Tracheo-oesophageal 'puncture speech'. An assessment technique for failed oesophageal speakers.

We describe the assessment procedures used at Charing-Cross Hospital to investigate laryngectomees who failed to develop oesophageal voice and give the results of assessment in 50 patients. Anatomical or physiological abnormalities in the reconstructed pharynx were found in all patients, and we feel these significantly contributed to the failure of achieving an oesophageal voice. The four cases of failure were due to hypotonicity of the pharyngo-oesophageal muscles, hypertonicity, frank spasm and stricture. This distinction can be used as a functional classification of failure as treatment for each group has to be different if successful surgical voice restoration is to be achieved. Patients with hypotonicity need to use external pressure; those with mild hypertonicity are able to use a low pressure tracheo-oesophageal voice prosthesis; those with spasm need a pharyngo-oesophageal myotomy prior to "puncture", while those with stricture need surgical correction.