The applicability of high resolution manometry in total laryngectomy

Abstract

Purpose: This study aims to measure the pressure of the pharynx and the pharyngoesophageal segment (PES) at rest and during phonation in total laryngectomized patients, with different levels of voice production. Methods: four total laryngectomized individuals participated in the study, All patients underwent High Resolution Manometry (MAR) at rest and during phonation. After this process, a descriptive analysis of the results was performed. Results: we observed that during rest the patients had PES pressure below normal and this data may be related to changes in the muscular connections at the level of the upper esophageal sphincter (UES) especially the interruption of the cricopharyngeal plexus. During phonation, two patients presented higher UES pressure values during phonation, when compared to the values found at rest, suggesting that introduction of air into the esophagus is followed by pharyngoesophageal contraction and that during phonation the patients with good esophageal speech may develop more pressure in this region. Conclusion: Studies with a greater number of participants may help define, for example, subjects who may benefit from procedures such as cricopharyngeal myotomy or other medical conduct in order to facilitate the acquisition of esophageal voice in these patients.

Swallowing after total laryngectomy surgery: where are we after 150 years?

“…A small study with four patients used manometry at rest and during phonation, and found reduced pressure at the pharyngoesophageal segment from normal. This finding is thought to be related to changes within the pharyngoesophageal connections which also affect swallowing [28]. Patients with self-reported dysphagia also had higher hypopharyngeal intrabolus pressures, indicating restriction to bolus flow that reduced following dilatation, and were reliably correlated with a symptomatic improvement in swallowing [7].…”

“…It is now recognized that most laryngectomy patients will have a degree of swallow dysfunction presenting as a propulsive and/or restrictive disorder [9]. In the instance of reduced pharyngeal propulsion, instinctive compensation is often seen with an effortful swallow correlating with manometrically recorded increased pressures at the top end of the swallow [26][27][28]. A propulsive swallow dysfunction can be further improved using therapeutic strategies including a smaller bolus, avoiding dry and particulate foods, and using a wash through swallow to clear any residue.…”