of the sound source by stroboscopy demonstrates the vibratory condition of the neoglottis.…”