Dynamics of subneoglottic lumen in tracheoesophageal phonation

The patient who employs tracheoesophageal (TE) phonation uses expiratory air passing through the TE fistula to vibrate the mucosa of the neoglottis located in the hypopharynx. To clarify the dynamics of the subneoglottic lumen during phonation, we performed fiberoptic endoscopy and fluoroscopy in 13 TE speakers. During phonation, fiberoptic endoscopy showed concentric closure of the esophagus with ballooning of the subneoglottic lumen, followed by opening of the esophagus during inspiration. Fluoroscopy revealed a dilated subneoglottic lumen and a closure of the esophagus at the bottom of the lumen during phonation. These findings provide evidence for a mechanism to protect against the influx of air deep into the esophagus during TE phonation. We conclude that during TE phonation, a closed airway is established from the lung to the neoglottis that enables the TE speaker to use expiratory air effectively for phonation.