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Doyle PC, Damrose EJ. Has Esophageal Speech Returned as an Increasingly Viable Postlaryngectomy Voice and Speech Rehabilitation Option? JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4714-4723. [PMID: 36450150 DOI: 10.1044/2022_jslhr-22-00356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE The literature on postlaryngectomy voice and speech rehabilitation is long-standing. Although multiple rehabilitation options have existed over the years, the acquisition and use of esophageal speech (ES) has decreased significantly over the past 40 years. This reduction coincides with the increased application of tracheoesophageal puncture (TEP) voice restoration. The literature suggests that voice acquisition failures observed secondary to TEP may represent a similar phenomenon that led to ES acquisition failures. METHOD A comprehensive review of the literature on ES and TEP voice/speech was conducted. Specific attention was directed toward information on ES and TEP speech failures. Information on pharyngoesophageal segment (PES) spasm in the context of ES and TEP voicing failures was of specific importance. RESULTS Similarities between voicing failures with both ES and TEP were identified. In order to resolve spasm in TEP speech, proactive efforts to eliminate it were undertaken, and regardless of the method used, voicing improvements were observed. These data suggest that both ES and TEP speech acquisition failures may be related to the same control mechanisms influencing the PES. CONCLUSIONS The elimination of PES spasm provides evidence that justifies the reconsideration of ES. Consequently, ES may return as an increasingly viable postlaryngectomy voice and speech rehabilitation option.
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Affiliation(s)
- Philip C Doyle
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford University, CA
| | - Edward J Damrose
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford University, CA
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Ku PKM, Vlantis AC, Yeung ZWC, Ho OYM, Cho RHW, Lee AKF, Hui TSC, So EPL, Law TKT, Abdullah V, van Hasselt A, Tong MCF. Perceptual Voice and Speech Analysis after Supraglottic Laryngeal Closure for Chronic Aspiration in Head and Neck Cancer. Laryngoscope 2020; 131:E1616-E1623. [PMID: 33264438 DOI: 10.1002/lary.29298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the voice and speech outcomes after tubed supraglottic laryngeal closure (TSLC) surgery to treat chronic aspiration after radiotherapy for head and neck cancer. STUDY DESIGN A retrospective case-control study. METHODS The data of patients who underwent radiotherapy for head and neck cancer and who later required total laryngectomy or TSLC for chronic aspiration between 2004 and 2017 were retrieved from a dysphagia clinic. Preoperative and postoperative voice and speech were assessed by the GRBAS and INFVo rating scales. Control subjects who underwent radiotherapy alone or total laryngectomy with a tracheoesophageal prosthesis for other indications were recruited for comparison. RESULTS Of 15 patients who underwent a TSLC with a mean age of 57.3 years (45-75 years), 13 were male and 2 female. All patients had a history of nasopharyngeal carcinoma. The success rate of speech production using their own larynx following an intact TSLC was 64%. There was no statistically significant difference in voice and speech ratings between preoperative and TSLC subjects on the GRBAS (P = .32) and INFVo scales (P = .57), although the quality of voice appeared to deteriorate after TSLC. However, the INFVo scale for impression, intelligibility and unsteadiness of the voice after TSLC was statistically significantly better than for laryngectomy with tracheoesophageal speech. CONCLUSIONS A tubed supraglottic laryngeal closure controls chronic aspiration while preserving the larynx for phonation, and results in a better voice and speech quality than a laryngectomy with a voice prosthesis. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1616-E1623, 2021.
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Affiliation(s)
- Peter K M Ku
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong.,Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Alexander C Vlantis
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Zenon W C Yeung
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Osan Y M Ho
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Ryan H W Cho
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Alex K F Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Thomas S C Hui
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Erin P L So
- Department of Speech Therapy, Prince of Wales Hospital, Shatin, Hong Kong
| | - Thomas K T Law
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Victor Abdullah
- Department of Otorhinolaryngology, Head and Neck Surgery, United Christian Hospital, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong
| | - Andrew van Hasselt
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Michael C F Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Noel CW, McMullen C, Yao C, Monteiro E, Goldstein DP, Eskander A, de Almeida JR. The fragility of statistically significant findings from randomized trials in head and neck surgery. Laryngoscope 2018; 128:2094-2100. [DOI: 10.1002/lary.27183] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Christopher W. Noel
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
| | - Caitlin McMullen
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
| | - Christopher Yao
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Hospital; Toronto Ontario Canada
| | - David P. Goldstein
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre; University Health Network; Toronto Ontario Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre; Odette Cancer Centre; Toronto Ontario Canada
| | - John R. de Almeida
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto Ontario Canada
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre; University Health Network; Toronto Ontario Canada
- Institute of Health Policy Management and Evaluation; University of Toronto; Toronto Ontario Canada
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Takeshita-Monaretti TK, Aguiar-Ricz L, Bastos P, Marques W, Ricz H. Electrophysiological activity of the pharyngoesophageal transition of total laryngectomees. Laryngoscope 2016; 127:1369-1375. [PMID: 27716924 DOI: 10.1002/lary.26266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/01/2016] [Accepted: 07/28/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the association of the electrophysiological activity of the pharyngoesophageal transition with tracheoesophageal speech proficiency in total laryngectomees. STUDY DESIGN An observational (nonexperimental) study of the correlation type with a descriptive approach. METHODS Thirty-four individuals (26 males), average age 62.5 years, total laryngectomees rehabilitated with the use of a tracheoesophageal prosthesis, were assessed for tracheoesophageal speech proficiency using an adapted protocol and classified as good, moderate, or poor speakers. Next they were submitted to electromyography of the muscles of the pharyngoesophageal transition with a needle electrode. The area to be examined was located by videofluoroscopy. Electromyographic analysis was characterized as normal, neurogenic injury (moderate to severe, severe, severe to total), myopathic injury, or inconclusive. The Fisher exact test was used to determine the association between the speech proficiency variables and electromyography. RESULTS in the final rating of tracheoesophageal speech proficiency, most laryngectomees were categorized as moderate (n = 24) and a few as good (n = 3). Electromyography revealed neurogenic injury in all laryngectomees, which was severe in most cases (n = 20), followed by severe to total (n = 10), and moderate to severe injury (n = 4). There was no significant association between he electromyographic analyses of neurogenic injuries and tracheoesophageal speech proficiency. CONCLUSIONS Whether or not the musculature of the pharyngoesophageal transition of tracheoesophageal speakers had a preserved motor unit, did not prevent voice acquisition and was not associated with tracheoesophageal speech proficiency. However, further studies are needed in this area. LEVEL OF EVIDENCE 4. Laryngoscope, 127:1369-1375, 2017.
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Affiliation(s)
- Telma K Takeshita-Monaretti
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Lílian Aguiar-Ricz
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Patrícia Bastos
- Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Wilson Marques
- Department of Neurosciences and Behavioral Sciences, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Hilton Ricz
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Investigation of intra-esophageal air kinetics and esophageal sphincters in patients with total laryngectomy during esophageal speech. Eur Arch Otorhinolaryngol 2015; 272:1967-72. [PMID: 25763572 DOI: 10.1007/s00405-015-3600-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to evaluate the air kinetics of well- and poor-speaking patients and their upper (UES) and lower (LES) esophageal sphincter pressures . The esophageal speech capability of 23 total laryngectomy patients was assessed with the Wepman scale. LES and UES points and pressures were measured, and air kinetics were compared. All patients were male, with an average age of 58 years. Both the LES and UES pressures were not statistically different between good-speaking and poor-speaking patients (p > 0.05). The ability to speak was estimated only by looking at tracings. Good speakers are able to retain air successfully and on a long-term basis between the upper and lower esophageal sphincters. During short and/or rapid speech, these patients are able to rapidly suck and then expel the air from their upper esophagus. During long speeches, after sucking the air into their distal esophagus, they used the air in the upper part of the esophagus during the speech, only later seeming to fill the lower esophagus with the air as a possible reserve in the stomach. It has been shown that the basic requirement for speaking is the capacity to suck and store the air within the esophagus. For successful speech, the air should be stored inside the esophagus. MII technology contributes to our understanding of speech kinetics and occupies an important place in patient training as a biofeedback technique.
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Chone CT, Seixas VO, Andreollo NA, Quagliato E, Barcelos IHK, Spina AL, Crespo AN. Computerized manometry use to evaluate spasm in pharyngoesophageal segment in patients with poor tracheoesophageal speech before and after treatment with botulinum toxin. Braz J Otorhinolaryngol 2009; 75:182-7. [PMID: 19575102 PMCID: PMC9450631 DOI: 10.1016/s1808-8694(15)30776-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 06/16/2008] [Indexed: 12/01/2022] Open
Abstract
Tracheoesophageal voice (TEV) with voice prosthesis (VP) is an efficient and reproducible method used in vocal rehabilitation after total laryngectomy (TL), prevented by spasms in the pharyngoesophageal segment (PES). Computerized Manometry (CM) is a new, direct and objective method used to assess the PES. Aim to carry out an objective analysis of the PES, with CM, before and after the injection of botulinum toxin (BT). Study design clinical-prospective. Materials and Methods analysis of eight patients consecutively submitted to TL with TEV and VP, without vocal emission, with PES spasms seen through videofluoroscopy, considered the gold standard for spasm detection. All had their spasms treated with the injection of 100 units of BT in the PES. The assessment was based on PES videofluoroscopy and CM, before and after BT injection. Results There was a PES pressure reduction according to the CM after BT injection in all patients. The average pressure in the PES seen through the CM in eight patients before BT injection was 25.36 mmHg, and afterwards it dropped to 14.31 mmHg (p=0.004). There was vocal emission without stress and PES spasm improvement seen through the videolaryngoscopy after BT injection. Conclusion We observed a reduction in PES pressure after BT injection, seen through CM in all the patients, with spasms improvement seen through videofluoroscopy.
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Affiliation(s)
- Carlos T Chone
- Head and Neck Department - Otorhinolaryngology Program - Unicamp
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Chone CT, Seixas VO, Paes LA, Gripp FM, Teixeira C, Andreollo NA, Spina AL, Quagliato E, Barcelos IK, Crespo AN. Use of computerized manometry for the detection of pharyngoesophageal spasm in tracheoesophageal speech. Otolaryngol Head Neck Surg 2008; 139:449-52. [DOI: 10.1016/j.otohns.2008.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 05/07/2008] [Accepted: 06/18/2008] [Indexed: 11/15/2022]
Abstract
Objective To evaluate the utility of computerized manometry (CM) to identify pharyngoesophageal segment (PES) spasm during tracheoesophageal speech. Study Design Prospective clinical, controlled study. Subjects and Methods Intraluminal pressures of the PES were collected in 12 tracheoesophageal speakers without spasm and 8 tracheoesophageal speakers with PES spasm before and after localized injection of botulinum toxin to the PES. All subjects underwent voice analysis and videofluoroscopy in addition to CM before and after treatment. Results All tracheoesphageal speakers with PES spasm presented with mean intraluminal pressures greater than 16 mmHg (mean, 25.36 mmHg). In contrast, mean intraluminal pressures of subjects without spasm was 11.76 mmHg ( P < 0.05). The negative predictive value associated with the use of 16 mmHg as a threshold value for spasm was 100%. Conclusion CM is a clinically useful tool to aid in speech rehabilitation for tracheoesophageal speakers. Intraluminal pressures of greater than 16 mmHg was highly predictive for PES spasm. © 2008 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved.
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Aguiar-Ricz L, Dantas RO, Ricz H, Gielow I, Mamede RCM, Perdoná GC. Behavior of the cricopharyngeal segment during esophageal phonation in laryngectomized patients. J Voice 2006; 21:248-56. [PMID: 16504467 DOI: 10.1016/j.jvoice.2005.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Accepted: 11/02/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND After total laryngectomy, the interruption of the upper digestive tube and the section of the cricopharyngeal segment alter the high-pressure zone of the pharyngoesophageal transition, which will not only start to have a digestive function, but also be stimulated to take on the production of voice and speech. The pressure observed in the cricopharyngeal segment seems to act as a critical factor for the development of esophageal sound production, and manometry is the procedure capable of quantifying the pressure observed in this region. OBJECTIVE The objective of the current study was to assess the upper esophageal sphincter pressure in laryngectomized patients who are either successful or unsuccessful esophageal speakers, both at rest and during esophageal phonation, using manometry. METHODS Twenty laryngectomized persons aged 32 to 83 years (mean, 44.2 years) were submitted to evaluation by a speech pathologist and divided into two groups, ie, successful esophageal speakers (N=12) and unsuccessful esophageal speakers (N=8), according to a scale validated by Wepman et al (1953). The upper esophageal sphincter (UES) pressure was assessed by manometry both at rest and during the following voice emissions in Portuguese: the vowel "a," the monosyllable "pa," and the sentence "papai papou pipoca." The amplitude, the duration of the pressure wave, and the area under the curve were measured. RESULTS At rest, the mean UES pressure was 11.83 mm Hg for successful esophageal speakers and 9.92 mm Hg for unsuccessful esophageal speakers, with no significant difference between groups; the mean for the two groups as a whole was 11.06 mm Hg. During the voice and speech sequence tests, no significant difference was observed when the emissions in Portuguese of "a," "pa," and the sentence were analyzed separately. CONCLUSION As the pressure observed at rest did not differ between the successful esophageal speakers and the unsuccessful esophageal speakers, and the amplitude, the duration of the pressure wave, and the area under the amplitude x duration curve were also equal for both groups, we conclude that the cricopharyngeal segment pressure is not a preponderant factor for the acquisition of esophageal voice and speech.
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Affiliation(s)
- Lílian Aguiar-Ricz
- Department of Opthalmology, Otolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
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