The relationship between biomechanics of pharyngoesophageal segment and tracheoesophageal phonation

Teng Zhang,Michał Szczęśniak,Catherine Madill,Ian Cook,Peter Wu,Julia Maclean,Duong Duy Nguyen

doi:10.1038/s41598-019-46223-7

Teng Zhang, Michał Szczęśniak + Show 5 more

Open Access

https://doi.org/10.1038/s41598-019-46223-7

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Abstract

This study examined the relationship between biomechanical features of the pharyngoesophageal (PE) segment, acoustic characteristics of tracheoesophageal (TE) phonation, and patients’ satisfaction with TE phonation. Fifteen patients using TE phonation after total laryngectomy completed the Voice Symptom Scale (VoiSS) and underwent acoustic voice analysis for cepstral peak prominence (CPP) and relative intensity. High resolution manometry (HRM) combined with videofluoroscopy was used to evaluate PE segment pressure and calculate the pressure gradient (ΔP), which was the pressure difference between the upper oesophagus and a point two centimetres above the vibrating PE segment. The upper oesophageal sphincter (UOS) minimal diameters were measured by Endolumenal Functional Lumen Imaging Probe (EndoFLIP). HRM detected rapid pressure changes at the level of the 4th – 6th cervical vertebra. CPP, relative intensity, and ΔP were significant predictors of satisfactory TE phonation. ΔP was a significant predictor of CPP and intensity. Minimal UOS diameter was a significant predictor of relative intensity of TE phonation. In two patients with unsuccessful TE phonation, endoscopic dilatation subsequently restored TE phonation. These findings suggest that sufficient ΔP and large UOS diameter are required for satisfactory TE phonation. Endoscopic dilatation increasing UOS diameter may provide a new approach to treat unsuccessful TE phonation.

Highlights

Verbal communication is one of the most important forms of human interaction[1]
Given that voice characteristics depend on biomechanics of the vibration source[10], the voice output of TE phonation is influenced by structure and function of the PE segment as a result of the surgical techniques and the patient’s specific anatomy[11]
In laryngectomees with failed TE phonation, no rapid pressure changes at the hypopharyngeal region and upper oesophageal sphincter (UOS) were present despite oesophageal pressurisation (Fig. 3B)

Summary

Introduction

Verbal communication is one of the most important forms of human interaction[1]. In normal laryngeal phonation, the vocal folds produce a voice signal with well-defined harmonic structures[2] which are the key component of normal voice quality[3]. The tracheoesophageal (TE) voice is currently the gold standard for voice restoration in laryngectomy patients[5] This involves surgical placement of a silicone valve called the TE voice prosthesis between the trachea and the oesophagus. A range of methods have been used to investigate the characteristics of the vibrating PE segment during TE phonation including videofluoroscopy[17], manometry[20], and acoustic analysis[21]. Van As et al.[17] found significant correlation between TE voice quality and the minimal distance between the PE segment prominence and anterior pharyngeal wall at rest and during phonation. Takeshita et al.[16] suggested that TE voice quality was correlated with the anteroposterior distance between the PE segment prominence and the posterior pharyngeal wall in both resting and phonation. There is conflicting evidence regarding the exact association between the quality of TE phonation and fluoroscopic dimensional parameters

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