Comparison of Pharyngoesophageal Segment Biomechanics Between Persons with Total Laryngectomy With and Without Dysphagia
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ORIGINAL ARTICLE
Comparison of Pharyngoesophageal Segment Biomechanics Between Persons with Total Laryngectomy With and Without Dysphagia Using sEMG: A Multicentric Swallow Study G. Harsha Raj1 · Venkataraja U. Aithal2 · Vasudeva Guddattu3 Received: 25 September 2019 / Accepted: 29 January 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Total laryngectomy (TL) is the surgical treatment option for advanced stage of laryngeal cancer, involving the removal of larynx along with several muscles attached to it. Several anatomical changes occur following the surgery which will in turn affect the swallowing mechanism. The severing of the cricopharyngeus muscle, which is an important muscle of the pharyngoesophageal segment (PES), may lead to dysphagia. Several other causes have also been explained in the literature. Several invasive instruments have been used to identify dysphagia in this population. The present study aimed to identify the differences in the biomechanics of the PES during dry and wet swallow tasks in persons with TL with and without dysphagia. Amplitude and duration of movement of PES was analysed using a non-invasive instrumental method surface electromyography. The results indicate that amplitude of PES movement was significantly higher in dysphagic group for solids and semisolids. A significantly longer duration was observed for solid consistency for dysphagic group when compared to non-dysphagic group. sEMG evidences suggestive of differences in amplitude and duration between the TL with and without dysphagia groups. Findings also revealed that TL with dysphagia group require more effort to swallow solids and semisolid consistencies when compared to the effort exerted by them during liquid and dry swallow. Keywords Surface electromyography · Total laryngectomy · Dysphagia · Deglutition problems · Pharyngoesophageal segment · Biomechanics
Introduction Total laryngectomy (TL) is the surgical treatment option for advanced stage of laryngeal cancer, either when chemoradiation is not possible or when the treatment has failed. It involves surgical excision of the larynx, epiglottis, the strap
* Venkataraja U. Aithal [email protected] 1
Masters in Audiology and Speech Language Pathology, Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka 576104, India
2
Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka 576104, India
3
Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka 576104, India
muscles, thyroid and cricoid cartilage, hyoid bone, and up to 2 proximal tracheal rings. Following the surgery, there is a permanent separation of the trachea from the pharynx/esophagus. Thus, there is major disruption to the anatomy and physiology of the pharynx and there are marked changes to speech, swallowing, and respiratory
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