Relation between Videofluoroscopy of the Esophagus and the Quality of Esophageal Speech

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 categories: fluent (n = 9), moderately fluent (n = 10) and nonfluent (n = 11). Videofluoroscopy of the PE region was then performed 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 videofluoroscopic indicators of nonfluent speakers were: (1) small or absent air reservoir and (2) lack of a vibrating PE segment. Fluent speakers presented with shorter PE segments (1.17 mm) compared to moderately fluent speakers (17.1-29.9 mm). Perceptually, 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 (C) 2009 S. Karger AG, Base

A new proposal for evaluation of the pharyngoesophageal segment and its relation with the narrow-band spectrogram in tracheoesophageal speakers

PURPOSE: The primary purpose of this study was to assess the relationship between pharyngoesophageal segment (PES) configuration and narrow-band spectrogram of tracheoesophageal voices. METHODS: This study included 30 total laryngectomees tracheoesophageal speakers. Patients were assessed by videofluoroscopy (VF), during deglutition and voicing, and the vowel /a/ was recorded for spectrographic analysis. The evaluation of VF recording consisted of visual perceptual rating of degree of contact between the prominence of PES and its anterior wall, defined as absent/mild (hypo contact), moderate (normo contact) and intense (hyper contact); and quantitative measures of PES: anteroposterior distance (APD) and length of the PES (lenPES); PES surface area in swallowing (areaSw), and phonation (areaPh), and the area of the air reservoir (areaAir). Visual inspection of a narrow-band spectrogram was made and four different acoustic signal typing were defined as Type I, II, III or IV. RESULTS: Type I-II is correlated with moderate contact; Type III, with intense and Type IV, with absent/mild contact. Type I-II has bigger APD and PES with lower length than Type IV. There is a correlation between bigger APD and shorter PES. CONCLUSION: The group with I-II signal typing has PES with normo contact; Type III with hyper contact and Type IV has PES with hypo contact. The best tracheoesophageal voices are achieved by PES with moderate contact of the prominence and with shorter and larger anteroposterior PES distances. What differentiates the PES with hyper contact from PES with normal one is only the degree of contact between the prominence of the PES and its anterior wall

Psychological contents and social effects associated to peripheral facial paralysis: a speech-language approach

Introduction: The peripheral facial paralysis (PFP) results from the reduction or interruption of the axonal transport to the seventh cranial nerve resulting in complete or partial paralysis of the facial movements. The facial deformity and limitation of movements, besides affecting the aesthetics and functionality, can significantly interfere with interpersonal communication. Objective: Investigate the psychological contents and other social effects associated to PFP in adult subjects, performing a comparative analysis in three groups of subjects with PFP: at flaccid, recovery and sequel phases. Method: Quantitative and qualitative research. 16 adult subjects, from both sexes, aging between 43 and 88 years old, with PFP. Procedure: Open interviews with subjects. The material was recorded in audio and video, literally transcribed, systematized through categorical and statistical analysis. Results: The subjects bearing sequels presented higher statistical significance of psychological contents and social effects associated to PFP. Followed, respectively, by those that were on flaccid and recovery phases. The results suggest that the speech-language therapist, besides performing functional and aesthetical rehabilitation with the subject with PFP, needs to be aware of psychological and social aspects that may be involved, in order to evaluate and seek to reduce the degree of psychological distress and promote the social adjustment of these patients. Conclusion: The biopsychosocial approach to patients with PFP revealed a wide and significant range of subjective contents that warrant new studies that may contribute to the effectiveness of the speech-language clinical method to approach this medical condition

Efeito imediato da técnica de firmeza glótica nas laringectomias parciais horizontais supracricoides: estudo inicial Hands-over-mouth exercise in supracricoid horizontal partial laryngectomy: initial study

A laringectomia parcial horizontal supracricoidea é indicada para o tratamento do câncer da laringe que não invade a subglote e preserva ao menos uma das aritenoides. Esta cirurgia possibilita a manutenção das funções respiratória e esfinctérica da laringe e permite a fonação com característica predominantemente rugosa. O trabalho fonoaudiológico visa promover a aproximação das estruturas remanescentes para reabilitar a deglutição e fonação do paciente. A técnica de firmeza glótica é um exercício indicado para melhorar a coaptação das pregas vocais, sendo realizado por meio da oclusão quase total da boca com a mão em concha, durante a emissão de fricativo sonoro sustentado. Para compreender como esta técnica atua nas estruturas supraglóticas, foi avaliada a configuração laríngea e a qualidade vocal de pacientes submetidos à laringectomia supracricoide, com voz supraglótica estável, após dois minutos de realização da técnica de firmeza glótica. Foram avaliados seis pacientes, com gravação das amostras de voz em programa computadorizado e nasolaringofibroscopia, antes e após dois minutos de realização da técnica. Para a avaliação perceptivo-auditiva das vozes foi utilizada a escala GRBASI. O tipo de constrição da laringe remanescente, grau de aproximação e amplitude de vibração das estruturas foram avaliados nos exames de nasolaringofibroscopia. Houve aumento da amplitude de vibração das estruturas remanescentes em cinco pacientes, redução da soprosidade em três e da tensão vocal em dois pacientes. Neste estudo inicial com seis indivíduos, observamos que a técnica de firmeza glótica pode ser utilizada como exercício complementar para melhorar a qualidade vocal supraglótica e ampliar a vibração das estruturas remanescentes.Supracricoid horizontal partial laryngectomy is a surgical technique used to treat laryngeal tumors restricted to glottic and supraglottic regions, preserving at least one of the arytenoids. This surgery allows for maintenance of the sphincter and respiratory functions, as well as phonation, with rough vocal quality. Rehabilitation aims to promote sphincter contraction of the remaining structures to improve swallowing and phonation. The hands-over-mouth exercise is usually employed to improve glottic closure: one cupped hand gently covers the half-open mouth to almost completely obstruct the airway during sustained emission of a voiced fricative phoneme. To understand the effect of this technique in patients submitted to supracricoid laryngectomy, we evaluated the configuration of the laryngeal remaining structures and vocal quality during supraglottic phonation, after a hands-over-mouth exercising period of two-minutes, by comparing digitizing voice samples and nasolaryngoscopic images of six patients, before and after the task. We used the GRBASI scale to access vocal quality and analyzed the pattern of constriction, the degree of approximation and the vibratory amplitude to evaluate the images. In this pilot, we observed an increase in vibratory amplitude of the remaining structures of five patients and concluded that the hands-over-mouth exercise can be used as a complementary exercise to improve supraglottic voice quality