Caetano Gonçalo, Morgado Filipa, Póvoa Joana, Branquinho Francisco
Hospital da Senhora da Oliveira, Guimarães, Portugal.
Hospital Beatriz Ângelo, Lisboa, Portugal.
Acta Otorrinolaringol Esp (Engl Ed). 2025 May-Jun;76(3):512222. doi: 10.1016/j.otoeng.2025.512222. Epub 2025 Mar 20.
Tracheoesophageal (TEP) speech is the main voice rehabilitation method following laryngectomy. Pharyngoesophageal hypertonicity is one of the main causes for failure to achieve tracheoesophageal speech after laryngectomy. Botulinum toxin A (BTA) has been used to chemically denervate the pharyngeal musculature, and is an alternative to invasive surgical procedures. The aim of this work is to study the effectiveness and safety of this procedure.
MATERIAL & METHODS: A retrospective cohort study from 2019 to 2023 was performed of 20 patients with failure to achieve a functional tracheoesophageal voice following laryngectomy. These patients undergone local pharyngoesophageal segment BTA injection. A total of 100 units of BTA were injected at 6 different sites, 3 in each side. Perceptual ratings of voice quality were performed before and 72 h after BTA injection by a speech therapist using a 7-point equal-appearing interval scale.
Speech quality mean rating (μ) improved from 2.05 before to 4.55 after BTA injection (P = .004), 17 (85%) patients had an improvement in postinjection perceptual TEP speech quality ratings, with scores in the good-to-excellent range (5-6 in the 7-point equal-appearing interval scale) in 12 patients (60%). Three patients (15%) didn't improve their voice quality, two of them with no discernible TEP speech. No adverse effects were reported.
The majority of the patients enrolled in this study (85%) showed an improvement in TEP speech following BTA injection. This is a safe and effective method to improve TEP speech following laryngectomy.
气管食管造瘘发音（TEP）是喉切除术后主要的语音康复方法。咽食管张力亢进是喉切除术后无法实现气管食管造瘘发音的主要原因之一。A型肉毒杆菌毒素（BTA）已被用于化学性去神经支配咽肌组织，是侵入性外科手术的一种替代方法。本研究的目的是探讨该治疗方法的有效性和安全性。
对2019年至2023年间20例喉切除术后未能实现功能性气管食管造瘘发音的患者进行回顾性队列研究。这些患者接受了局部咽食管段BTA注射。在6个不同部位共注射100单位BTA，每侧各3个部位。在BTA注射前和注射后72小时，由言语治疗师使用7分等距量表对语音质量进行感知评分。
语音质量平均评分（μ）从注射前的2.05提高到注射后的4.55（P = 0.004），17例（85%）患者注射后感知到的TEP语音质量评分有所改善，其中12例（60%）患者的评分在良好至优秀范围内（7分等距量表中的5 - 6分）。3例（15%）患者的语音质量没有改善，其中2例没有可识别的TEP语音。未报告不良反应。
本研究纳入的大多数患者（85%）在BTA注射后TEP语音有所改善。这是一种改善喉切除术后TEP语音的安全有效的方法。
