An objective method for prediction of tracheoesophageal speech production

Current methods of esophageal air insufflation testing to predict postoperative tracheoesophageal speech success lack procedural objectivity and rely on subjective interpretation of the voice production results. A range of intraesophageal pressure measurements was obtained prior to tracheoesophageal (TE) puncture in each of 27 laryngectomized patients in an attempt to predict TE speech outcome. Postoperatively, three levels of speech production were identified. Fluent speakers, nonfluent speakers, and nonspeakers demonstrated low, intermediate, and high intraesophageal pressures, respectively. Patients with intermediate and high preoperative pressures did not achieve fluent speech without myotomy. This technique offers a reliable, objective preoperative indication of expected TE speech fluency.