Pharyngoesophageal Research Articles

Surgical Outcome and Quality of Life After Total Laryngectomy in Advanced Laryngeal Cancer- A Study in Combined Military Hospital, Dhaka

Introduction: Total laryngectomy is the gold standard treatment for advanced laryngeal cancer. Sacrifice of voice is one of the most important shortcomings of the procedure. Possibility of achieving good quality voice is greater with prosthesis compared to other method. Post laryngectomy voice rehabilitation with prosthesis yield excellent outcome in most of the cases. Swallowing, pulmonary and olfactory rehabilitation should be managed by multidisciplinary team for better quality of life (QoL).
 Objectives: The purpose of this study was to observe the outcomes of voice, swallowing pulmonary and olfactory rehabilitation and QoL following total laryngectomy.
 Methods: This cross sectional retrospective clinical study was conducted at the Head & Neck Oncology Unit, Combined Military Hospital (CMH), Dhaka. Total 57 candidates were selected. Diagnosis was done by thorough clinical examination, Fibre Optic Laryngoscopy. Contrast Enhanced Computed Tomography (CECT) scan of neck was done except few cases where MRI of neck was done for subtle cartilage erosion was suspected. Examination under anaesthesia, direct larangoscopy and biopsy was done for every cases. Candidates were post chemo-radiated/ radiated biopsy proven recurrent cases, clinically nonfunctional larynx with aspiration and radiologically evident of cartilage erosion. In all cases artificial voice prosthesis was used. All the laryngectomees underwent voice, swallowing, pulmonary and olfactory rehabilitation in laryngectomy club of head & neck oncology unit, CMH Dhaka for a period of 3 months as per standard protocol.
 Results: Among the 57 patients 42 of them are using voice prosthesis without any complications till to date. Voice rehabilitation started after wound healing & developed meaningful voice in around 6 weeks. Satisfactory speech & voice outcomes were observed near about 3 months. Voice quality was assessed by multivariate statistical analysis. Excellent voice was observed for 38 patients, good voice for 12 patients, fair voice for 05 patients and poor voice for 02 patients. Troubleshooting like mycotic infection developed in 6 patients which was managed by anti-fungal medication with regular appropriate cleaning, Pharyngocutaneous fistula developed in 5 patients, 3 healed later by pressure dressing and anticholinergic & 1 required exploration and flap reconstruction, 01 developed recurrent stomal stenosis which managed surgically by Y-V advancement. Prosthesis expelled out in 3 cases. 02 cases developed dysphagia due to tonicity of pharyngoesophageal (PE) segment & managed by botox injection. Significantly better voice & swallowing were reported by patients undergone laryngectomy alone in comparison with patients receiving adjuvant radiotherapy & patient undergoing salvage laryngectomy.
 Conclusion: Awareness should be developed as sacrifice of voice box is no more a permanent comorbidity of total laryngectomy. Excellent voice can be developed by insertion of voice prosthesis as well as swallowing pulmonary and olfactory rehabilitation following laryngectomy for better of QoL.
 Bangladesh J Otorhinolaryngol; April 2021; 27(1): 5-11

The relationship between biomechanics of pharyngoesophageal segment and tracheoesophageal phonation

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.

Pharyngoesophageal reconstruction outcomes following 349 cases.

Pharyngoesophageal (PE) reconstruction is complex, with a diverse set of reconstructive considerations. This large series examines the impact of various defect characteristics and reconstructive modalities on outcomes. A retrospective review identified 349 cases from 2000 to 2011. Patients were grouped according to defect extent and location. Groups were compared by comorbidities, flap type, donor and recipient site complications, postoperative diet, and tracheoesophageal speech. Of 349 cases, 193 (55.3%) PE defects were circumferential and 156 (44.7%) were partial. The majority of defects resulted from laryngopharyngectomy (72.5%), most reconstructed with the anterolateral thigh flap (60%). There were 15.5% total esophagectomies, all of which received supercharged jejunal flaps. Of 349 patients, 81 patients (23.2%) had recipient site complications and 51 patients (14.6%) had donor site complications. The fistula rate trended higher in circumferential defects (11 vs. 6%, p = 0.144), and the stricture rate was significantly higher (9.3 vs. 3.8%, p = 0.044). In total, 302 patients (86.5%) had an oral diet after reconstruction, 64 (18%) of whom required supplemental tube feeds. Among 147 patients (42%) who received tracheoesophageal puncture (TEP), 19 (12.9%) eventually failed. Approximately 87% of patients with TEPs achieved fluent speech. The 5-year survival was low for all groups, ranging from 0 to 35%. PE reconstruction can be performed safely, and most patients will achieve functional speech and swallowing. Swallowing function is worse when the larynx is removed, and the stricture rate is higher with circumferential defects. Specific technical measures can reduce the rate of common complications. The level of evidence of this article was level III.

Development of a time-dependent numerical model for the assessment of non-stationary pharyngoesophageal tissue vibrations after total laryngectomy.

Laryngeal cancer due to, e.g., extensive smoking and/or alcohol consumption can necessitate the excision of the entire larynx. After such a total laryngectomy, the voice generating structures are lost and with that the quality of life of the concerning patients is drastically reduced. However, the vibrations of the remaining tissue in the so called pharyngoesophageal (PE) segment can be applied as alternative sound generator. Tissue, scar, and geometric aspects of the PE-segment determine the postoperative substitute voice characteristic, being highly important for the future live of the patient. So far, PE-dynamics are simulated by a biomechanical model which is restricted to stationary vibrations, i.e., variations in pitch and amplitude cannot be handled. In order to investigate the dynamical range of PE-vibrations, knowledge about the temporal processes during substitute voice production is of crucial interest. Thus, time-dependent model parameters are suggested in order to quantify non-stationary PE-vibrations and drawing conclusions on the temporal characteristics of tissue stiffness, oscillating mass, pressure, and geometric distributions within the PE-segment. To adapt the numerical model to the PE-vibrations, an automatic, block-based optimization procedure is applied, comprising a combined global and local optimization approach. The suggested optimization procedure is validated with 75 synthetic data sets, simulating non-stationary oscillations of differently shaped PE-segments. The application to four high-speed recordings is shown and discussed. The correlation between model and PE-dynamics is ≥ 97%.

High-resolution impedance manometry facilitates assessment of pharyngeal residue and oropharyngeal dysphagic mechanisms

The utility of high-resolution impedance manometry (HRIM) for evaluating oropharyngeal dysphagia (OPD) has been investigated. These approaches are limited because of the sophisticated methodology. A method of transforming HRIM into a simple and useful diagnostic tool for evaluating OPD is needed. A videofluoroscopic swallowing study (VFSS) and HRIM were performed by independent blinded examiners in 26 consecutive healthy volunteers (12 men; median age, 56.5 years) and 10 OPD patients (five men; median age, 59.5 years). Upper esophageal sphincter (UES) relaxation parameters were measured using a standard HRIM protocol. Peristalsis and bolus transit of the pharyngoesophageal (PE) segment were assessed using an HRIM-modified protocol in which the catheter was pulled back 10 cm. PE bolus transits were evaluated with an impedance contour pattern (linear vs. stasis) method. A significant difference was observed between the manometric measures of healthy volunteers and OPD patients for only the duration of pharyngeal contraction (0.49 ± 0.19 vs. 0.76 ± 0.33 s, P = 0.04). The percentage agreement and kappa value for detecting pharyngeal residue between the VFSS and the impedance analysis were 100% and 1.00, respectively. HRIM allowed for comprehensive assessment of abnormal pharyngeal components that caused pharyngeal residue on VFSS in two patients; reduced base of the tongue versus weak pharyngeal contraction in one, and reduced relaxation of the UES versus reduced laryngeal elevation in the remaining patient. Our findings demonstrated that HRIM using a simple methodology (i.e., pull-back of the catheter) detected pharyngeal residue through a simple analysis of the impedance contour pattern (linear vs. stasis). Furthermore, HRIM facilitated a comprehensive assessment of OPD mechanisms and recognition of subtle abnormalities not yet visible to the naked eye on VFSS.

Comprehensive approach to restoration of function in patients with radiation‐induced pharyngoesophageal stenosis: Report of 31 patients and proposal of new classification scheme

The treatment for upper aerodigestive tract malignancy with external beam radiation therapy and chemotherapy can result in a "cure," yet result in pharyngoesophageal (PE) stenosis. To improve communication, compare therapeutic results, and assist in treatment planning, we developed a new classification system to describe PE stenoses. Additionally, we analyzed our 6-year experience. The new classification system was defined and used to assess patient management. Thirty-one patients underwent treatment for PE stenoses using: 4 rendezvous dilations, 3 regional, and 24 free tissue transfers. Overall success was based on airway status, speech, and swallowing outcomes. Classification of posttreatment stenoses has been applied to this patient group. It is effective in defining the problem and considerations related to treatment planning and surgical access when augmentation pharyngoplasty is required. Patients with an intact larynx have many issues that make recovery of function less consistent, despite segment restoration.

Biomechanical modeling of non‐stationary vibrations of the pharyngo‐esophageal segment.

After total laryngectomy, a substitute voice is generated by means of the tissue vibrations of the pharyngo‐esophageal (PE) segment. The quality of the substitute voice significantly depends on the vibration characteristics of the PE segment. A numerical model is presented that allows for the simulation of non‐stationary vibrations of the PE segment, i.e. the fundamental frequency varies with time. The introduced time dependent multi‐mass model for the PE segment (PE‐MMM(t)) has been developed from the non‐stationary two‐mass model of the vocal folds. The pseudo‐glottal opening and vibrations are modeled by 6×2 coupled mass‐spring‐oscillators placed in two horizontal planes. The masses are arranged to describe enclosed shapes. The model parameters masses, their rest positions, the sub‐glottal pressure and the anchor spring couplings are all variable with time. The PE vibrations are described by the time dependent quantities frequency, opening area and pseudo‐glottal shape. We will present the PE‐MMM(t) that is appropriate to generate self‐sustained, non‐stationary vibrations. Furthermore, we show dynamics of different model configurations, particular circular and elliptical arranged masses, to simulate different shapes of the PE segment.

Relation between Videofluoroscopy of the Esophagus and the Quality of Esophageal Speech

The goal of the current study was to compare the quality of esophageal speech and voice to videofluoroscopic features of the esophagus and pharyngoesophageal (PE) segment. The speech and voice characteristics of 30 laryngectomized patients were rated by 5 speech-language pathologists. Based on these ratings, patients were divided into 3 categories: fluent (n = 9), moderately fluent (n = 10) and nonfluent (n = 11). Videofluoroscopy of the PE region was then performed during both swallowing and voice production. An insufflation test and percutaneous pharyngeal plexus block were required in 9 patients to determine the etiology of poor esophageal voice production. The strongest videofluoroscopic indicators of nonfluent speakers were: (1) small or absent air reservoir and (2) lack of a vibrating PE segment. Fluent speakers presented with shorter PE segments (1.17 mm) compared to moderately fluent speakers (17.1–29.9 mm). Perceptually, fluent speakers presented with a predominantly rough vocal quality. In contrast, moderately fluent speakers presented with a tense quality. In addition, stoma blast noise was reduced in fluent speakers. Videofluoroscopic findings highly correlated with the quality of esophageal speech.

Is electroglottography-based videostroboscopic assessment of post-laryngectomy prosthetic speech useful?

To use an electroglottography (EGG)-based videostroboscopy tool to assess the anatomical and morphologic characteristics of the pharyngoesophageal (PE) segment in tracheoesophageal (TO) speakers. Cross-sectional cohort study. Fifty-two post-laryngectomy patients with no recurrence and using prosthetic (Blom-Singer) speech. An electroglottography (EGG)-based videostroboscopy tool EGG-based rigid videostroboscopy as well as perceptual evaluation. Stroboscopic protocol included nine subjective/visual parameters to evaluate the neoglottis and study correlation of the G (GRBAS scale) and the overall voice quality (OVQ) with the treatment variables. Of the 52 laryngectomees, videostroboscopic recordings were possible in 46 patients (36 males and 10 females) with a mean age of 63.4 +/-10.5 (SD) an electroglottography (EGG)-based videostroboscopy tool years. All used the Blom-Singer valve and the median time since Total Laryngectomy was 2 years. The neoglottis was assessable in 26 patients. We were able to strobe only 9 patients. There was excellent correlation between G and OVQ (Spearman rho > 0.9). Statistically significant correlation was found between G1 and saliva (P = 0.03) and between good OVQ and saliva (P = 0.02); similarly, there was significant correlation between G1 and LVV (P = 0.05) and between good OVQ and LVV (P = 0.03). This study is the first to examine the use of an EGG-based stroboscopy instrument to evaluate TO speech. Our observations suggest that from the standpoint of functional voice, saliva and the LVV had statistically significant effect in determining voice quality.

The pharyngoesophageal segment in laryngectomees—videoradiographic, acoustic, and voice quality perceptual data

This study aimed to relate the results of physiological measurements of the pharyngoesophageal (PE) segment in subjects using tracheoesophageal (TE) or esophageal (E) speech with perceptual assessment of the speakers’ voice quality and acoustic measurements of the voice function. It further aimed to investigate possible differences in appearance and placement of the voice source between TE and E speakers. Nine subjects who had undergone a laryngectomy (five TE speakers and four E speakers) participated in the study. They were videoradiographically examined during phonation and silence. Measurements were made of size and placement of the PE segment, the distance between the PE segment and the anterior wall, and the distance between the posterior and anterior esophageal walls beneath the segment. Five trained listeners perceptually assessed the subjects’ voice quality, and acoustical analyses of fundamental frequency and sound pressure level were made.The physiological measurements of the nine subjects’ individual PE segments varied in terms of appearance and placement during both phonation and silence, but all of the subjects showed a good closure at the PE segment level during phonation. Statistically significant results were found between all of the physiological measurements of the PE segment. Significant results were also found between the acoustical and perceptual assessments of the subjects’ voices. No relations were found between the physiological measurements and the acoustic and perceptual results. The conclusion of this study was that there were no specified differences in the PE segment between TE speakers and E speakers, but that there were large individual differences within each speaker group.

Formant Characteristics of Vowels Produced by Mandarin Esophageal Speakers

With the use of the pharyngoesophageal (PE) segment as the neoglottis in esophageal speakers, their voice quality becomes significantly different from that of laryngeal speakers. The present study investigated the characteristics of the vocal tract resonance in Mandarin esophageal speakers. The first three formant frequencies of vowels /a, epsilon, i, [see in text], u, y/ produced by seven superior esophageal and seven laryngeal speakers of Mandarin were obtained. For each formant, the formant frequencies measured from the medial 80% of the vowel portion were averaged, and data obtained from esophageal speakers were compared with that obtained from laryngeal speakers. The results indicated that esophageal speakers were associated with significantly higher formant frequencies (F(1), F(2), and F(3)) and a significantly diminished vowel space circumscribed by the three corner vowels /i/, /a/, and /u/ when compared with laryngeal speakers. The findings that formant frequency changes across vowels were systematic and similar for esophageal and laryngeal speakers are consistent with those previously reported in English. It can be concluded that vocal tract transmission has been changed in esophageal speakers of Mandarin after laryngectomy.

Aerodynamic and Sound Intensity Measurements in Tracheoesophageal Voice

Background: In laryngectomized patients, tracheoesophageal voice generally provides a better voice quality than esophageal voice. Understanding the aerodynamics of voice production in patients with a voice prosthesis is important for optimizing prosthetic designs and successful voice rehabilitation. Objectives: To measure the aerodynamics and sound intensity in tracheoesophageal voice production. Study Design and Methods: We built a special setup, which consisted of a Pentium 200 MHz computer with an AD-DA interface card and Labview 4.01 software. In an oral/nasal mask we constructed several mass flow sensors and a microphone. This measured both the oral airflow and the level of sound. For the measurement of endotracheal pressure, which is the driving force behind the airflow, we used a transducer which was connected to the tracheostoma. The endoesophageal pressure was measured at the level of the prosthesis in the esophagus by a Mikrotip transducer. Using this we could determine how much the voice prosthesis contributes to the overall pressure drop of the phonatory tract. Furthermore, the average airflow rate as a function of the sound pressure levels could be determined. Results: In our population, 6 out of 7 patients showed a positive relationship between trans-source airflow and generated sound intensity. We compared our prosthesis pressure drop values with in vitro data and found that there are some differences, possibly due to difference in age of the prosthesis and physiological circumstances in vivo. The overall contribution of the voice prosthesis to the airway resistance depends on the level of phonation and the type of device. In our patient group it is apparent that the pharyngoesophageal (PE) segment has the greatest share of the total pressure drop, especially at higher airflow rates. We measured a 27% pressure drop in airflow over the voice prosthesis. Different tracheostoma occlusion methods did not have any effect on the aerodynamics and sound intensity. One patient that had had a jejunal graft for reconstruction showed, not unexpectedly, extremely different aerodynamic values. We were unable to define optimal airflow rates or optimal resistance values for sound production in the PE segment. Conclusion: The aerodynamic characteristics of voice production in laryngectomized patients with voice prostheses are determined by both prosthetic factors and PE segment tissue factors. In our patient group the PE segment is responsible for the greatest pressure drop. We found no significant difference in pressure drop and sound intensity for different tracheostoma occlusion methods.

The Effect of Tonal Changes on Voice Onset Time in Mandarin Esophageal Speech

The present study investigated the effect of tonal changes on voice onset time (VOT) between normal laryngeal (NL) and superior esophageal (SE) speakers of Mandarin Chinese. VOT values were measured from the syllables /pha/, /tha/, and /kha/ produced at four tone levels by eight NL and seven SE speakers who were native speakers of Mandarin. Results indicated that Mandarin tones were associated with significantly different VOT values for NL speakers, in which high-falling tone was associated with significantly shorter VOT values than mid-rising tone and falling-rising tone. Regarding speaker group, SE speakers showed significantly shorter VOT values than NL speakers across all tone levels. This may be related to their use of pharyngoesophageal (PE) segment as another sound source. SE speakers appear to take a shorter time to start PE segment vibration compared to NL speakers using the vocal folds for vibration.

Effect of tone on voice onset time in laryngeal and esophageal speech of Mandarin

Defined as the time between the release of burst of a stop and the onset of the following vowel, voice onset time (VOT) directly indicates the interarticulator timing between the voicing source and the articulatory movement in the vocal tract. A number of studies have investigated the VOT characteristics of different languages. Yet, few have studied how VOT is affected by tone level in a tone language, and by the type of phonation. The present study investigated the possible effect of tone level and phonation type on such interarticulator timing characteristics. VOT values were measured from the syllables /pha/, /tha/, and /kha/ produced at four Mandarin tone levels by eight laryngeal (NL) and seven esophageal (SE) speakers who were native speakers of Mandarin. Results indicated that significant differences in VOT were found in the NL speaker group, but not in the SE speaker group. With respect to phonation type, SE speakers showed significantly shorter VOT values than NL speakers. Such differences may be related to the use of pharyngoesophageal (PE) segment as a new sound source. SE speakers appear to take a shorter time to start PE segment vibration as compared to NL speakers.

Thyroidectomy and hypoparathyroidism in patients with pharyngoesophageal tumors

Total pharyngolaryngoesophagectomy and gastric transposition (TPLEGT) for pharyngoesophageal (PE) tumors may require thyroidectomy (with or without removal of the parathyroid glands) to obtain adequate margins around the tumor. As a result, a considerable number of patients may have hypoparathyroidism (HP) develop. The objective of this article is to report our experience with different types of thyroidectomy and to describe the relationship of thyroidectomy to HP in TPLETG. These results are compared with data in the literature. From 1985 to 2001, 40 patients underwent TPLEGT, with main index tumors in the esophagus (n = 17), hypopharynx (n = 17), and larynx (n = 6). All patients had advanced cTNM or pTNM stages (III or IV). Postoperative HP was diagnosed based primarily on the symptoms and calcium and phosphorus analysis but not on parathyroid hormone (PTH) levels. Total thyroidectomy (TT) was done in 12 (30%) patients and 11 (91.6%) had permanent HP develop. In none of these patients was the parathyroid separated and implanted (fear of a tumor implant). Partial thyroidectomy (PT) (lobectomy and isthmus) was done in 25 (62.5%) patients, and permanent HP occurred in 11 (44%) patients. The thyroid was preserved in three patients, and none had HP develop. Of the 40 patients, 13 (32.5%) had no HP, five (12.5%) had temporary HP, and 22 (55%) had permanent HP. There was a correlation between the type of thyroidectomy, location of primary tumors, and development of HP. Only seven reports in the past 30 years have dealt with TPLEGT, thyroidectomy, and HP. HP occurred in 32.5% of the cases of TT and in 19.5% of the cases of PT. Permanent HP was very frequent (55%) in our series. In patients who underwent TPLEGT, HP was almost certain when TT was done (91.6%). PT was no guarantee that HP would not occur (44% permanent HP). The frequency of permanent HP based on primary index tumors was 47%, 59%, and 66.6% for esophageal, hypopharyngeal, and laryngeal cancer, respectively.

Quantitative Detection of Substitute Voice Generator During Phonation in Patients Undergoing Laryngectomy

To evaluate the vibration pattern of the substitute voice generator of patients who have undergone laryngectomy. For automatic quantification of the oscillations of the pharyngoesophageal (PE) segments, image processing of digital high-speed video sequences is applied. Physiologic analysis. An acute care hospital. Endoscopic recordings were taken of 10 men who underwent laryngectomy (mean +/- SD age, 61.5 +/- 5.2 years) during sustained phonation of a vowel using a 90 degree endoscope coupled to a high-speed camera. An image-processing algorithm was developed to automatically define the pseudoglottis in each recording and track its movements. The clinical assessment of the high-speed technique for the endoscopic examination of the substitute voice generator yields the following results. The forms and oscillation characteristics of the pseudoglottides varied considerably: 3 pseudoglottides were circular, 6 were split shaped, and 1 was triangle shaped. A quasi-periodic opening and closing were observed and automatically detected by the described algorithm in each recording independently from quality of the recording and from morphologic and oscillation characteristics of the PE segment. The frequencies of the extracted oscillations of the pseudoglottides correspond to the structure of the acoustic signals. Automatic image processing of PE segments derived from high-speed endoscopic recordings enables the detection and quantification of the substitute voice generator's oscillations in high temporal resolution. These data directly prove that the detected pseudoglottis is the source of the substitute voice. Close relations between substitute voice and functional properties of the PE segment exist. In the future, these data will be interpreted by applying biomechanical models of the PE segment. Presumably, results may help to optimize surgical and adaptive procedures for specific substitute voice restoration.

Reconstruction after resection of hypopharyngeal carcinoma: Comparison of the postoperative complications and oncologic results of different methods

Radical surgery followed by radiotherapy plays an important role in the treatment of patients with hypopharyngeal cancer. However, there is no general consensus as to which is the best method of reconstruction after surgical resection. We retrospectively reviewed the records of 91 patients who underwent radical surgery and reconstruction. Postoperative complications and oncologic results of the different reconstructive methods were compared. Reconstruction with gastric pull-up had the lowest pharyngocutaneous (PC) fistula (0%) and pharyngoesophageal (PE) stenosis rates (0%). However, the overall postoperative complication rate was high (64%). Laryngotracheal flap (LTF) reconstruction had relatively lower rates of PC fistula (3%), PE stenosis (10%), and overall complications (22%). The introduction of the LTF technique significantly decreased postoperative complications from 71% to 30% (p = .0001), with similar tumor control and survival. Hypopharyngeal reconstruction with an LTF is a simple and effective method. The chance of using a complex flap is decreased. The postoperative complications are reduced, and the oncologic results are satisfactory.

頭頚部癌術後えん下障害患者に対する姿勢調節法の効果―えん下造影画像解析による直立姿勢と健側傾斜姿勢との比較検討―

Postsurgical dysphagia in patients with head and neck cancer is often improved by postural techniques, one procedure for compensatory treatment.This study was done to analyze videofluorographic (VF) images of postsurgical patients with head and neck cancer by comparing upright posture with head tilting posture on the stronger side. Twelve postsurgical patients with head and neck cancer whose aspiration was improved by head tilting posture on the stronger side were studied.The tilting magnitude, vallecular angle, and epiglottic angle were measuredon VF prints. Retained amounts of swallowed barium were evaluated in the oral region, vallecular region, and pyriform sinus on VF images.Pharyngeal delay time, pharyngeal passage time, and pharyngo-esophageal (PE) segment opening time were measured on VF images. The results were as follows:1) There was no correlation between any two of the following three variables: tilting magnitude, vallecular angle, and epiglottic angle.2) The retained amount of swallowed barium swallow in tilting posture on the stronger side was less than that in upright posture in 10 of 12 subjects.3) As compared with upright position, pharyngeal delay time and pharyngeal passage time were shorter in tilting posture on the stronger side.

Space-time pressure structure of pharyngo-esophageal segment during swallowing.

We applied high-resolution manometry with spatiotemporal data interpolation and simultaneous videofluoroscopy to normal pharyngeal swallows to correlate specific features in the space-time intraluminal pressure structure with physiological events and normal deglutitive transsphincteric bolus flow to define normal biomechanical properties of the pharyngo-esophageal (PE) segment. Pressures were recorded by microperfused catheter, and the two-dimensional space-time data sets were plotted as isocontours. On these were superimposed bolus trajectories, anatomic segment movements, and hyo-laryngeal trajectories from concurrent videofluoroscopy. Correlation of the highly reproducible space-time-pressure structure with radiographic images confirmed that primary deglutitive PE segment functions (pressure profile, laryngeal elevation, axial sphincter motion, timing of relaxation, contraction) are accurately discernible from single isocontour pressure visualization. Pressure during bolus flow was highly dependent on axial location within PE segment and time instant. The intrabolus pressure domain, corresponding to the space-time region between bolus head and tail trajectories, demonstrated significant bolus volume dependence. High-resolution manometry accurately, comprehensively, and highly reproducibly depicts the PE segment space-time-pressure structure and specific physiological events related to upper esophageal sphincter opening and transsphincteric flow during normal swallowing. Intrabolus pressure variations are highly dependent on position within the PE segment and time.

Intelligibility of stops and fricatives in tracheoesophageal speech

Listener accuracy in identifying voiced and voiceless stops and fricatives in tracheoesophageal (TE) and laryngeal speech were compared. Sixteen TE and ten laryngeal speakers produced ten phonemes embedded in a nonsense word in a carrier phrase. Four experienced listeners phonetically transcribed the experimental phonemes. As expected, perceptual error rates were higher for the TE samples for all comparisons completed. The dominant error for laryngeal samples was a misperception of manner of production. The dominant error for TE samples was a perception of voiced for voiceless phonemes. Such voicing misperceptions occurred more frequently for fricatives than stops. Previous studies have implicated the vibratory characteristics of the pharyngoesophageal (PE) segment for the voicing errors in TE speech. However, PE features would not fully explain why stops were less affected than fricatives and why the expected error was reversed for two TE phonemes (perceptions of voiceless for voiced consonants). Learning outcomes: (1) As a result of this activity, the participant will be able to identify the most common listener misperceptions of tracheoesophageal speech. (2) As a result of this activity, the participant will be able to discuss possible reasons for the predominant error that occurs.