The Pharyngoesophageal Segment in Laryngectomees with Non-Functional Voice: Is It All about Spasm?

Objective: The aim of the present study was to characterize the pharyngoesophageal segment in non functional tracheoesophageal speakers and to confirm that the patients responded to treatment with decreased pressures, better voice and increased neoglottis vibration.

Methods: Voice perceptual assessment, high-resolution videomanometry of swallowing and phonation and high-speed camera recording during phonation provided information about anatomy and function of the pharyngoesophageal segment before and 1 month after treatment with balloon dilatation and/or botulinum toxin.

Results: High resolution videomanometry revealed 12 patients with phonation pressure higher than 20 mm Hg before treatment: 2 patients with pressure between 20-45 mm Hg, 5 patients with pressure between 45-66 mmHg and 5 patients with pressure higher than 66 mm Hg. Eight of twelve patients reported clinical improvement after treatment. Their phonation index (defined as the ratio between phonation pressure at pharyngoesophageal segment and distal oesophagus), phonation pressure and residual pressure at the pharyngoesophageal segment decreased after treatment. There was no significant difference between voice variables values before and after treatment. High-speed camera recordings revealed a wide variation in the anatomical and functional characteristics of the neoglottis.

Conclusions: Normal pressure of the PES during phonation is an important factor for successful sound emission in TE speakers. Others aspects as fibrosis at pharyngoesophageal segment and oesophageal peristalsis should be considered.