After
laryngectomy for treatment of
cancer of the larynx, the patient may have vocal rehabilitation by
esophageal speech. Some patients fail to achieve the
esophageal speech due to reasons involving surgery,
radiotherapy, and psychological alterations. Our hypothesis is that the esophageal motility alterations consequent to
laryngectomy may be involved in the failure to achieve
esophageal speech. Using manometry with continuous perfusion, we studied the esophageal motility of 25 laryngectomized patients, 10 of them able to produce
esophageal speech and 15 unable to produce
esophageal speech, and 40 asymptomatic normal volunteers. The lower esophageal sphincter (LES) pressure was measured by the rapid pull-through method and the upper esophageal sphincter (UES) pressure by the station pull-through method. The contractions were measured at 5, 10, and 15 cm above the LES after the subjects performed 10 swallows with a 5-mL bolus of water. By comparing volunteers and laryngectomized patients, we found a lower UES pressure, lower amplitude of contractions, and increased percentage of simultaneous contractions in laryngectomized patients (p < 0.05). There was no difference between patients able and unable to produce
esophageal speech in LES and UES pressure, esophageal contraction duration and velocity, or in the percentage of failed and simultaneous contractions. The esophageal contraction amplitude was lower in patients who acquired
esophageal speech than in patients who did not (p < 0.05
at 10 cm from LES). We conclude that there are esophageal motility alterations in laryngectomized patients but only the decrease of esophageal contraction amplitude seems to be associated with the acquisition of
esophageal speech.