1. Stomal manometry as a simple objective measure of pharyngo oesophageal tonicity
S Ahluwalia, R Govender, P Stimpson, P O’Flynn, F Vaz
Dept Head & Neck Cancer Surgery and Speech & Language Therapy
BAHNO LONDON April 2010
Introduction
Most laryngectomees have a tracheo oesophageal puncture (TOP) performed with one way prosthesis inserted allowing the majority to gain satisfactory and functional voice. A small proportion fail to achieve good voice restoration due to hypertonicity or spasm of the pharyngo oesophageal segment (PES) resulting in inability of this area to relax.
Stomal manometry is effective in demonstrating high pressures in the PES which are subsequently reduced on administration of Botulinum toxin (BT).
BT is used to selectively relax the vibratory segment resulting in voice improvement.
Table I
Methods
5 laryngectomees who failed to achieve satisfactory voice due to PES spasm or hypertonicity as diagnosed on videofluoroscopy were selected.
Voice was assessed by a locally developed protocol including patient and clinician rated voice measures, videofluoroscopy and manometry using the Sunderland air pressure meter.
100U Botulinum toxin was administered in 3 places via fine needle injection into the PES.
Voice assessement was repeated after 4 weeks.
Patient
Pressure mmHG
Pre Botox
Post Botox 1 55 22 2 61 43 3 54 26 4 33 29 5 53 34
Results
Voice quality improved in all patients as assessed by questionnaire. Manometric analysis revealed reduction in tracheal back pressure in all patients following BT administration.
Table I
Mean manometric pressure was 51 cmH2O (SD 11) prior to and 31 cmH2O (SD 8) following treatment.
Table II
Statistical analysis using a paired t-test revealed a statistically significant difference between pre and post BT manometric tracheal back pressure. (p=0.01) .
Table II
Pre Botox
Post Botox
Mean 51 31 SD 11 8
SEM 5 4 N
Conclusions
Stomal pressure measurement is an effective means of assessment for the PES segment response to BT injection in the management of hypertonicity or spasm.
Protocol driven assessment is essential for identification of appropriate patients and monitoring outcome.
Manometry counting
post Botox
Manometry counting
pre Botox
The Sunderland Air Pressure Meter