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Dynamic Study of Oesophageal Function during Phonation: Simple but Effective.

Giovanni Paolo Santoro1, Antonino Maniaci2, Paolo Luparello1

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PubMed
Summary

Pharyngeal-esophageal spasm can cause voice loss after laryngectomy. A new diagnostic approach using videofluoroscopy and lidocaine, followed by neurotoxin therapy, improved speech outcomes in patients with aphonia.

Keywords:
Iatrogenic aphoniaPharyngo-oesophageal muscle disorderTracheo-oesophageal voiceVideofluoroscopy in phonation

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Area of Science:

  • Otolaryngology
  • Speech and Language Pathology

Background:

  • Secondary aphonia significantly impacts laryngectomy patients' quality of life.
  • Tracheoesophageal speech, the standard for voice restoration, often fails due to pharyngoesophageal segment spasm.
  • Diagnosing this spasm is challenging and costly.

Purpose of the Study:

  • To evaluate a phonatory and swallowing assessment for pharyngoesophageal segment disorders.
  • To investigate the efficacy of neurotoxin blockade for improving esophageal speech.

Main Methods:

  • Retrospective study (2012-2017) of 6 laryngectomy patients with post-surgical aphonia.
  • Dynamic phonation videofluoroscopy and lidocaine hydrochloride challenge test.
  • Treatment with neurotoxin blockers.

Main Results:

  • Videofluoroscopy identified an air-trapping phenomenon and spasmodic block in all patients.
  • Lidocaine test provided transient speech improvement.
  • Neurotoxin therapy led to improved phonatory performance and rehabilitation.

Conclusions:

  • Pharyngoesophageal segment disorders are a significant cause of voice restoration failure post-laryngectomy.
  • Videofluoroscopy and lidocaine challenge are valuable diagnostic tools.
  • Neurotoxin blockade offers a promising treatment for selected patients to enhance esophageal speech.