Correlation of intraluminal esophageal pressure with the dynamic extension of tracheoesophageal voice in total laryngectomees

Abstract

PURPOSE:To evaluate and correlate the amplitude of esophageal contractions triggered by swallowing water with dynamic extension and habitual, strong and weak sound intensity in total laryngectomees wearing a tracheoesophageal prosthesis. METHODS:Thirty total laryngectomees using tracheoesophageal voice with a phonatory prosthesis were evaluated by measuring the amplitude of contractions in the proximal, middle and distal esophagus and the pressure of the pharyngoesophageal transition by manometry. In order to measure vocal intensity the subject was asked to emit phonation of the vowel /a/ at habitual, strong and weak intensity which was captured with a sound pressure meter. Dynamic extension was calculated by subtracting strong intensity from weak intensity. RESULTS:A positive correlation was observed between contraction amplitude and dynamic extension in the proximal (rho: 0.45; p=0.01) and distal (rho: 0.41; p=0.02) esophagus There was no correlation with other parameters.. Total laryngectomees wearing a phonatory prosthesis with a dynamic extension above 21 dBNPS had greater contraction amplitude than laryngectomees with a dynamic extension below this value. CONCLUSIONS:There was a positive correlation between pressure amplitude in the proximal and distal esophagus and increased dynamic extension. The individuals with normal dynamic extension had greater contraction amplitude in the proximal esophagus than individuals with dynamic extension lower than the expected values for age .

Voice quality and surgical detail in post-laryngectomy tracheoesophageal speakers

“…To compensate for a wide pharynx, external pressure (e.g., by PM flap) might be useful to compensate for a low tonicity. These findings are confirmed in previous studies using videofluoroscopy in which it has been shown that smaller pharyngeal diameters and optimization of the intraluminal pressures favor voicing [14,16,24,37,42,46].…”

“…Positioning and muscular control of the vibratory segment play a significant role in f0 alterations, and in some patients there is a striking pharyngeal control, leading to a good control over loudness and dynamic range [47,48]. Dynamic range of the TL voice has been reported to correlate with the contraction amplitude in the neoglottis [14], and air pressure with esophageal expansion [16]. Although ideally we would like to create the narrowest point at the optimal level with maximal muscular control, we do not have enough knowledge and data to determine the optimal creation of the pharynx and neoglottic bar.…”

“…Furthermore, in view of the fact that air pressure control is needed to initiate and extend vibration, it seems a 'drawback' that the PE segment below and at the neoglottic region is expandable, while the (sub)glottic larynx and trachea are stabilized through their cartilage framework. After TL, the laryngeal differences between the sexes are lost and the limited neurological control, the myo-elastic properties, mass, size, and diameter of the neoglottis and its surrounding tissues bring about a lower frequency and more irregular voice, decreased dynamic range, and less aerodynamic voice and f0 control [13][14][15][16].…”

“…In the literature, various variables were found to affect functional outcomes. Among these, besides the extent of the resection, are the surgical method of pharynx closure and reconstruction (muscle closing techniques, donor site tissue properties), the conservation of the posterior pharyngeal wall, the degree and level of neoglottic closure during phonation (presence and place of the neoglottic bar and distance and intensity of contact between posterior and anterior wall), the pressure built up below the neoglottic bar during phonation (intraluminal pressure), the diameter of the pharynx (pharyngeal and esophageal volume and extension), previous or post-operative (chemo-)radiotherapy, and (the extent of) neck dissections [14,[16][17][18][19][20][21][22][23][24][25][26][27][28]. Although the extent of the surgical resection is primarly dictated by tumor extent, surgical techniques, such as neurectomy and upper esophageal myotomy, and the technique of pharynx (muscle) closure and type of reconstruction thus seem to be important phonosurgical aspects of TL.…”

Correlation of Maximum Phonation Time and Vocal Intensity With Intraluminal Esophageal and Pharyngoesophageal Pressure in Total Laryngectomees

“…The proximal participation in an inverse manner in relation to the dynamic extension may be related to its possible function of regulating the air flow and the pressure amplitude in such a way as to respond appropriately to the minimum and maximum intensities when necessary. Reis et al 22 identified a positive correlation between pressure amplitude in the proximal and distal esophagus and dynamic extension in total laryngectomees speaking with a TEP. Kotby et al 17 did not detect a positive correlation between sound pressure level and air flow, that is, a strong vocal intensity does not mean that the air flow is elevated.…”