Skip to main content Accessibility help

Effect of primary, cross-over, zigzag neopharyngoplasty on acoustic characteristics of alaryngeal, tracheoesophageal voice

  • O A Albirmawy (a1)



To evaluate the effect of primary, cross-over, zigzag neopharyngeal construction on tracheoesophageal voice, compared with pharyngoesophageal myotomy, following total laryngectomy with partial pharyngectomy.

Study design:

Prospective clinical trial.


Otolaryngology department, Tanta University Hospital (tertiary referral centre), Egypt.

Patients and methods:

Over five years, 30 patients underwent total laryngectomy with partial pharyngectomy to manage stage III or IV laryngeal cancer, followed by primary tracheoesophageal puncture for voice restoration. For neopharyngeal construction, 15 patients underwent pharyngoesophageal myotomy (group one) and 15 cross-over, zigzag neopharyngoplasty (group two). Acoustic parameters of tracheoesophageal voice were compared.


Most acoustic parameters were almost equivalent for the two groups, although significant differences were seen for loud intensity, dynamic range, shimmer, loud fundamental frequency, loud jitter, fluency and speaking rate. One post-operative pharyngocutaneous fistula (6.6 per cent) occurred in each group, and resolved with conservative measures.


The cross-over neopharyngoplasty modification of hypopharyngeal closure may help avoid pharyngoesophageal spasm and assist maintenance of effective voice amplitude, fundamental frequencies, temporal measures and perceptual values.


Corresponding author

Address for correspondence: Dr Osama Amin Albirmawy, 88 Reyad St, Tanta 31211, Gharbeya, Egypt E-mail:


Hide All
1Terada, T, Saeki, N, Toh, K, Uwa, N, Sagawa, K, Takayasu, S. Voice rehabilitation with Provox 2™ voice prosthesis following total laryngectomy for laryngeal and hypopharyngeal carcinoma. Auris Nasus Larynx 2007;34:6571
2Grolman, W, Eerenstein, SEJ, Tange, RA, Canu, G, Bogaardt, H, Dijkhuis, JP et al. Vocal efficiency in tracheoesophageal phonation. Auris Nasus Larynx 2008;35:83–8
3Kazi, R, Kanagalingam, J, Venkitaraman, R, Prasad, V, Clarke, P, Nutting, CM et al. Electroglottographic and perceptual evaluation of tracheoesophageal speech. J Voice 2009;23:247–53
4Singer, MI, Blom, ED, Hamaker, RC. Further experience with voice restoration after total laryngectomy. Ann Otol Rhinol Laryngol 1981;90:498502
5Blom, ED, Pauloski, BR, Hamaker, RC. Functional outcome after surgery for prevention of pharyngospasms in tracheoesophageal speakers. Part 1: speech characteristics. Laryngoscope 1995;105:1093–103
6Deschler, DG, Doherty, ET, Reed, CG, Hayden, RE, Singer, MI. Prevention of pharyngoesophageal spasm after laryngectomy with a half-muscle closure technique. Ann Otol Rhinol Laryngol 2000;109:514–18
7Albirmawy, OA, Elsheikh, MN, Saafan, ME, Elsheikh, E. Managing problems with tracheoesophageal puncture for alaryngeal voice rehabilitation. J Laryngol Otol 2006;120:470–7
8Albirmawy, OA, El-Guindy, AS, Elsheikh, MN, Saafan, ME, Darwish, ME. Effect of primary neopharyngeal repair on acoustic characteristics of tracheoesophageal voice after total laryngectomy. J Laryngol Otol 2009;123:426–33
9Singer, MI, Blom, ED, Hamaker, RC. Pharyngeal plexus neurectomy for alaryngeal speech rehabilitation. Laryngoscope 1986;96:50–4
10Hamaker, RC, Singer, MI, Blom, ED, Daniels, HA. Primary voice restoration at laryngectomy. Arch Otolaryngol 1985;111:182–6
11Clevens, RA, Esclamado, RM, Martshorn, DO, Lewin, JS. Voice rehabilitation after total laryngectomy and tracheoesophageal puncture using nonmuscle closure. Ann Otol Rhinol 1993;102:792–6
12Singer, MI, Blom, ED. Selective mytomy for voice restoration after laryngectomy. Arch Otolaryngol 1981;107:670–3
13Baugh, RF, Baker, SR, Lewis, JS. Surgical treatment of pharyngoesophageal spasm. Laryngoscope 1988;98:1124–6
14Yoshida, GY, Hamaker, RC, Singer, MI, Blom, ED. Primary voice restoration at laryngectomy: 1989 update. Laryngoscope 1989;99:1093–5
15Most, T, Tobin, Y, Mimran, RC. Acoustic and perceptual characteristics of esophageal and tracheoesophageal speech production. J Commun Disord 2000;33:165–81
16Hamaker, RC, Cheesman, AD. Surgical management of pharyngeal constrictor muscle hypertonicity. In: ED, Blom, MI, Singer, RC, Hamaker, eds. Tracheoesophageal Voice Restoration Following Total Laryngectomy. San Diego: Singular, 1998;33–9
17Deschler, DG, Doherty, ET, Reed, CG, Singer, MI. Effects of sound pressure levels on fundamental frequency in tracheoesophageal speakers. Otolaryngol Head Neck Surg 1999;121:23–6
18Moon, JB, Weinberg, B. Aerodynamic and myoelastic contributions to tracheoesophageal voice production. J Speech Hear Res 1987;30:387–95
19Omori, K, Kojima, H, Nonomura, M, Fukushima, H. Mechanism of tracheoesophageal shunt phonation. Arch Otolaryngol Head Neck Surg 1994;120:648–52
20Hui, Y, Wei, WI, Yuen, PW, Lam, LK, Nho, WK. Primary closure of pharyngeal remnant after total laryngectomy and partial pharyngectomy: how much residual mucosa is sufficient? Laryngoscope 1996;106:490–4
21Iwai, H, Tsuji, H, Tachikawa, T, Inoue, T, Izumikawa, M, Yamamichi, K et al. Neoglottic formation from posterior pharyngeal wall conserved in surgery for hypopharyngeal cancer. Auris Nasus Larynx 2002;29:153–7
22Robbins, J, Fisher, H, Blom, E, Singer, M. A comparative acoustic study of normal, esophageal, and tracheoesophageal speech production. J Speech Hear Dis 1984;49:202–10
23Blood, G. Fundamental frequency and intensity in laryngeal and alaryngeal speakers. J Communic Dis 1984;17:319–24
24Cornu, AS, Vlantis, AC, Elliott, H, Gregor, RT. Voice rehabilitation after laryngectomy with the Provox voice prosthesis in South Africa. J Laryngol Otol 2003;117:56–9
25Van As, CJ, Koopmans-Van Beinum, FJ, Pols, LCW, Hilgers, FJM. Perceptual evaluation of tracheoesphageal speech by naïve and experienced judges through the use of semantic scales. J Speech Lang Hear Res 2003;46:947–59
26Van Gogh, CD, Festen, JM, Verdonck-de Leeuw, IM, Parker, AJ, Traissac, L, Cheesman, AD, et al. Acoustical analysis of tracheoesophageal voice. Speech Communic 2005;47:160–8



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed