title: Mechanism of tracheoesophageal shunt phonation.
abstract: OBJECTIVE
  To elucidate the phonatory mechanism of tracheoesophageal shunt speech after total laryngectomy, we examined the dynamics and origin of neoglottis in tracheoesophageal shunt speakers.
  
  
  METHODS
  We conducted the videofluoroscopic, strobofiberscopic, and electromyographic studies of the pharyngoesophageal segment in tracheoesophageal shunt photonation.
  
  
  METHODS
  Academic referral medical center.
  
  
  METHODS
  Twenty-five tracheoesophageal shunt speakers were examined.
  
  
  RESULTS
  Videofluorescopic and fiberscopic examinations showed two bulges in the pharyngeoesophageal segment. The upper bulge was revealed to be the sound source of tracheoesophageal shunt speech by the stroboscopic examination; anteroposterior and undulating regular movements were observed. Electromyographic study elucidated the contribution of muscle contraction to the two bulges; the upper bulge is formed by the thyropharyngeal muscle, whereas the lower bulge corresponds to the cricopharyngeal muscle.
  
  
  CONCLUSIONS
  The neoglottis was considered to be formed by the stenotic portion due to thyropharyngeal muscle contraction and mucosal vibration due to expiratory airflow. This new understanding of the phonatory mechanism will be indispensable in the treatment of cases with failing shunt speech.
authors.affiliation: Department of Otolaryngology, Faculty of Medicine, Kyoto, Japan University.
authors.forename: K
authors.initials: K
authors.lastname: Omori
authors.forename: H
authors.initials: H
authors.lastname: Kojima
authors.forename: M
authors.initials: M
authors.lastname: Nonomura
authors.forename: H
authors.initials: H
authors.lastname: Fukushima
mesh_terms: D000368:Aged; D002933:Cineradiography; D004576:Electromyography; D004724:Endoscopy; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005336:Fiber Optic Technology; D005471:Fluoroscopy; D005931:Glottis / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D010609:Pharyngeal Muscles / Q000502:physiology / Q000601:surgery; D010614:Pharynx / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D010699:Phonation / Q000502:physiology*; D013071:Speech, Alaryngeal; D014132:Trachea / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D014732:Vibration; D014833:Voice Quality