Vuyk H D, Klinkenberg-Knol E, Tiwari R M
J Laryngol Otol. 1986 Jan;100(1):59-68. doi: 10.1017/s0022215100098753.
The Staffieri method was used for voice rehabilitation after total laryngectomy in our patients. Leakage of saliva has been a problem in some. It has been suggested that aspiration could be due to specific pressure relations in the pharynx, upper oesophageal sphincter and cervical oesophagus during deglutition (Mann et al., 1980). Regarding voice production, the upper oesophageal sphincter is probably the main sound source, functioning in essentially the same way as in oesophageal speech. Intraluminal pressure recordings at rest and during swallowing were used in 16 Staffieri speakers and 9 oesophageal speakers. Upper oesophageal sphincter dysfunction was seen more often in Staffieri speakers with aspiration problems than in Staffieri speakers without aspiration problems, but the relation is not clearly understood. A definite relation could be established between upper oesophageal sphincter function in terms of relaxation and coordination and aerodynamic pressure measured in the tracheostoma, necessary to sustain phonation. After dilatation of the oesophagus, produced by the inflow of air, a reflex rise in the upper oesophageal sphincter pressure is thought to occur. The pressure necessary to sustain phonation probably depends on the extent to which this reflex mechanism occurs and on the ability of the patient to induce a relaxation of the upper oesophageal sphincter before air expulsion. Selective myotomy will possibly lower the necessary pressure and enhance vocal rehabilitation. Whether this will solve a part of the aspiration problems in Staffieri speakers is completely unpredictable, as the relation of the motor function of the upper oesophageal sphincter and the aspiration problems is not well understood.
我们的患者在全喉切除术后采用斯塔菲耶里方法进行嗓音康复。部分患者存在唾液渗漏问题。有研究表明，吞咽过程中咽部、食管上括约肌和颈段食管的特定压力关系可能导致误吸（曼恩等人，1980年）。关于发声，食管上括约肌可能是主要声源，其功能与食管言语基本相同。对16名采用斯塔菲耶里方法的发声者和9名食管发声者进行了静息和吞咽时的腔内压力记录。有误吸问题的采用斯塔菲耶里方法的发声者比无误吸问题的采用斯塔菲耶里方法的发声者更常出现食管上括约肌功能障碍，但这种关系尚不清楚。可以确定，食管上括约肌在松弛和协调方面的功能与维持发声所需的气管造口处测量的气动压力之间存在明确关系。空气流入导致食管扩张后，食管上括约肌压力会反射性升高。维持发声所需的压力可能取决于这种反射机制发生的程度以及患者在空气排出前诱导食管上括约肌松弛的能力。选择性肌切开术可能会降低所需压力并增强嗓音康复效果。这是否能解决采用斯塔菲耶里方法的发声者的部分误吸问题完全无法预测，因为食管上括约肌的运动功能与误吸问题之间的关系尚未完全了解。
