Predictive value of objective esophageal insufflation testing for acquisition of tracheoesophageal speech

Abstract

This prospective study was undertaken to assess the predictive value of esophageal insufflation on the acquisition of tracheoesophageal (TE) speech. Fourteen total laryngectomy patients were evaluated prior to tracheoesophageal puncture (TEP) using objective esophageal pressure measurements. These patients then were followed prospectively for 6 to 13 months. Speech was assessed at the time of prosthesis fitting, at 1 month, at less than 6 months, and at greater than 6 months post-TEP. No patient underwent pharyngeal myotomy. Pre-TEP esophageal insufflation pressure was associated (P = .065) with successful TE speech at the time of prosthesis fitting, but was not associated with successful TE speech acquisition after 6 months. This study's results suggest that patients with poor pre-TEP esophageal insufflation test results will usually obtain successful TE speech given adequate time and training, even without pharyngeal myotomy.

Reabilitação fonatória do laringectomizado total: utilização de toxina botulínica na voz tráqueo-esofágica com prótese fonatória

“…The true need for myotomy in TEP is a controversial issue in the literature, varying from 9% to 79% in TL patients. [1][2][3][4][5][6][7][8][9][10][11][12][13] In secondary TEP, myotomy is associated with a 10% to 20% incidence of salivary fistulae, 26 with the same consequences mentioned above. Using the BT for the treatment of PES spasm makes it possible to restrict myotomy for those patients that truly require this method for treating the PES; this avoids unnecessary procedures in the remaining patients, and reduces their surgery time and complication rate.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Altered PES motor activity in these cases is a reflex initiated by air entering the esophagus, blocking air from progressing to the pharynx. Consequently, the pharyngeal mucosa does not vibrate, and there is no phonation.…”

“…Consequently, the pharyngeal mucosa does not vibrate, and there is no phonation. 1,[3][4][5][7][8][9]13,18 Spasm may be seen in videofluoroscopy done during phonation with the PP; 5,7,8,15,24 it is absent during swallowing when the PES relaxes. During constriction there is no relaxation when swallowing.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] There are three approaches for the treatment of PES alterations: myotomy of the middle and lower constrictors of the pharynx, neurectomy of the pharyngeal plexus, and the recently described chemical denervation of the PES with the botulinum toxin (BT). 6,7,8,10,11,[14][15][16][17][18][19][20][21][22][23] The BT is a presynaptic blocker of acetylcholine release at the neuromuscular junction.…”

Reabilitação vocal pós-laringectomia total: resultados em longo prazo com prótese fonatória Blom-Singer® de longa permanência

“…This motor affection of PES is a reflex triggered by input of air into the esophagus and it prevents progression of airflow to the pharynx. Thus, there is no vibration of pharyngeal mucosa and phonation 9,10,27,[30][31][32][33][34][35] . The spasm may be observed in the videofluoroscopy during phonation with VP 12,27,28,33,[35][36][37] and it is absent during swallowing, with relaxation of PES.…”