Mechanism of Tracheoesophageal Shunt Speech.
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Tracheoesophageal (TE) shunt speech is a good method of vocal rehabilitation after total laryngectomy. The mechanism of TE shunt speech is described in this paper.Fluoroscopic and strobofiberscopic examinations showed two bulges in the pharyngoesophageal (PE) segment. The upper one was a posterior bulging at the orifice of the PE segment, located in C4-C6, and the lower one was a circular bulging, located in C5-C7. The upper one was the sound source, i.e., the neoglottis, of TE shunt speech. In most patients, anteroposterior and undulating movements were found in the neoglottis and complete neoglottis closure was achieved. Electromyographic and anatomical findings suggested that the neoglottis was formed by the thyropharyngeal muscle. Manometric examination showed that the lower bulge had an adverse effect on the vibrating status of the neoglottis.It was concluded that the neoglottis of TE shunt speech was formed by (1) the stenotic portion of the PE segment by muscle contraction and (2) mucosal vibration caused by expiratory airflow. This mechanism was like that of normal laryngeal phonation. The mechanism of vibration in esophageal speech was similar to that in TE shunt speech.The reasons for poor shunt phonation are: (1) phonation gap at the neoglottis, (2) random vibration of the neoglottis and (3) infraneoglottic stenosis. Surgical interventions were developed to improve (1) and (3) and good results were achieved clinically. Determination of the vibrating status of the neoglottis is the most important aspect in improving TE shunt speech.
- 耳鼻咽喉科臨床学会の論文
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