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2 results

  • 9 - Airstream Mechanisms: Clicks, Implosives, Ejectives, Esophageal Speech

  • Ian R. A. MacKay, University of Ottawa
  • Book:
    Phonetics and Speech Science
    Published online:
    19 May 2023
    Print publication:
    11 May 2023, pp 211-229

  • Summary

    Airstream mechanism refers to the mechanism by which air pressure or airflow is created in order to power speech production. The most basic and universal is the pulmonic airstream mechanism, whereby the lungs power an egressive airflow that produces both an airstream and a heightened air pressure when the vocal tract is blocked. The glottalic airstream mechanism involves vertical movement of the larynx with closed glottis, pushing air upward or drawing air in. This mechanism produces ejectives (glottalized consonants) and implosives. The velaric airstream mechanism produces clicks and is powered by tongue movements. Esophageal speech is produced by a controlled release of air from the esophagus (i.e., belching) in which the vibration of the esophageal sphincter substitutes for the vibration of the vocal folds.

  • Primary versus secondary tracheoesophageal puncture: systematic review and meta-analysis

  • P D Chakravarty, A E L McMurran, A Banigo, M Shakeel, K W Ah-See
  • Journal:
    The Journal of Laryngology & Otology / Volume 132 / Issue 1 / January 2018
    Published online by Cambridge University Press:
    27 November 2017, pp. 14-21
    Print publication:
    January 2018
    • Article
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  • Background:

    Tracheoesophageal puncture represents the ‘gold standard’ for voice restoration following laryngectomy. Tracheoesophageal puncture can be undertaken primarily during laryngectomy or in a separate secondary procedure. There is no current consensus on which approach is superior. The current evidence comparing primary and secondary tracheoesophageal puncture was assessed.

    Methods:

    A systematic review and meta-analysis of articles comparing outcomes for primary and secondary tracheoesophageal puncture after laryngectomy were conducted. Outcome measures were: voice success, overall complication rate and pharyngocutaneous fistula rate.

    Results:

    Eleven case series met the inclusion criteria, two prospective and nine retrospective. Meta-analysis did not demonstrate statistically significant differences in overall complication rate or voice outcomes, though it suggested a significantly increased risk of pharyngocutaneous fistula in primary compared to secondary tracheoesophageal puncture.

    Conclusion:

    Primary tracheoesophageal puncture is a safe and efficient approach for voice rehabilitation. However, secondary tracheoesophageal puncture should be preferred where there is a higher risk of pharyngocutaneous fistula.