Tracheoesophageal Voicing Following Resistance-Based Dysphagia Rehabilitation: An Exploratory Multidimensional Assessment

Abstract

Background: This exploratory study investigated tracheoesophageal voicing following 6 weeks of resistance-based dysphagia rehabilitation with the SEA2.0, using a multidimensional assessment approach.

Methods: Twenty laryngectomized participants were assessed at T0 (baseline), T1 (after 6 weeks training), and T2 (after 8 weeks rest). Training included the chin tuck, jaw opening, and effortful swallow against resistance. Multidimensional assessments included acoustic analysis (AVQI, intensity, dynamic range), clinician-rated perceptual evaluations (voice tonicity, intelligibility), PROMs (VHI-10, V-RQOL, CPIB-10), and tracheal manometry and pharyngeal-/esophageal high-resolution impedance manometry during voicing.

Results: No significant changes in mean AVQI, intensity, dynamic range, voice tonicity, intelligibility, PROMs, and physical outcomes (manometry) were found. However, several clinically relevant changes, mostly improvements, were noted in 14 participants for AVQI and PROMs.

Conclusion: Tracheoesophageal voice, on average, is not affected by resistance-based muscle training for swallowing rehabilitation. For some participants, however, several clinically relevant improvements in voice quality and quality of life were noticeable.

Keywords: high‐resolution (impedance) manometry; swallowing rehabilitation; total laryngectomy; tracheal pressure; tracheoesophageal voice.

FIGURE 1

Exercises performed with the Swallowing Exercise Aid 2.0 (SEA2.0). From left to right: (1) resting position, (2) chin tuck against resistance, (3) jaw opening against resistance, (4) effortful swallow against resistance. Picture of the Swallowing Exercise Aid 2.0 (SEA2.0). [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

The 3D‐printed connector for the tracheal pressure measurement with the FLUKE Gasflow Analyzer VT590 consists of a ring that fits the stoma adhesive (1), a cone that accommodates the 1‐m plastic flexible tube between the connector and the GFA device (2), and a front opening for the participant's heat and moisture exchanger (HME) filter (3). [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Videofluoroscopic image of a participant with the pharyngeal high‐resolution impedance manometry (HRIM)—catheter in situ.

FIGURE 4

Example of tracheal (air) pressure (in mmHg) per second for various tracheoesophageal voice tasks, measured using the FLUKE VT590 gas flow analyzer. During inhalations, the pressure drops below zero.

FIGURE 5

Color plot of HRIM measurement during swallow and tracheoesophageal voicing. Blue, no pressure (~0 mmHg); green, low pressure (~45 mmHg); red, high pressure (~100 mmHg). [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 6

Heat map for β estimates from standardized linear mixed effect regression models for all parameter pairs. Formula: Dependent − Predictor + (1|Subject). The numbers are the coefficient estimates (β) for all pairs where the absolute value of I was ≥ 0.4. CPIB, Communication Participation Item Bank; CSpmean, mean tracheal pressure of 3 s of continued speech; dBSoft/Low/High/Loud/Neu, intensity in dB of sustained vowel/a/on soft/low/high/loud/neutral pitch; DynRange, dynamic range (maximal‐minimal) in intensity; HRMSoft/Neu/Low/High/Loud, esophageal pressure measured with high‐resolution (impedance) manometry during sustained vowel/a/on soft/neutral/low/high/loud pitch; SVpmean, mean tracheal pressure of 3 s of the sustained vowel/a/on neutral pitch; TrachPSoft/Low/Loud/High/Neu, Tracheal air pressure measured in mmHg with the FLUKE during sustained vowel/a/on soft/low/loud/high/neutral pitch; VHI, Voice Handicap Index‐10; VRQOL, Voice‐Related Quality of Life. [Color figure can be viewed at wileyonlinelibrary.com]