Botulinum toxin in speech rehabilitation with voice prosthesis after total laryngectomy

Carlos Takahiro Chone,Cristiane Teixeira,Nelson A Andreollo,Ana Lucia Spina,Irene H.K Barcelllos,Elizabeth Quagliato,Agricio N Crespo

doi:10.1016/s1808-8694(15)31093-4

Abstract

SummaryIn tracheo esophageal puncture (TEP), we carry out a myotomy of the pharynx constrictor muscle; however, about 9 to 79% of patients need such procedure. The consequence of such procedure is an increase in salivary fistula rates in the postoperative. Botulin toxin is used in an outpatient basis.Aimanalyzing the efficacy of botulin toxin (BT) use in the rehabilitation of totally laryngectomized patients with tracheoesophageal voice (TEV) with spasms (S) of the pharyngoesophageal segment (PES) without myotomy.Materials and MethodsWe analyzed eight patients submitted to total laryngectomy (TL), rehabilitated with TEV, with speech prosthesis (SP) and struggle to utter voice because of PES spasms. They were all submitted to treatment of such motor alteration with the injection of 100 units of BT in the PES. The evaluation was based on perceptive voice analysis, video fluoroscopy (VF) of the PES, acoustic voice analysis and computerized manometry (CM) of the PES, all before and after BT injection.Study designprospectiveResultsThere was a reduction in PES CM pressure after BT injection. Acoustic analysis showed an improvement in harmonics quality after treatment. There was smoother voice utterance and spasm improvement after BT.Conclusionall patients with PES spasms presented vocal improvement after BT injection in the PES.

Highlights

About 9% to 79% of total laryngectomy (TL) patients undergoing rehabilitation with tracheoesophageal voice (TEV), phonatory prostheses (PP), and primary or secondary tracheoesophageal needle puncture (TEP), present effort-induced phonatory difficulties associated with motility alterations in the pharyngoesophageal segment (PES) secondary to spasm of this segment.[1,2,3,4,5,6,7,8,9,10,11,12,13]
computed manometry (CM) revealed a decrease in the mean PES pressure following botulinum toxin (BT) injection in eight patients (Table 1, Figure 2a and 2b)
Computed acoustic analysis demonstrated the production of harmonics after BT injection in the PES of eight patients (Figure 3a and 3b)

Summary

Introduction

About 9% to 79% of total laryngectomy (TL) patients undergoing rehabilitation with tracheoesophageal voice (TEV), phonatory prostheses (PP), and primary or secondary tracheoesophageal needle puncture (TEP), present effort-induced phonatory difficulties associated with motility alterations in the pharyngoesophageal segment (PES) secondary to spasm of this segment.[1,2,3,4,5,6,7,8,9,10,11,12,13] There are three approaches for the treatment of PES alterations: myotomy of the middle and lower constrictors of the pharynx, neurectomy of the pharyngeal plexus, and the recently described chemical denervation of the PES with the botulinum toxin (BT).[6,7,8,10,11,14,15,16,17,18,19,20,21,22,23] The BT is a presynaptic blocker of acetylcholine release at the neuromuscular junction. There are indirect assessment methods of the PES pressure, such as the modified esophageal insufflation test,[4,6,15] measurement of intratracheal pressure and the phonation time.[7,18] The purpose of this study was to assess the efficacy of the BT in TL patients rehabilitated by TEV with PP that presented emission of voice under effort due to spasm of the PES

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Methods

Results

Conclusion