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Effect of primary neopharyngeal repair on acoustic characteristics of tracheoesophageal voice after total laryngectomy

Published online by Cambridge University Press:  28 October 2008

O A Albirmawy ,
A S El-Guindy ,
M N Elsheikh ,
M E Saafan  and
M E Darwish
O A Albirmawy*
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tanta University, Egypt
A S El-Guindy
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tanta University, Egypt
M N Elsheikh
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tanta University, Egypt
M E Saafan
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tanta University, Egypt
M E Darwish
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Tanta University, Egypt
*
Address for correspondence: Dr Osama Amin Albirmawy, 88 Reyad St, Tanta 31211, Gharbeya, Egypt. E-mail: [email protected]
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Abstract

Objectives:

The tracheoesophageal puncture technique of voice restoration enables successful voice rehabilitation after total laryngectomy. Because post-operative voice quality can vary significantly, depending on which type of hypopharyngeal repair is chosen, the aim of this study was to evaluate the effect of such repair on tracheoesophageal puncture voice after total laryngectomy.

Study design:

Prospective, clinical study.

Setting:

Otolaryngology department, Tanta University, Egypt.

Methods:

Tracheoesophageal puncture voice was quantitatively and qualitatively evaluated in 40 patients using a Provox 2TM prosthesis after standard total laryngectomy. The patients were divided, according to the type of hypopharyngeal repair, into four groups of 10 cases each, as follows: group one, pharyngoesophageal myotomy; group two, pharyngeal plexus neurectomy; group three, non-muscle vertical repair; and group four, transverse repair. These surgical groups were compared with each other with respect to different voice parameters.

Results:

Patient profiles were almost equivalent in all surgical groups. The mean values of most of the parameters of quantitative tracheoesophageal puncture voice did not differ significantly, comparing the four surgical groups; however, a slightly significant difference was observed regarding loud intensity in the non-muscle repair group, and soft and loud jitter in the transverse repair group. Mean values for qualitative measures of intelligibility and communicative effectiveness did not show significant difference. However, a slightly significant difference was observed regarding fluency, word correctness, speaking rate and wetness, with higher values for all these parameters except wetness in the myotomy group, and higher values for wetness in the non-muscle repair group.

Conclusion:

The four hypopharyngeal repair types – primary pharyngoesophageal myotomy, pharyngeal plexus neurectomy, non-muscle vertical repair and transverse hypopharyngeal repair – were almost equivalent in prevention of pharyngoesophageal spasm in total laryngectomy patients who had undergone primary tracheoesophageal puncture for voice restoration.

Keywords

LaryngectomyVoiceLarynx Neoplasms
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 4 , April 2009 , pp. 426 - 433
Copyright
Copyright © JLO (1984) Limited 2008

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References

1 Blom, ED, Hamaker, RC. Tracheoesophageal voice restoration following total laryngectomy. In: Myers, EN, Suen, J, eds. Cancer of the Head and Neck. Philadelphia: WB Saunders, 1998;839–52Google Scholar
2 Theo, RG. Total laryngectomy. In: Bleach, N, Milford, C, Van Hasselt, A, eds. Operative Otolaryngology. Oxford: Blackwell Science, 1997;365–72Google Scholar
3 Singer, MI, Blom, ED. An endoscopic technique for restoration of voice after laryngectomy. Ann Otol Rhinol Laryngol 1980;89:529–33CrossRefGoogle ScholarPubMed
4 Hamaker, RC, Singer, MI, Blom, ED, Daniels, HA. Primary voice restoration at laryngectomy. Arch Otolaryngol Head Neck Surg 1985;111:182–6CrossRefGoogle ScholarPubMed
5 Cornu, AS, Vlantis, AC, Elliott, H, Gregor, RT. Voice rehabilitation after laryngectomy with the Provox voice prosthesis in South Africa. J Laryngol Otol 2003;117:56–9CrossRefGoogle ScholarPubMed
6 Tisch, M, Lorenz, KJ, Storrle, E, Maier, H. Quality of life for patients after laryngectomy and surgical voice rehabilitation. Experience with the Provox prosthesis. HNO 2003;51:467–72CrossRefGoogle ScholarPubMed
7 Edels, Y. Pseudo-voice: its theory and practice. In: Edels, Y, ed. Laryngectomy: Diagnosis to Rehabilitation. London: Croom-Helm, 1983;107–42Google Scholar
8 Blom, ED, Pauloski, BR, Hamaker, RC. Functional outcome after surgery for prevention of pharyngospasm in tracheoesophageal speakers. Part 1: speech characteristics. Laryngoscope 1995;105:1093–103CrossRefGoogle Scholar
9 Singer, MI, Blom, ED. Selective myotomy for voice restoration after total laryngectomy. Arch Otolaryngol Head Neck Surg 1981;107:670–3CrossRefGoogle ScholarPubMed
10 Ramalingam, CW, Chikara, D, Rajagopal, G, Mehta, AR, Sarkar, S. Tracheo-esophageal puncture (TEP) for voice rehabilitation in laryngectomised patients; Blom Singer vs Provox prosthesis: our experience. Medical Journal Armed Forces India (MJAFI) 2007;63:15–18CrossRefGoogle ScholarPubMed
11 Blom, ED, Remacle, M. Tracheoesophageal voice restoration problems and solutions. In: Blom, ED, Singer, MI, Hamaker, RC, eds. Tracheoesophageal Voice Restoration Following Total Laryngectomy. San Diego: Singular Publishing, 1998;73–82Google Scholar
12 Albirmawy, OA, Elsheikh, MN, Saafan, ME, Elsheikh, E. Managing problems with tracheoesophageal puncture for alaryngeal voice rehabilitation. J Laryngol Otol 2006;120:470–7CrossRefGoogle ScholarPubMed
13 Blom, ED. Tracheoesophageal values. Problems, solutions and directions for the future. Head Neck Surg 1988;10:142–54CrossRefGoogle Scholar
14 Yoshida, GY, Hamaker, RC, Singer, MI, Blom, ED. Primary voice restoration at laryngectomy: 1989 update. Laryngoscope 1989;99:1093–5CrossRefGoogle ScholarPubMed
15 Singer, MI, Blom, ED, Hamaker, RC. Pharyngeal plexus neurectomy for alaryngeal speech rehabilitation. Laryngoscope 1986;96:50–4CrossRefGoogle ScholarPubMed
16 Clevens, RA, Esclamando, RM, Hartshorn, DO, Lewin, JS. Voice rehabilitation after total laryngectomy and tracheoesophageal puncture using nonmuscle closure. Ann Otol Rhinol Laryngol 1993;102:792–6CrossRefGoogle ScholarPubMed
17 Deschler, DC, Doherthy, ET, Reed, CG, Hayden, RE, Singer, MI. Prevention of pharyngoesophageal spasm after laryngectomy with a half-muscle closure technique. Ann Otol Rhinol Laryngol 2000;109:514–18CrossRefGoogle ScholarPubMed
18 Hamaker, RC, Cheesman, AD. Surgical management of pharyngeal constrictor muscle hypertonicity. In: Blom, ED, Singer, MI, Hamaker, RC, eds. Tracheoesophageal Voice Restoration Following Total Laryngectomy. San Diego: Singular Publishing, 1998;33–9Google Scholar
19 Blood, G. Fundamental frequency and intensity measurements in laryngeal and alaryngeal speakers. J Communic Dis 1984;17:319–24CrossRefGoogle ScholarPubMed
20 Robbins, J, Fisher, H, Blom, E, Singer, M. A comparative acoustic study of normal, esophageal, and tracheoesophageal speech production. J Speech Hear Dis 1984;49:202–10CrossRefGoogle ScholarPubMed
21 Qi, Y, Weinberg, B. Characteristics of voicing source wave-forms produced by esophageal and tracheoesophageal speakers. J Speech Hear Res 1995;38:536–48CrossRefGoogle Scholar
22 Pindzola, RH, Cain, BH. Duration and frequency characteristics of tracheoesophageal speech. Ann Otol Rhinol Laryngol 1989;98:960–4CrossRefGoogle ScholarPubMed
23 Baggs, T, Pine, S. Acoustic characteristics: tracheoesophageal speech. J Communic Dis 1983;16:299–307CrossRefGoogle ScholarPubMed
24 Deschler, DC, Doherty, ET, Reed, CG, Anthony, JP, Singer, M. Tracheoesophageal voice following tubed free radial forearm flap reconstruction of the pharynx. Ann Otol Rhinol Laryngol 1994;103:929–36CrossRefGoogle Scholar
25 Medina, JE, Nance, A, Burns, L, Overton, R. Voice restoration after total laryngopharyngectomy and cervical esophagectomy using the duckbill prosthesis. Ann J Surg 1987;154:407–10CrossRefGoogle ScholarPubMed