Pharyngeal myotomy for vocal rehabilitation postlaryngectomy

In those patients requiring total laryngectomy, esophageal speech appears to be the most desirable form of rehabilitation. Satisfactory esophageal speech is only obtained in 40 to 65% of the patients. Tracheoesophageal shunts as per Singer and Panje have provided solutions for a significant number of non-speakers, but still present problems as well as failures. Efforts to correct these failures have led to the concept of constrictor and cricopharyngeal discoordination. Pharyngeal block has demonstrated not only temporary correction of tracheoesophageal shunt failure but improvement and production of esophageal speech in non-shunted patients. Subsequently myotomy has provided permanent esophageal speech. This paper proposes consideration of this procedure in esophageal speech failures, when the Taub test and/or pharyngeal block demonstrates the presence of constrictor-cricopharyngeus discoordination. Representative cases are presented.