The applicability of high resolution manometry in total laryngectomy / Aplicabilidade da manometria de alta resolução na laringectomia total

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.

Resumo: Objetivo: medir a pressão da faringe e do segmento faringo-esofágico (SFE), no repouso e durante a sua vibração (na produção de voz esofágica) em pacientes laringectomizados totais com diferentes níveis de produção de voz. Método: participaram do estudo quatro indivíduos laringectomizados totais, todos submetidos à Manometria de Alta Resolução (MAR) no repouso e durante a fonação. Após esse processo, foi realizada uma análise descritiva dos resultados. Resultados: em nosso estudo, observamos que, durante o repouso, os pacientes apresentaram pressão do esfíncter esofágico superior (EES) abaixo da normalidade, e este dado pode estar relacionado a alterações das conexões musculares, ao nível do EES, especialmente, a interrupção do plexo cricofaríngeo. Durante a fonação, dois pacientes apresentaram maiores valores de pressão do EES, em todas as fonações, quando comparado com os valores encontrados no repouso, sugerindo que a introdução de ar no esôfago é seguida de contração faringo-esofágica e que, durante a fonação, os pacientes bons falantes esofágicos, podem desenvolver maior pressão nesta região. Conclusão: estudos com maior número de participantes podem ajudar a definir, por exemplo, sujeitos que poderão se beneficiar de procedimentos como a miotomia do cricofaríngeo ou outra conduta médica, a fim de facilitar a aquisição de voz esofágica nesses pacientes.

Characteristics of Esophageal Voice /a/ and /i/ in Totally Laryngectomized Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The esophageal voice can be a choice for alaryngeal patients. However, many patients fail to get a esophageal voice, because there are no known systematic principles nor specific training methods of producing the esophageal voice. We evaluated the difference between two vowels of the esophageal voice that have different shapes and movements of the speech apparatus. We also tried to find a relationship between the speech apparatus and the esophageal voice. MATERIALS AND METHODS: Alaryngeal patients were investigated with acoustic analysis, aerodynamic analysis and pharyngoesophagogram. We used the vowel /a/ in which the mouth is widely open and the tongue is posteriorly positioned and vowel /i/ in which the mouth is less widely open and the tongue is anteriorly positioned. We compared the results of analytic studies between two vowels. RESULTS: The esophageal voice has a higher pitch and a lower sound in the /i/ vowel. The hypopharyngeal space above the neoglottis was extended more anteriorly. The /i/ vowel made a more tight contact with the neoglottis to the anterior wall and the short length of the neoglottis. CONCLUSIONS: The results of acoustic analysis and pharyngoesophagogram showed that there were differences between the /a/ vowel and the /i/ vowel of the esophageal voice.