Phonation Using the Tracheo-Esophageal Shunt after Total Laryngectomy

A functional speech mechanism was created during laryngectomy in five patients. The method used involved construction of a shunt between the esophagus inferior to the superior esophageal constrictor and membranous portion of the trachea. Speech produced with the tracheo-esophageal shunt was highly intelligible and is functional after the nasal gastric tube is removed. Speech characteristics resemble closely those of superior esophageal speech. Pitch, intensity, and intelligibility were comparable to superior alaryngeal speech, and cinefluorographic analysis revealed that the pseudoglottis frequently used by esophageal speakers also was used by speakers with tracheo-esophageal shunts. Late stenosis has been the primary disadvantage; a new method to eliminate closure is being investigated. Since the tracheo-esophageal shunt can be used effectively in communication, further patient application and construction modifications are warranted.