Laryngeal Phonation after Tracheoesophageal Diversion

Chiba, Yu; Nishio, S.; Yamaguchi, Akira; Eto, Fumio

doi:10.1007/s00455-005-0011-3

Cited by 3 publications

(7 citation statements)

References 8 publications

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“…TEP can be performed in patients with total laryngectomy as well as those who have undergone LTS or tracheoesophageal diversion [93][94][95]. In rare cases, patients who have undergone tracheoesophageal diversion may accidentally regain laryngeal speech without additional treatment or special training [96]. Regarding voice quality, the best sound quality is achieved by reacquisition of the voice through the vocal cords after APSs.…”

Section: Speech After Aspiration Prevention Surgerymentioning

confidence: 99%

Aspiration prevention surgeries: a review

et al. 2023

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Background Severe dysphagia can cause intractable pneumonia and lead to life-threatening conditions. Intractable aspiration can occur despite medical management for aspiration prevention. Surgical intervention is indicated for intractable aspiration to prevent potentially life-threatening complications. Since the 1970s, several surgical treatments to prevent aspiration have been reported, and various aspiration prevention surgeries have been introduced, but little is known about them or their benefits. This is a review of the types of aspiration prevention surgery, with the aim of increasing aspiration prevention surgery awareness and their clinical outcomes among medical professionals, which will guide the choices of aspiration prevention surgeries for patients with intractable aspiration. Main body Aspiration prevention surgeries can be categorized into three according to their approaches: removal of the larynx, altering the structure of the trachea, and closure of the larynx. Aspiration prevention surgeries to remove the larynx include total and central-part laryngectomy. Aspiration prevention surgeries to alter the structure of the trachea include tracheoesophageal diversion, laryngotracheal separation, and the tracheal flap method. Surgeries to close the larynx can be divided into supraglottic laryngeal closure, glottic laryngeal closure, and subglottic laryngeal closure. Aspiration prevention surgeries prevent aspiration and increase oral intake in 50–80% of patients. Most patients lose vocal function after aspiration prevention surgeries; however, some patients who have undergone total laryngectomy or laryngotracheal separation restored their speech function through tracheoesophageal puncture and use of voice prosthesis. Postoperative suture failure is frequent after epiglottic flap closure and total laryngectomy but rare after central-part laryngectomy, laryngotracheal separation, glottic closure, and subglottic closure. Furthermore, aspiration prevention surgeries improve the quality of life of patients and their caregivers by decreasing suctioning frequency. Conclusions In this review, we described the history and development of aspiration prevention surgeries. Medical professionals need to continually improve their knowledge and skills to facilitate appropriate aspiration prevention surgeries according to patient condition.

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Section: Speech After Aspiration Prevention Surgerymentioning

confidence: 99%

Aspiration prevention surgeries: a review

et al. 2023

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“…However, this improvement often occurs at the expense of phonatory function. In fact, it is impossible to phonate after LTS and very difficult to do so after TED 8 . Therefore, other approaches have been proposed to compensate for these deficits.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, it is impossible to phonate after LTS and very difficult to do so after TED. 8 Therefore, other approaches have been proposed to compensate for these deficits. Biller et al used laryngoplasty to prevent aspiration and maintain phonatory function;.…”

Section: Discussionmentioning

confidence: 99%

“…Both approaches aim to prevent aspiration and promote safe oral intake and can be reversed if the patient's condition improves sufficiently 6, 7 . However, this improvement nearly always occurs at the expense of phonation, which is impossible after LTS and very difficult after TED 8 . Although some reports have described patients who recovered phonation after LTS, 9, 10 the voices in such cases originated from the pharyngeal mucosa, but not from the vocal folds.…”

Section: Introductionmentioning

confidence: 99%

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Tracheoesophageal Diversion and Puncture for Preserving Phonation in Intractable Aspiration: A Case Series

Adachi¹,

Umezaki²,

Inoguchi³

et al. 2020

The Laryngoscope

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Objective/Hypothesis: Tracheoesophageal diversion (TED) can prevent damage to the respiratory system in patients with swallowing disorders and/or repetitive aspiration pneumonia; however, TED may cause the loss of phonation. Our previous study demonstrated that TED with tracheoesophageal puncture (TEP) prevents aspiration while retaining phonation. In this study, we aimed to further evaluate the feeding status and phonation of patients who underwent TED with TEP to verify the reproducibility of this procedure.Study Design: Case series study. Methods: We retrospectively reviewed the medical records of 11 patients who underwent TED with TEP for intractable aspiration from February 2017 to August 2019 at Fukuoka Sanno Hospital. We evaluated the preoperative penetration aspiration score (PPAS), daily activities, preoperative and postoperative food intake level scale (FILS) score, nutrition route, maximum phonation time(MPT), and postoperative communication method.Results: The study population included 10 men and 1 woman (mean age, 66 years; range, 44-81) with a PPAS of 6.8 ± 1.0. The FILS score changed from 2.1 ± 0.5 preoperatively to 7.5 ± 2.0 postoperatively (paired t-test, P < .05), while the MPT changed from 7.9 ± 4.1 to 10.3 ± 4.2 s (paired t-test, P = .9). Preoperatively, a gastric fistula (eight patients [73%]) was the main nutrition route, followed by a gastric tube (two patients [18%]). Postoperatively, the main nutritional route for eight patients (73%) was oral, while the remaining three patients (27%) used the oral route occasionally. All patients maintained laryngeal phonation function, and eight (73%) used only laryngeal phonation for communication.Conclusions: Patients with intractable aspiration who wish to retain phonatory function should be advised to undergo TED with TEP.

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“…Both TED and LTS aim at preventing aspiration and facilitating safe oral intake; if the patient's condition improves, reversal of the separation is possible . However, both operations compromise phonatory function; phonation is generally impossible after LTS and is very difficult after TED . Although the potential for some phonation after LTS has been reported, the voice originates from the pharyngeal mucosa and differs from that originating from the vocal folds.…”

Section: Introductionmentioning

confidence: 99%