Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Folia Phoniatr Logop 2009;61:29–36 DOI: 10.1159/000191471 Relation between Videofluoroscopy of the Esophagus and the Quality of Esophageal Speech Marina Lang Fouquet a, b Antônio José Gonçalves a Mara Behlau b, c a Head and Neck Surgery Discipline, Santa Casa de Misericórdia de São Paulo Hospital, b Faculdade de Medicina, Universidade de São Paulo, and c Centro de Estudos da Voz – CEV, São Paulo, Brazil Introduction Total laryngectomy may greatly impact patient qual- ity of life, primarily due to the loss of laryngeal voice and the associated communication deficits. Esophageal voice (EV), in Brazil, remains the primary rehabilitation tech- nique to facilitate communication after total laryngec- tomy due to both social and economic constraints. How- ever, the percentage of successful acquisition of EV varies greatly, ranging from 32 to 63% [1–5]. Several variables, including age and socioemotional status, as well as ana- tomical and functional factors have been linked to suc- cessful EV acquisition. Several authors have described patient age as the pri- mary factor associated with successful EV acquisition, suggesting that the complex processes associated with EV acquisition are highly dependent upon a patient’s capac- ity to learn new tasks, which diminishes with advancing age [4, 5]. Socioemotional factors including depression, loss of identity, lack of practice, inadequate instruction or lack of opportunities for communication [6] may also in- fluence successful acquisition of EV. Finally, anatomical variables are highly correlated to EV acquisition includ- ing stenosis (occasionally referred to as difficulty swal- lowing solids), pseudovallecula [6, 7], cricopharyngeal bar (bulging of the posterior wall of the pharynx into the lumen of the hypopharynx), gastroesophageal reflux, hi- atal hernia [6] , dysphagia, small tracheostoma, perma- Key Words Evaluation  Fluoroscopy  Voice quality  Esophageal speech  Rehabilitation Abstract The goal of the current study was to compare the quality of esophageal speech and voice to videofluoroscopic features of the esophagus and pharyngoesophageal (PE) segment. The speech and voice characteristics of 30 laryngectomized patients were rated by 5 speech-language pathologists. Based on these ratings, patients were divided into 3 catego- ries: fluent (n = 9), moderately fluent (n = 10) and nonfluent (n = 11). Videofluoroscopy of the PE region was then per- formed during both swallowing and voice production. An insufflation test and percutaneous pharyngeal plexus block were required in 9 patients to determine the etiology of poor esophageal voice production. The strongest videofluoro- scopic indicators of nonfluent speakers were: (1) small or ab- sent air reservoir and (2) lack of a vibrating PE segment. Flu- ent speakers presented with shorter PE segments (1.17 mm) compared to moderately fluent speakers (17.1–29.9 mm). Per- ceptually, fluent speakers presented with a predominantly rough vocal quality. In contrast, moderately fluent speakers presented with a tense quality. In addition, stoma blast noise was reduced in fluent speakers. Videofluoroscopic findings highly correlated with the quality of esophageal speech. Copyright © 2009 S. Karger AG, Basel Published online: January 15, 2009 Marina Lang Fouquet Rua Ministro Álvaro de Souza Lima, 253 apto 701/1 São Paulo, SP 04664-020 (Brazil) Tel. +55 11 5686 1236, Fax +55 11 5548 3107 E-Mail marinalfouquet@uol.com.br © 2009 S. Karger AG, Basel 1021–7762/09/0611–0029$26.00/0 Accessible online at: www.karger.com/fpl Downloaded by: Universidade Federal de Sao Paulo 200.144.93.190 - 2/20/2015 5:13:55 PM