Coffey Margaret M, Tolley Neil, Howard David, Hickson Mary
Imperial College Healthcare Trust, SLT Department, Charing Cross Hospital, Ground Floor, South Wing, Fulham Palace Road, London, W6 8RF, UK.
Imperial College Healthcare Trust, ENT Department, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
Dysphagia. 2018 Oct;33(5):616-626. doi: 10.1007/s00455-018-9880-0. Epub 2018 Feb 19.
Voice prostheses have been examined for their effect on voice production but there is little datum on their effect on swallow function. This study investigated the difference between six commonly available voice prostheses in terms of swallowing. Laryngectomy patients had up to six voice prostheses placed in a random order over two visits. Swallowing was evaluated for each prosthesis using FEES (Fibreoptic Endoscopic Evaluation of Swallowing). After each prosthesis trial, patients self-evaluated their experience of swallowing. Three independent experts indicated which prosthesis they considered best for swallowing for each patient and judged residue on the voice prosthesis and in the upper esophagus. Raters were blinded to participant details, voice prosthesis type and scores of other raters. On patient self-evaluation, scores were equally distributed across all prostheses for swallowing. Experts most frequently chose the Blom Singer Low pressure and Blom Singer Classic Indwelling voice prostheses as best for swallowing but consensus was poor for most patients. Experts found that the Blom Singer Classic Indwelling and the Provox Vega had least residue on the voice prosthesis on thin liquid (p ≤ 0.001) and soft (p = 0.001), respectively. Experts also found that the Blom Singer Low Pressure had least residue in the upper esophagus on soft consistency (p ≤ 0.001). While self-evaluation by patients did not identify a consistently preferred prosthesis for swallow, many patients expressed personal preferences, suggesting benefits to involving patients in the choice of prosthesis. Some voice prostheses may be associated with lower levels of residue on the prosthesis and upper esophagus with certain consistencies.
已对语音假体对语音产生的影响进行了研究，但关于其对吞咽功能影响的数据却很少。本研究调查了六种常用语音假体在吞咽方面的差异。喉切除患者在两次就诊期间以随机顺序最多佩戴六种语音假体。使用纤维内镜吞咽评估（FEES）对每种假体的吞咽情况进行评估。在每次假体试验后，患者对自己的吞咽体验进行自我评估。三位独立专家指出他们认为对每位患者吞咽最有利的假体，并判断语音假体和上食管中的残留物情况。评分者对参与者的详细信息、语音假体类型和其他评分者的分数不知情。在患者自我评估中，吞咽评分在所有假体中均匀分布。专家最常选择Blom Singer低压和Blom Singer经典留置语音假体作为最有利于吞咽的假体，但大多数患者的共识性较差。专家发现，Blom Singer经典留置假体和Provox Vega在稀薄液体（p≤0.001）和软性食物（p = 0.001）情况下，语音假体上的残留物最少。专家还发现，Blom Singer低压假体在软性食物情况下上食管中的残留物最少（p≤0.001）。虽然患者的自我评估未确定一种始终被偏爱的吞咽假体，但许多患者表达了个人偏好，这表明让患者参与假体选择有益处。某些语音假体在特定质地的食物情况下，可能与假体和上食管中较低水平的残留物有关。
