Aguiar-Ricz Lílian, Dantas Roberto Oliveira, Ricz Hilton, Gielow Ingrid, Mamede Rui C M, Perdoná Gleici Castro
Department of Opthalmology, Otolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
J Voice. 2007 Mar;21(2):248-56. doi: 10.1016/j.jvoice.2005.11.001. Epub 2006 Feb 28.
After total laryngectomy, the interruption of the upper digestive tube and the section of the cricopharyngeal segment alter the high-pressure zone of the pharyngoesophageal transition, which will not only start to have a digestive function, but also be stimulated to take on the production of voice and speech. The pressure observed in the cricopharyngeal segment seems to act as a critical factor for the development of esophageal sound production, and manometry is the procedure capable of quantifying the pressure observed in this region.
The objective of the current study was to assess the upper esophageal sphincter pressure in laryngectomized patients who are either successful or unsuccessful esophageal speakers, both at rest and during esophageal phonation, using manometry.
Twenty laryngectomized persons aged 32 to 83 years (mean, 44.2 years) were submitted to evaluation by a speech pathologist and divided into two groups, ie, successful esophageal speakers (N=12) and unsuccessful esophageal speakers (N=8), according to a scale validated by Wepman et al (1953). The upper esophageal sphincter (UES) pressure was assessed by manometry both at rest and during the following voice emissions in Portuguese: the vowel "a," the monosyllable "pa," and the sentence "papai papou pipoca." The amplitude, the duration of the pressure wave, and the area under the curve were measured.
At rest, the mean UES pressure was 11.83 mm Hg for successful esophageal speakers and 9.92 mm Hg for unsuccessful esophageal speakers, with no significant difference between groups; the mean for the two groups as a whole was 11.06 mm Hg. During the voice and speech sequence tests, no significant difference was observed when the emissions in Portuguese of "a," "pa," and the sentence were analyzed separately.
As the pressure observed at rest did not differ between the successful esophageal speakers and the unsuccessful esophageal speakers, and the amplitude, the duration of the pressure wave, and the area under the amplitude x duration curve were also equal for both groups, we conclude that the cricopharyngeal segment pressure is not a preponderant factor for the acquisition of esophageal voice and speech.
全喉切除术后，上消化道的中断以及环咽段的切断改变了咽食管移行部的高压区，这不仅会开始具备消化功能，还会被刺激承担起发声和言语的功能。在环咽段观察到的压力似乎是食管发声发展的关键因素，而测压法是能够量化该区域所观察到压力的方法。
本研究的目的是使用测压法评估成功或不成功的食管发声喉切除患者在静息状态和食管发声时的食管上括约肌压力。
20名年龄在32至83岁（平均44.2岁）的喉切除患者接受了言语病理学家的评估，并根据Wepman等人（1953年）验证的量表分为两组，即成功的食管发声者（N = 12）和不成功的食管发声者（N = 8）。通过测压法在静息状态以及在发出葡萄牙语的以下语音时评估食管上括约肌（UES）压力：元音“a”、单音节“pa”和句子“papai papou pipoca”。测量压力波的幅度、持续时间以及曲线下面积。
静息状态下，成功的食管发声者的平均UES压力为11.83 mmHg，不成功的食管发声者为9.92 mmHg，两组之间无显著差异；两组总体平均值为11.06 mmHg。在语音和言语序列测试期间，分别分析葡萄牙语的“a”、“pa”和句子的发声时，未观察到显著差异。
由于成功的食管发声者和不成功的食管发声者在静息状态下观察到的压力没有差异，并且两组的压力波幅度、持续时间以及幅度×持续时间曲线下面积也相等，我们得出结论，环咽段压力不是获得食管发声和言语的主要因素。
