gms | German Medical Science

Introduction: Esophageal speech requires the patient to inject or inhale air into the oesophagus and expel the air through the surgically created pharyngo-esophageal (PE) segment. A good tonicity of the PE segment to allow vibration is an important factor for good voicing and can be achieved after ph. constr. myotomy. We investigated the effects of myotomy on the results of esophageal speech rehabilitation.

Methods: 527 laryngectomized patients were included in the study over a three years period.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 performend at the beginning an end of rehabilitation.

Results: A general improvement of voice restoration, regard-ing all three possibilities of speech reha-bilitation, 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 any communication possibility.77% of the myotomy-patients learned esophageal speech in contrast to 62% who were laryngectomized without myotomy (p=0,009). Sub-group 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%).

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