Predictive value of esophageal motility test in the proficiency of esophageal speech

Abstract

One method of speech rehabilitation following total laryngectomy surgery is esophageal speech therapy (EST). In this method, which has witnessed relatively low success rates at the end of therapy, identification of patients who can benefit from EST beforehand will be important for determining the appropriate method for alaryngeal speech rehabilitation and might be cost-effective, saving time and labor. To this end, this study conducted research on the feasibility of manometric data measured prior to therapy using an esophageal motility test (EMT) in order to determine the candidates most suitable for esophageal speech (ES) beforehand. A total of 51 total laryngectomy male patients who had never been subject to any kind of speech rehabilitation and had always been articulate were included in the study. Data were collected from 44 patients who completed EST, lasting for 6 months in total and consisting of 11 sessions. Manometric measures were obtained through EMT using a water-perfusion system with a Dent sleeve catheter on the patients prior to the therapy. Wepman's scale was used in order to evaluate ES proficiency. Following the therapy, in accordance with this scale, while patients whose scores was 1, 2, or 3 were considered as adequate, those whose scores were 4, 5, 6, or 7 were considered inadequate and were divided into two groups. Manometric correlations were analyzed between 17 patients (group I) who were able to perform ES at an adequate level and 27 patients (group II) who could not. No statistically significant difference between the groups could be observed in terms of average pressure generated within the upper and lower esophageal sphincters obtained through EMT, peak amplitude of esophageal body contraction pressure, contraction duration time, onset velocity, or peak velocity values. EMT conducted prior to application of EST to total laryngectomized patients did not have any value in determining the level of ES that a patient could reach. Our results also suggest that sphincter pressures or esophageal motility patterns do not have any predictive value and should not be performed.

Quality of life among total laryngectomized patients undergoing speech rehabilitation: correlation between several instruments

“…Several studies have categorized patients who underwent total laryngectomy into speakers and non-speakers according to the scale of Wepman (40,48,49,50). In this study, we applied different instruments to evaluate patients' quality of life after laryngectomy according to their ability to speak or not using oesophageal speech.…”

Electrophysiological activity of the pharyngoesophageal transition of total laryngectomees

“…The inability to identify patients who will not benefit from the method of alaryngeal communication is still a challenge that involves costs, time, and emotional content . In addition, the management of the obstacles in the way of tracheoesophageal voice acquisition to reduce the recovery time should permit a larger number of individuals to benefit from the restoration of oral communication …”

Proficiência da voz esofágica e qualidade de vida em laringectomizados totais

“…Este protocolo possui 30 questões que se dividem nas subescalas funcional (1, 3, 5, 6, 8, 11, 12, 16, 19 e 22), emocional (7, 9, 15, 23, 24, 25, 27, 28, 29 e 30) e orgânica (2,4,10,13,14,17,18,20,21 Wepman et al (1953). Outros estudos utilizaram esta escala para verificar o nível de proficiência da voz esofágica (Keith et al, 1974;Dantas et al, 2005;Aguiar-Ricz et al, 2007;Sahin et al, 2015;Bozan et al, 2015).…”