Original article Predictive value of esophageal motility test in the proficiency of esophageal speech M. Sahin, 1 R. Vardar, 2 T. Kirazli, 3 F. Ogut, 3 S. Akyildiz, 3 S. Bor 2 1 Department of Otolaryngology, Dıs ¸kapı Yıldırım Beyazıt Training and Research Hospital, Ankara, and 2 Department of Internal Medicine, Division of Gastroenterology and 3 Department of Otolaryngology, Ege University Faculty of Medicine, Izmir, Turkey SUMMARY. One method of speech rehabilitation following total laryngectomy surgery is esophageal speech therapy (EST). In this method, which has witnessed relatively low success rates at the end of therapy, identification of patients who can benefit from EST beforehand will be important for determining the appropriate method for alaryngeal speech rehabilitation and might be cost-effective, saving time and labor. To this end, this study conducted research on the feasibility of manometric data measured prior to therapy using an esophageal motility test (EMT) in order to determine the candidates most suitable for esophageal speech (ES) beforehand. A total of 51 total laryngectomy male patients who had never been subject to any kind of speech rehabilitation and had always been articulate were included in the study. Data were collected from 44 patients who completed EST, lasting for 6 months in total and consisting of 11 sessions. Manometric measures were obtained through EMT using a water-perfusion system with a Dent sleeve catheter on the patients prior to the therapy. Wepman’s scale was used in order to evaluate ES proficiency. Following the therapy, in accordance with this scale, while patients whose scores was 1, 2, or 3 were considered as adequate, those whose scores were 4, 5, 6, or 7 were considered inadequate and were divided into two groups. Manometric correlations were analyzed between 17 patients (group I) who were able to perform ES at an adequate level and 27 patients (group II) who could not. No statistically significant difference between the groups could be observed in terms of average pressure generated within the upper and lower esophageal sphincters obtained through EMT, peak amplitude of esophageal body contraction pressure, contraction duration time, onset velocity, or peak velocity values. EMT conducted prior to application of EST to total laryngectomized patients did not have any value in determining the level of ES that a patient could reach. Our results also suggest that sphincter pressures or esophageal motility patterns do not have any predictive value and should not be performed. KEY WORDS: esophageal motility, esophageal speech, speech rehabilitation. INTRODUCTION Following total laryngectomy surgery applied in the treatment of advanced laryngeal cancer, the most important social problem that the patients face is inarticulate speech. One method used to solve this problem is esophageal speech therapy (EST). In this method, patients who have completely lost their voices following total laryngectomy are taught to produce sounds through mucosal vibrations at the upper pharyngoesophageal level while conveying the inhaled air from the upper esophageal sphincter (UES) toward the esophagus and exhaling the air retained through burping. 1 However, the greatest dis- advantage of this alaryngeal speech method, which requires neither any surgical intervention nor extra device, is the long duration and difficulty of therapy. This therapy, which requires the patients and the speech therapy instructors to be patient and diligent, may yield low success rates even if it is carried out by an experienced team. Furthermore, it cannot be fore- seen which patients will benefit from the therapy. 2 Therefore, determining those patients who could benefit from EST beforehand could provide a better way to choose the most convenient alaryngeal speech rehabilitation method to be applied to the patient; may prevent the patient and the therapy team from any disappointment; and may also save time, labor, and cost. While esophageal motility test (EMT) is routinely used worldwide to analyze the dynamics of Address correspondence to: Dr Rukiye Vardar, MD, Department of Internal Medicine, Division of Gastroenterology, Ege University Faculty of Medicine, Izmir 35040, Turkey. Email: rukiyevardar@gmail.com Diseases of the Esophagus (2014) ••, ••–•• DOI: 10.1111/dote.12188 © 2014 International Society for Diseases of the Esophagus 1