Impairment of Pharyngoesophageal Segment Opening

Voice Rehabilitation after Total Laryngectomy and Tracheoesophageal Puncture Using Nonmuscle Closure

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949310201010 ◽

1993 ◽

Vol 102 (10) ◽

pp. 792-796 ◽

Cited By ~ 20

Author(s):

Ross A. Clevens ◽

Duane O. Hartshorn ◽

Ramon M. Esclamado ◽

Jan S. Lewin

Keyword(s):

Total Laryngectomy ◽

Voice Rehabilitation ◽

Rehabilitation Outcomes ◽

Pharyngoesophageal Segment ◽

Pharyngeal Plexus ◽

Neck Recurrence ◽

Tracheoesophageal Puncture ◽

Early Primary ◽

Successful Production

The successful production of voice with a tracheoesophageal puncture (TEP) and voice prosthesis requires a compliant pharyngoesophageal segment. Speech failure is commonly attributed to spasm of the pharyngoesophageal segment. During total laryngectomy (TL), a 3-layer closure is typically performed. This prospective single-arm study examines the safety and efficacy of TL and TEP with nonclosure of the pharyngeal musculature to prevent pharyngoesophageal spasm as an alternative to 3-layer closure with pharyngeal plexus neurectomy and/or pharyngeal constrictor myotomy. Twenty-one consecutive patients were enrolled by a single surgeon. The mean duration of follow-up was 19.5 ± 7.9 months. Surgical complications and voice rehabilitation outcomes were examined. An overall complication rate of 28.5% was observed. Fluency was achieved in 75% of patients within a mean of 4.3 ± 5.1 months. Speech failure was attributable to early primary site and neck recurrence (5%), hypoglossal nerve palsy (5%), hypopharyngeal stricture and recurrence (5%), dementia (5%), and intransigent alcohol abuse (5%). Pharyngeosophageal spasm was not observed in any subjects. We conclude that primary TEP with nonclosure of the pharyngeal muscle during TL is relatively safe. Furthermore, it is preferable over 3-layer closure because it avoids pharyngeosophageal spasm, a factor limiting voice rehabilitation.

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SIMULTANEOUS MANOMETRY AND ELECTROMYOGRAPHY IN THE PHARYNGOESOPHAGEAL SEGMENT

The Laryngoscope ◽

10.1288/00005537-198505000-00011 ◽

1985 ◽

Vol 95 (5) ◽

pp. 582???584 ◽

Cited By ~ 28

Author(s):

Jos J. M. van Overbeek ◽

Richard H. L. Paping

Keyword(s):

Pharyngoesophageal Segment

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The techniques of nonmuscular closure of hypopharyngeal defect following total laryngectomy: the assessment of complication and pharyngoesophageal segment

The Journal of Laryngology & Otology ◽

10.1017/s0022215100139337 ◽

1997 ◽

Vol 111 (11) ◽

pp. 1060-1063 ◽

Cited By ~ 10

Author(s):

Ching-Ping Wang ◽

Tzu-Chan Tseng ◽

Rheun-Chuan Lee ◽

Shyue-Yih Chang

Keyword(s):

Total Laryngectomy ◽

Fistula Formation ◽

Voice Rehabilitation ◽

Pharyngocutaneous Fistula ◽

Swallowing Function ◽

Pharyngeal Muscle ◽

Constrictor Muscle ◽

Pharyngoesophageal Segment ◽

Pharyngeal Muscles ◽

Closure Group

AbstractThe usual method of reconstructing a hypopharyngeal defect during total laryngectomy includes pharyngeal muscle layer closure, which may result in high pharyngoesophageal pressure. We hypothesize that nonclosure of the pharyngeal muscle can reduce the pressure of the pharyngoesophageal segment which can reduce the chances of the formation of pharyngocutaneous fistulae. A technique of nonmuscular closure of a hypopharyngeal defect is presented. The differences in the rate of fistula formation and swallowing function between patients with usual and nonmuscular closure were also studied. Sixty consecutive laryngectomees were enrolled in this study. Thirty patients received usual closure after total laryngectomy, whereas the other 30 patients underwent non closure of their pharyngeal muscles. One patient (3.3 per cent) in the nonmuscular closure group and three patients (10 per cent) in the usual closure group developed a pharyngocutaneous fistula. The pharyngoesophageal pressures of the nonmuscular closure group were significantly lower than those of the usual closure group. We conclude that the technique of nonclosure of the pharyngeal constrictor muscle after total laryngectomy is relatively more simple and is not associated with a higher rate of fistula formation. Furthermore, nonclosure of the pharyngeal constrictor muscle is preferable to muscular closure because it reduces the spasm of the pharyngoesophageal segment which limits voice rehabilitation.

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Simultaneous Videoradiography and Computerized Pharyngeal Manometry — Videomanometry

Acta Radiologica ◽

10.1177/028418519403500107 ◽

1994 ◽

Vol 35 (1) ◽

pp. 30-34

Author(s):

R. Olsson ◽

H. Nilsson ◽

O. Ekberg

Keyword(s):

Solid State ◽

Muscle Function ◽

Barium Swallow ◽

Pharyngeal Wall ◽

Pressure Transducers ◽

Pharyngoesophageal Segment ◽

Fluoroscopic Control ◽

Pharyngeal Manometry ◽

State Pressure

To obtain more information about muscle function in patients with dysphagia, simultaneous barium swallow and computerized pharyngeal manometry with solid-state pressure transducers was employed for the evaluation of the pharynx and the pharyngoesophageal segment (PES) in 30 consecutive patients. The manometry catheter was positioned under fluoroscopic control, providing localized measurements of the intraluminal pressures in the pharynx. Sixteen patients had a normal barium swallow. In 5 (31%) of these the manometry disclosed PES dysfunction, i.e. increased resting pressures between swallows in 3 patients (mean 120 ± 13 mm Hg), and increased contraction pressures during peristalsis in 2 (mean 297 ± 21 mm Hg). Barium swallow and manometry are complementary: the former reflecting transport through the pharynx and penetration to the airways, the latter the intraluminal pressures created by the pharyngeal wall. The combination of barium swallow and manometry gives information about pressure in relation to bolus transport, which may elucidate pharyngeal dysfunction.

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Listeners' Perceptions of Consonants Produced by Esophageal and Tracheoesophageal Talkers

Journal of Speech and Hearing Disorders ◽

10.1044/jshd.5304.400 ◽

1988 ◽

Vol 53 (4) ◽

pp. 400-407 ◽

Cited By ~ 33

Author(s):

Philip C. Doyle ◽

Jeffrey L. Danhauer ◽

Charles G. Reed

Keyword(s):

Young Adult ◽

Sound Field ◽

Normal Hearing ◽

Clinical Implications ◽

Dual Mode ◽

Pharyngoesophageal Segment ◽

Te Mode ◽

Audio Recordings ◽

Confusion Matrices ◽

Better Than

The purpose of this study was to investigate the consonant intelligibility of 3 esophageal (E) and 3 tracheoesophageal(TE) talkers, and 1 dual-mode (DM) talker proficient in both E and TE speech modes. Audio recordings of 24 English consonants produced by each talker in a consonant-vowel-consonant-vowel-consonant (CVCVC) context were presented in the sound field to 15 normal-hearing, naïve, young adult listeners who phonetically transcribed their responses using an open-response paradigm. Listeners' pooled responses were converted to confusion matrices and analyzed for overall intelligibility, voicing and manner features, and consonant omissions. Ratings of speech proficiency were also obtained. Overall, the intelligibility of the TE talkers was significantly better than that of the E talkers. The DM talker was also more intelligible in the TE mode. Voiced consonants, plosives, fricatives, nasals, and liquid-glides were signifieantly more intelligible when produced by TE talkers. Affrieates were also more intelligible for the DM talker in his TE mode. The different patterns of intelligibi!ity observed between the E and TE talkers studied may be due to temporal speech distinctions evolving from the influence of dissimilar driving sources upon the vibratory characteristics of the pharyngoesophageal segment. Clinical implications are presented.

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