Voice evaluation of myomucosal shunt after total laryngectomy: comparison with esophageal speech

High-speed digital imaging and electroglottography of tracheoesophageal phonation by Amatsu's method

BACKGROUND

Our previous findings have indicated that the thyropharyngeal muscles form a retropharyngeal prominence during alaryngeal phonation via the TE fistula. This prominence forms a so-called 'neoglottis', which is thought to function as the vibratory source. To better understand the mechanism of TE phonation, we analyzed the vibration of the neoglottis using electroglottography (EGG) and a high-speed digital imaging system.

PATIENTS AND METHODS

Two volunteers who use TE phonation for their daily speech communication were subjected to this study. The vibrations of the neoglottis were recorded simultaneously as EGG and high-speed imaging with acoustic signals.

RESULTS

The vibrations of the neoglottis, recorded by means of high-speed digital imaging, were exactly synchronized with the waveforms of the acoustic signals and EGG.

CONCLUSIONS

These results further confirm the neoglottis as the source of vibration during tracheoesophageal (TE) phonation.

Myomucosal shunt following total laryngectomy: a report of 31 cases

An original technique of voice rehabilitation following total laryngectomy based on the concept of a myomuscosal unit was originally described by Strome. Thirty-one cases of myomucosal shunts (MMS) are analyzed in the present report. The 14 initial cases failed because of a lack clinical and surgical experience and insufficient selection of the patients. Among the last 17 cases, 1 was lost to follow-up, 1 had an insufficient follow-up, and 2 patients refused to speak with the MMS instead of a patent shunt; 5 of the remaining patients had voices evaluated as excellent, 7 had voices interpreted as good and only 1 patient had a voice evaluated as poor. Aspiration was not a problem. Eleven patients were found to stenose their shunt, but fistula were recalibrated successfully. The MMs can be used safely in oncological surgery and only 1 of 31 deaths in our total experience was due to a local recurrence. These findings show that the MMS is a reliable procedure for voice restoration following total laryngectomy; a prosthesis is not required and there are currently no oncological limits to the procedure. However, a very close follow-up of the patients is required after surgery.