Quantitative and Qualitative Analysis of Tracheoesophageal Voice after Pectoralis Major Flap Reconstruction of the Neopharynx

Abstract

Although tracheoesophageal voice restoration is accepted after reconstruction of the neopharynx with the pectoralis major myocutaneous flap, the character of such voice is not well described. Six patients reconstructed with the pectoralis major flap after laryngopharyngectomy underwent successful voice restoration with the Blom-Singer prosthesis. Voice was evaluated by a standardized protocol and compared with voices of control subjects treated with total laryngectomy and similar voice restoration. The patients with pectoralis major flaps produced similar intensity levels for soft voice (53.7 dB vs. 55.6 dB) and loud voice (61.3 dB vs. 65.3 dB) when compared with controls (p > 0.05). No significant differences (p > 0.05) were noted for fundamental frequency (F0) between patients with pectoralis major flaps and controls for soft (62.3 Hz vs. 85.4 Hz) and loud (109.8 Hz vs. 133.8 Hz) voice. Jitter was also comparable. Trained and naive listeners completed qualitative analyses for 10 parameters and judged that control patients had significantly better voice for most parameters. This finding demonstrates that dependable voice is attainable after pectoralis major flap reconstruction of the neopharynx. Although this voice does not differ significantly from voice after standard laryngectomy for acoustic parameters, perceptual analysis does reveal significant differences.

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

“…There is no difference in dynamic extension in patients submitted to reconstruction of the pharynx with flaps 20 . What has been observed is that different types of prostheses [2][3][4][5][6][7] and the manner of stoma occlusion 3,5,7 influence dynamic extension.…”

Voice quality of prepubescent children with quiescent recurrent respiratory papillomatosis

“…This finding is significant clinically because poor speech quality in children has been demonstrated to have a negative influence on the perception the listener has of the individual [19,20]. The results of perceptual analysis such as were performed in our study of children with RRP provide clinicians with a baseline of voice quality and a way to monitor the course of therapy to improve voice quality [21][22][23].…”

Magnitude and Variability of Oral Pressure in Tracheoesophageal Speech

“…Deschler et al [38] reported perceptual differences (but not acoustic) between patients undergoing standard laryngectomy and those who had pectoralis flap reconstruction, raising the possibility that other differences may be present. The limited number of TL+PM speakers (n = 4), however, precluded more detailed statistical analysis.…”