Abstract
The primary purpose of this study was to assess the relationship between pharyngoesophageal segment (PES) configuration and narrow-band spectrogram of tracheoesophageal voices. This study included 30 total laryngectomees tracheoesophageal speakers. Patients were assessed by videofluoroscopy (VF), during deglutition and voicing, and the vowel /a/ was recorded for spectrographic analysis. The evaluation of VF recording consisted of visual perceptual rating of degree of contact between the prominence of PES and its anterior wall, defined as absent/mild (hypo contact), moderate (normo contact) and intense (hyper contact); and quantitative measures of PES: anteroposterior distance (APD) and length of the PES (lenPES); PES surface area in swallowing (areaSw), and phonation (areaPh), and the area of the air reservoir (areaAir). Visual inspection of a narrow-band spectrogram was made and four different acoustic signal typing were defined as Type I, II, III or IV. Type I-II is correlated with moderate contact; Type III, with intense and Type IV, with absent/mild contact. Type I-II has bigger APD and PES with lower length than Type IV. There is a correlation between bigger APD and shorter PES. The group with I-II signal typing has PES with normo contact; Type III with hyper contact and Type IV has PES with hypo contact. The best tracheoesophageal voices are achieved by PES with moderate contact of the prominence and with shorter and larger anteroposterior PES distances. What differentiates the PES with hyper contact from PES with normal one is only the degree of contact between the prominence of the PES and its anterior wall.
Highlights
In oral communication rehabilitation of patients with total laryngectomies, the tracheoesophageal (TE) voice is considered a superior option to the esophageal voice[1,2], primarily because of the high percentage of success achieved (88% of success) with this type of rehabilitation[3,4]
Lung air is directed toward the esophagus, through the vocal prosthesis, and the sound source vibrates, which is labeled as pharyngoesophageal segment (PES)
With regard to the objective evaluation of the PES video fluoroscopy (VF) of patients with total laryngectomies with vocal prosthesis, the anteroposterior distance (APD) of the PES resulted in a mean of 14.02 mm (SD=7.85 mm); the average PES length resulted in 17.95 mm (SD=10.57 mm); and the minimum distance of the PES prominence with its anterior wall was found to be 0.65 mm (SD=1.38 mm)
Summary
In oral communication rehabilitation of patients with total laryngectomies, the tracheoesophageal (TE) voice is considered a superior option to the esophageal voice[1,2], primarily because of the high percentage of success achieved (88% of success) with this type of rehabilitation[3,4]. A growth of a mucosa on the posterior wall of the hypopharynx that actively projects in its lumen, in contact with its anterior wall, vibrating when air passes through, and participating as a sound source, was observed[12]. This mucosa was positively associated with the success of the esophageal and the TE voices and was labeled “cricopharyngeal bar,” “neoglottal bar,” “prominence of the neoglottis,” or “prominence of the PES”(8,9,13-16)
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