gms | German Medical Science

Introduction: Three different rehabilitation methods can restore communication for patients after total laryngectomy, ie, esophageal, tracheosophageal (voice prothesis) and electrolaryngeal voice. Esophageal voice is an inexpensive, non-invasive rehabilitation method that does not require artificial device. On the other hand, reported success rates for this option vary between 26% and 70%. Esophageal speech requires the patient to inject or inhale air into the esophagus and expel the air through the surgically created pharyngo-esophageal (PE) segment. Tonicity of the PE segment to allow vibration is one of the most important factors for good voicing. Pharyngeal constrictor myotomy can lower pharyngeal contraction pressure with improvement of voice restoration after surgical application of voice prostheses. This study was undertaken to determine the effect of myotomy on the results of esophageal speech rehabilitation.

Methods: 527 laryngectomized patients from different institutions were included in the study between 2002 and 2005. Mean age was 62 years. The 489 evaluable patients were investigated in four groups: laryngectomy with or without myotomy and with or without additional application of voice prothesis (Provox). Logopaedic treatment was carried out daily with an average number of 21 treatments per patient in a median treatment time of 18 days. The assessment of voice quality was performed at the beginning and end of rehabilitation using a 12-point scale rating, ranging from “fluently speaking” to “no communication possible”.

Results: A general improvement of voice restoration, regarding all three possibilities of speech rehabilitation, could be achieved in 95% of the patients with myotomy and in 84% of patients without (p=0,001). 322 patients presented at the beginning of rehabilitation without being able to produce esophageal tones or a communication possibility by voice prothesis or electrolarynx respectively. 77% of the myotomy-patients learned esophageal speech in contrast to 62% who were laryngectomized without myotomy (p=0,009). Subgroup analysis showed the highest response for myotomy-patients without Provox with 82,4% (Myotomy + Provox 68,8%). Patients without myotomy and without Provox 69,7% (No myotomy + Provox 50%). Differences between beginning and end of rehabilitation in all subgroups (p=0,000).

Conclusions: 1. For a successful esophageal voice rehabilitation laryngectomy should be performed with myotomy. 2. A standardized logopaedic training program with intensive daily lessons during rehabilitation is necessary. 3. Application of voice prostheses should be elective and performed only together with myotomy.