Use of computerized manometry for the detection of pharyngoesophageal spasm in tracheoesophageal speech.

OBJECTIVE: To evaluate the utility of computerized manometry (CM) to identify pharyngoesophageal segment (PES) spasm during tracheoesophageal speech. STUDY DESIGN: Prospective clinical, controlled study. SUBJECTS AND METHODS: Intraluminal pressures of the PES were collected in 12 tracheoesophageal speakers without spasm and 8 tracheoesophageal speakers with PES spasm before and after localized injection of botulinum toxin to the PES. All subjects underwent voice analysis and videofluoroscopy in addition to CM before and after treatment. RESULTS: All tracheoesophageal speakers with PES spasm presented with mean intraluminal pressures greater than 16 mmHg (mean, 25.36 mmHg). In contrast, mean intraluminal pressures of subjects without spasm was 11.76 mmHg (P<0.05). The negative predictive value associated with the use of 16 mmHg as a threshold value for spasm was 100%. CONCLUSION: CM is a clinically useful tool to aid in speech rehabilitation for tracheoesophageal speakers. Intraluminal pressures of greater than 16 mmHg was highly predictive for PES spasm.

Botulinum toxin in speech rehabilitation with voice prosthesis after total laryngectomy.

UNLABELLED: In tracheo esophageal puncture (TEP), we carry out a myotomy of the pharynx constrictor muscle; however, about 9 to 79% of patients need such procedure. The consequence of such procedure is an increase in salivary fistula rates in the postoperative. Botulin toxin is used in an outpatient basis. AIM: analyzing the efficacy of botulin toxin (BT) use in the rehabilitation of totally laryngectomized patients with tracheo-esophageal voice (TEV) with spasms (S) of the pharyngo-esophageal segment (PES) without myotomy. MATERIALS AND METHODS: We analyzed eight patients submitted to total laryngectomy (TL), rehabilitated with TEV, with speech prosthesis (SP) and struggle to utter voice because of PES spasms. They were all submitted to treatment of such motor alteration with the injection of 100 units of BT in the PES. The evaluation was based on perceptive voice analysis, video fluoroscopy (VF) of the PES, acoustic voice analysis and computerized manometry (CM) of the PES, all before and after BT injection. STUDY DESIGN: prospective. RESULTS: There was a reduction in PES CM pressure after BT injection. Acoustic analysis showed an improvement in harmonics quality after treatment. There was smoother voice utterance and spasm improvement after BT. CONCLUSION: all patients with PES spasms presented vocal improvement after BT injection in the PES.

Reabilitação fonatória do laringectomizado total: utilização de toxina botulínica na voz tráqueo-esofágica com prótese fonatória / Botulinum toxin in speech rehabilitation with voice prosthesis after total laryngectomy

Na punção tráqueo-esofágica(PTE) é realizada miotomia do músculo constritor da faringe, mas sua necessidade é entre 9 por cento a 79 por cento dos pacientes. Sua realização pode aumentar as taxas de fístula salivar no pós-operatório. A aplicação da TB é ambulatorial. OBJETIVO: Análise da eficácia da aplicação de toxina botulínica (TB), na reabilitação do laringectomizado total com voz tráqueo-esofágica(VTE) com espasmo(E) do segmento faringo-esofágico (SFE) sem miotomia. MATERIAL E MÉTODOS: Análise de oito pacientes submetidos à laringectomia total (LT), reabilitados com VTE com prótese fonatória (PF), esforço para emissão de voz devido à E do SFE. Todos submetidos a tratamento dessa alteração motora com injeção de 100 unidades de TB no SFE. A avaliação constituiu-se de análise perceptiva de voz, videofluoroscopia (VF) do SFE, análise acústica de voz e manometria computadorizada (MC) do SFE, todos antes e após aplicação de TB. DESENHO DE ESTUDO: Estudo prospectivo. RESULTADOS: Houve diminuição na pressão à MC do SFE, após a injeção de TB. Análise acústica demonstrou melhora na qualidade de harmônicos após o tratamento. Houve emissão de voz sem esforço e melhora do E após o uso da TB. CONCLUSÃO: Todos os pacientes com E do SFE apresentaram melhora vocal após aplicação da TB neste SFE.

In tracheo esophageal puncture (TEP), we carry out a myotomy of the pharynx constrictor muscle; however, about 9 to 79 percent of patients need such procedure. The consequence of such procedure is an increase in salivary fistula rates in the postoperative. Botulin toxin is used in an outpatient basis. AIM: analyzing the efficacy of botulin toxin (BT) use in the rehabilitation of totally laryngectomized patients with tracheo-esophageal voice (TEV) with spasms (S) of the pharyngo-esophageal segment (PES) without myotomy. MATERIALS AND METHODS: We analyzed eight patients submitted to total laryngectomy (TL), rehabilitated with TEV, with speech prosthesis (SP) and struggle to utter voice because of PES spasms. They were all submitted to treatment of such motor alteration with the injection of 100 units of BT in the PES. The evaluation was based on perceptive voice analysis, video fluoroscopy (VF) of the PES, acoustic voice analysis and computerized manometry (CM) of the PES, all before and after BT injection. STUDY DESIGN: prospective. Results: There was a reduction in PES CM pressure after BT injection. Acoustic analysis showed an improvement in harmonics quality after treatment. There was smoother voice utterance and spasm improvement after BT. CONCLUSION: all patients with PES spasms presented vocal improvement after BT injection in the PES.

[Diffuse esophageal spasm (DES). Practical concepts of diagnosis and treatment]. / El espasmo esofágico difuso (EED). Conceptos prácticos sobre diagnóstico y tratamiento.

Diffuse esophageal spasm (DES) is a motility disorder of undetermined etiology, typically presenting with chest pain, dysphagia or both. The aim of this paper is to provide a critical review of the prevalence, pathogenesis, diagnosis and therapy of DES. Data from referral centers indicates that this is a rare disorder with a prevalence of 4-7%. The diagnosis is based on the combination of typical symptoms, radiological findings and manometry (simultaneous contractions (SC) in the distal esophagus in > or = 20% of wet swallows mixed with normal peristalsis). The pathogenesis remains poorly understood. Recent evidence suggests that nitric oxide deficiency may explain the SC that characterizes this condition at manometry. Gastroesophageal reflux (GER) can coexist in DES and GER has also been implied in the pathogenesis of DES. Whether patients with DES and GER represent a subtype of DES with a different prognosis or outcome is unknown. We present a critical appraisal regarding different therapeutic approaches available for DES and conclude suggesting a management algorithm based on current available literature.

Emprego da toxina botulínica no tratamento do espasmo difuso esofagiano. Relato de caso / Use of botulin toxin in the treatment of esiohageal spasm. Case report

O espasmo difuso do esôfago destaca-se dos demais distúrbios motores pela gravidade dos sintomas e falta de resposta satisfatória ao tratamento conservador. Esta condiçao requer indicaçao de tratamento cirúrgico ou dilatador. Nos pacientes de alto risco cirúrgico, esta situaçao configura grave problema, pela falta de outra opçao terapêutica. Em paciente nessa condiçao utilizamos a injeçao endoscópica de toxina botulínica na cárdia com bons resultados após seguimento de três meses. Apesar do curto período de observaçao, acreditamos que a infiltraçao de toxina botulínica na cárdia constitui opçao terapêutica válida no tratamento do espasmo difuso do esôfago.

[Use of botulin toxin in the treatment of diffuse esophageal spasm. A case report]. / Emprego da toxina botulínica no tratamento do espasmo difuso esofagiano. Relato de caso.

The diffuse esophageal spasm distinguishes from others esophageal disturbs by the symptoms severity and bad results to conservative treatment. This situation requires formal indication to surgical treatment or dilation. In high risk patients this situation becomes a big problem, due to the lack of another therapeutic option. In a patient with this problem we use an endoscopic injection of botulin toxin in cardia with good results in three months follow-up. Despite this short period of observation we believe that the infiltration with botulin toxin in cardia constitutes a valid therapeutic option in treatment of diffuse esophageal spasm.