Defining and predicting tracheoesophageal puncture success.

There is considerable variability in the reported success rates of tracheoesophageal puncture due, in part, to the lack of a clear definition of success and a paucity of knowledge about factors that determine success. In this article, we define success on a continuum with the use of a 15-point rating scale that incorporates aspects of use and quality of speech and ability to care for the fistula and prosthesis. We suggest a cutoff score for functional and nonfunctional speakers. We define immediate and short- and long-term success. Variables related to the patient, clinician, surgical procedure, and extent of disease were subjected to a multiple regression analysis to determine which predicted success. Overall success was predicted by greater clinician expertise, younger patient age, and better patient health. We discuss the use of the rating scale and an equation to predict success.

Laryngectomee study: clinical and radiologic correlates of esophageal voice.

This study reports the results of an analysis of the relationship between clinical and radiologic factors, on the one hand, and the acquisition of esophageal speech, on the other. It involved 25 laryngectomees who underwent videofluoroscopy of their pseudoglottis at least 6 months following laryngectomy. Significant correlations were found between esophageal speech performance and each of the following variables: tumor size, pseudoglottis length, pseudoglottis shape, and presence of a geometric prominence on the posterior hypopharyngeal wall. The most important is the logarithmic correlation between speech skill and pseudoglottis length. Other factors that yielded controversial results in previous studies were not found significant in this investigation.