Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-18T08:53:09.122Z Has data issue: false hasContentIssue false
  • English
  • Français

The role of the upper oesophageal sphincter in voice rehabilitation after laryngectomy and Staffieri's procedure

Published online by Cambridge University Press:  29 June 2007

H. D. Vuyk ,
E. Klinkenberg-Knol  and
R. M. Tiwari
H. D. Vuyk*
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Free University Hospital, Amsterdam, The Netherlands.
E. Klinkenberg-Knol
Affiliation:
Department of Gastro-enterology, Free University Hospital, Amsterdam, The Netherlands.
R. M. Tiwari
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Free University Hospital, Amsterdam, The Netherlands.
*
H. D. Vuyk, M.D., Free University Hospital, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Get access Rights & Permissions [Opens in a new window]

Abstract

The Staffieri method was used for voice rehabilitation after total laryngectomy in our patients. Leakage of saliva has been a problem in some. It has been suggested that aspiration could be due to specific pressure relations in the pharynx, upper oesophageal sphincter and cervical oesophagus during deglutition (Mann et al., 1980). Regarding voice production, the upper oesophageal sphincter is probably the main sound source, functioning in essentially the same way as in oesophageal speech.

Intraluminal pressure recordings at rest and during swallowing were used in 16 Staffieri speakers and 9 oesophageal speakers. Upper oesophageal sphincter dysfunction was seen more often in Staffieri speakers with aspiration problems than in Staffieri speakers without aspiration problems, but the relation is not clearly understood. A definite relation could be established between upper oesophageal sphincter function in terms of relaxation and coordination and aerodynamic pressure measured in the tracheostoma, necessary to sustain phonation. After dilatation of the oesophagus, produced by the inflow of air, a reflex rise in the upper oesophageal sphincter pressure is thought to occur. The pressure necessary to sustain phonation probably depends on the extent to which this reflex mechanism occurs and on the ability of the patient to induce a relaxation of the upper oesophageal sphincter before air expulsion.

Selective myotomy will possibly lower the necessary pressure and enhance vocal rehabilitation. Whether this will solve a part of the aspiration problems in Staffieri speakers is completely unpredictable, as the relation of the motor function of the upper oesophageal sphincter and the aspiration problems is not well understood.

Type
Research Article
Information
The Journal of Laryngology & Otology , Volume 100 , Issue 1 , January 1986 , pp. 59 - 68
Copyright
Copyright © JLO (1984) Limited 1986

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Batson, O. V. (1955) The cricopharyngeus muscle. Annals of Otology. Rhinology and Laryngology, 64: 47–54.CrossRefGoogle ScholarPubMed
Chodosh, P. L., Giancarlo, H. R. and Goldstein, J. (1984) Pharyngeal myotomy for vocal rehabilitation postlaryngectomy. The Laryngoscope, 94: 52–57.CrossRefGoogle ScholarPubMed
Code, C. F. and Schlegel, J. F. (1968) In Handbook of Physiology, Keidel, W. (Ed.) section 6, chapter 90, pp. 1821–1839. American Physiological Society, Washington DC.Google Scholar
Collo, D., Werhrauch, T. R. and Förster, C. F. (1977) Vergleichende intraluminale Ösophagusdruckmessungen nach Laryngektomie. Laryngologie, Rhinologie, Otologie, 56: 1003–1007.Google Scholar
Creamer, B. and Schlegel, J. F. (1957) Motor responses of the esophagus to distension. Journal of Applied Physiology, 10: 498–504.CrossRefGoogle Scholar
Damsté, P. H. (1958) Oesophageal speech after laryngectomy. Thesis, Groningen.Google Scholar
Diedrich, W. M. and Youngstrom, K. A. (1966) Alaryngeal speech, Charles C. Thomas, Springfield Illinois.Google Scholar
Duranceau, A., Jamieson, G., Hurwitz, A. L., Scott Jones, R. and Postlethwait, R. W. (1976) Alteration in esophageal motility after laryngectomy. American Journal of Surgery, 131: 30–35.CrossRefGoogle ScholarPubMed
Ellis, F. H. Jr. (1971) Symposium on gastrointestinal surgery: upper esophageal sphincter in health and disease. Surgical Clinics of North America, 51: 553–565.CrossRefGoogle Scholar
Goyal, R. K. (1984) Symposium on the larynx: disorders of the cricopharyngeus muscle. Otolarvngologic Clinics of North America, 17: 115–130.CrossRefGoogle Scholar
Hanks, J. B., Fisher, S. R., Meyers, W. C., Christian, K. C., Postlethwait, R. W. and Scott Jones, R. (1981) Effect of total laryngectomy on esophageal motility. Annals of Otology, Rhinology and Laryngology, 90: 331–334.CrossRefGoogle ScholarPubMed
Holden, H. B. (1984) Surgical implications of tracheo-esophageal punctures. Proceedings of the International Workshop on Voice Prosthesis, Würzburg (in press).Google Scholar
Ingelfinger, F. J. (1958) Esophageal motility. Physiological reviews, 38: 533–584.CrossRefGoogle ScholarPubMed
Kelly, D. R., Adamowich, B. L. B. and Roberts, T. A. Jr. (1981) Detailed investigation of alaryngeal speech to elucidate etiology of variation in quality. Otolaryngology Head and Neck Surgery, 89: 613–623.CrossRefGoogle ScholarPubMed
Mann, W., Laniado, K. and Schumann, K. (1980) Pitfalls after laryngectomy and neoglottis formation. Archives of Otorhinolaryngology, 226: 207–211.CrossRefGoogle ScholarPubMed
McConnel, F. M. S. and Teichgraeber, J. (1982) Neoglottis reconstruction following total laryngectomy: the Emory experience. Otolaryngology Head and Neck Surgery, 90: 569–575.CrossRefGoogle ScholarPubMed
McCurtain, F. (1982) Xeroradiography—electro laryngography: an evaluative procedure for surgical speech rehabilitation. International Conference on Surgical Speech Rehabilitation. Charing Cross Hospital, London.Google Scholar
Novák, A., Hlava, A., Hybášek, I. and Pršiková, I. (1982) Phonation with the neoglottis phonatoria according to Staffieri. In: Novák, A., Sram, F. (eds) Abstracta Congressus Decimus Societatus Phoniatricae Europaeae Prague, 81–85.Google Scholar
Pruszewicz, A., Obrebowski, A. and Woznica, B. (1982); EMG examination of musculus cricopharyngeus in patients with oesophageal speech. In: NováK, A., Sram, F. (eds)— Abstracta Congressus Decimus Societatus Fhoniatricae Europaeae, Prague, 70–72.Google Scholar
Reichbach, E. J. and Winans, C. S. (1970) Esophageal manometrics in the post-laryngectomy patient. Gastroenterology, 58: 987.Google Scholar
Shipp, T. (1970) EMG of pharyngoesophageal musculature during alaryngeal voice production. Journal of Speech and Hearing Research, 13: 184–192.CrossRefGoogle ScholarPubMed
Singer, M. I. and Blom, ED. (1981) Selective myotomy for voice restoration after total laryngectomy. Archives of Otolaryngology, 107: 670–673.CrossRefGoogle ScholarPubMed
Staffieri, A. (1979) Katamnestische Erhebungen über funktionelle Resultate der Rehabilitation von Stimme under natürlicher Atmung nach Laryngektomie bei über 1000 von verschiedenen Chirurgen operierten Patienten. HNO-Praxis, 4: 301–309.Google Scholar
Steiner, W. (1980) Chirurgische rehabilitation der Stimme nach Laryngektomie (derzeitiger Stand). Therapeutische Umschau, Band, 37: 1117–1127.Google Scholar
Vuyk, H. D., Festen, J. M., Spaelotra, U. J. G. and Tiwari, R. M. (1986) Acoustic and aerodynamic data of speech after total laryngectomy and Staffieri's procedure (in press).CrossRefGoogle Scholar
Van Den Berg, J. and Mollenaar-Bijl, A. J. (1959) Crico-pharyngeal sphincter, pitch, intensity and fluency in oesophageal speech. Practica Oto-Rhino-Laryngologica, 21: 298–315.Google ScholarPubMed
Welch, R. W., Gates, G. A., Luckmann, K. F., Ricks, P. M. and Drake, S. T. (1979) Changes in the force-summed pressure measurements of the upper esophageal sphincter prelaryngectomy and postlaryngcctomy. Annals of Otology, Rhinology and Laryngology, 88: 804–806.CrossRefGoogle Scholar
Winans, C. S., Reichbach, E. J. and Waldorp, W. F. (1974) Esophageal Determinants of alaryngeal speech. Archives of Otolaryngology, 99: 10–14.CrossRefGoogle ScholarPubMed