Comparison of Pharyngoesophageal Segment Biomechanics Between Persons with Total Laryngectomy With and Without Dysphagia Using sEMG: A Multicentric Swallow Study


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.

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  1. 1.

    Maclean J, Cotton S, Perry A. Variation in surgical methods used for total laryngectomy in Australia. J Laryngol Otol. 2008;122(7):728–32.

    CAS  Article  Google Scholar 

  2. 2.

    McConnel FM, Hester TR, Mendelsohn MS, Logemann JA. Manofluorography of deglutition after total laryngopharyngectomy. Plast Reconstr Surg. 1988;81(3):346–51.

    CAS  Article  Google Scholar 

  3. 3.

    Welch RW, Luckmann K, Ricks PM, Drake ST, Gates GA. Manometry of the normal upper esophageal sphincter and its alterations in laryngectomy. J Clin Invest. 1979;63(5):1036–41.

    CAS  Article  Google Scholar 

  4. 4.

    McConnel FMS, Mendelsohn MS, Logemann JA. Examination of swallowing after total laryngectomy using manofluorography. Head Neck Surg. 1986;9(1):3–12.

    CAS  Article  Google Scholar 

  5. 5.

    Schobinger R. Spasm of the cricopharyngeal muscle as cause of dysphagia after total laryngectomy. AMA Arch Otolaryngol. 1958;67(3):271–5.

    CAS  Article  Google Scholar 

  6. 6.

    Crary MA, Carnaby (Mann) GD, Groher ME. Identification of swallowing events from sEMG signals obtained from healthy adults. Dysphagia. 2007;22(2):94–9.

    Article  PubMed  Google Scholar 

  7. 7.

    Lippert D, Hoffman MR, Britt CJ, Jones CA, Hernandez J, Ciucci MR, McCulloch TM. Preliminary evaluation of functional swallow after total laryngectomy using high-resolution manometry. Ann Otol Rhinol Laryngol. 2016;125(7):541–9.

    Article  Google Scholar 

  8. 8.

    Balfe DM, Koehler RE, Setzen M, Weyman PJ, Baron RL, Ogura JH. Barium examination of the esophagus after total laryngectomy. Radiology. 1982;143(2):501–8.

    CAS  Article  Google Scholar 

  9. 9.

    Hillman RE, Walsh MJ, Wolf GT, Fisher SG, Hong WK. Functional outcomes following treatment for advanced laryngeal cancer: Part I–voice preservation in advanced laryngeal cancer; Part II–laryngectomy rehabilitation: the state of the art in the VA system. Ann Otol Rhinol Laryngol. 1998;107(5):2.

    Google Scholar 

  10. 10.

    Landera MA, Lundy DS, Sullivan PA. Dysphagia after total laryngectomy. Perspect Swallowing Swallowing Disord. 2010;19(2):39–44.

    Article  Google Scholar 

  11. 11.

    Starmer HM, Tippett DC, Webster KT. Effects of laryngeal cancer on voice and swallowing. Otolaryngol Clin North Am. 2008;41(4):793–818.

    Article  Google Scholar 

  12. 12.

    Duranceau A, Jamieson G, Hurwitz AL, Jones RS, Postlethwait RW. Alteration in esophageal motility after laryngectomy. Am J Surg. 1976;131(1):30–5.

    CAS  Article  Google Scholar 

  13. 13.

    Hanks JB, Fisher SR, Postlethwait RW, Meyers WC, Jones RS, Christian KC. Effect of total laryngectomy on esophageal motility. Ann Otol Rhinol Laryngol. 1981;90(4):331–4.

    CAS  Article  Google Scholar 

  14. 14.

    Vaiman M, Eviatar E, Segal S. Evaluation of normal deglutition with the help of rectified surface electromyography records. Dysphagia. 2004;19(2):125–32.

    Article  PubMed  Google Scholar 

  15. 15.

    Vaiman M, Eviatar E, Segal S. Surface electromyographic studies of swallowing in normal subjects: a review of 440 adults. Report 2. Quantitative data: amplitude measures. Otolaryngol Neck Surg. 2004;131(5):773–80.

    Article  Google Scholar 

  16. 16.

    Crary MA, Carnaby GD, Groher ME. Biomechanical correlates of surface electromyography signals obtained during swallowing by healthy adults. Lang Hear Res: J Speech; 2006.

    Book  Google Scholar 

  17. 17.

    Ackerstaff AH, Hilgers FJM, Aaronson NK, Balm AJM. Communication, functional disorders and lifestyle changes after total laryngectomy. Clin Otolaryngol Allied Sci. 1994;19(4):295–300.

    CAS  Article  Google Scholar 

  18. 18.

    Maclean J, Szczesniak M, Cotton S, Cook I, Perry A. Impact of a laryngectomy and surgical closure technique on swallow biomechanics and dysphagia severity. Otolaryngol Neck Surg. 2011;144(1):21–8.

    Article  Google Scholar 

  19. 19.

    Zhang T, Szczesniak M, Maclean J, Bertrand P, Wu PI, Omari T, et al. Biomechanics of pharyngeal deglutitive function following total laryngectomy. Otolaryngol Neck Surg. 2016;155(2):295–302.

    Article  Google Scholar 

  20. 20.

    Moerman M, Fahimi H, Ceelen W, Pattyn P, Vermeersch H. Functional outcome following colon interposition in total pharyngoesophagectomy with or without laryngectomy. Dysphagia. 2003;18(2):78–84.

    Article  Google Scholar 

  21. 21.

    Dantas RO, Aguiar-Ricz LN, Gielow I, Filho FVM, Mamede RCM. Proximal esophageal contractions in laryngectomized patients. Dysphagia. 2005;20(2):101–4.

    Article  PubMed  Google Scholar 

  22. 22.

    Monaco A, Cattaneo R, Spadaro A, Giannoni M. Surface electromyography pattern of human swallowing. BMC Oral Health. 2008;8(1):6.

    Article  Google Scholar 

  23. 23.

    Regan J, Walshe M, Timon C, McMahon BP. Endoflip® evaluation of pharyngo-oesophageal segment tone and swallowing in a clinical population: a total laryngectomy case series. Clin Otolaryngol. 2015;40(2):121–9.

    CAS  Article  Google Scholar 

  24. 24.

    Hrycyshyn AW, Basmajian JV. Electromyography of the oral stage of swallowing in man. Am J Anat. 1972;133(3):333–40.

    CAS  Article  Google Scholar 

  25. 25.

    Gupta V, Reddy NP, Canilang EP. Surface EMG measurements at the throat during dry and wet swallowing. Dysphagia. 1996;11(3):173–9.

    CAS  Article  Google Scholar 

  26. 26.

    Molfenter SM, Cliffe Polacco R, Steele CM. The validity of multiple swallows per bolus as a sign of swallowing impairment. In: European society of swallowing disorders. Leiden, The Netherlands: Dysphagia; 2011;476e88.

  27. 27.

    De Casso C, Slevin NJ, Homer JJ. The impact of radiotherapy on swallowing and speech in patients who undergo total laryngectomy. Otolaryngol Neck Surg. 2008;139(6):792–7.

    Article  Google Scholar 

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Our sincere thanks to NITTE Institute of Speech and Hearing, Mangalore, Karnataka and HCG Hospital, Bangalore for their support.

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Correspondence to Venkataraja U. Aithal.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Ethical Committee of Kasturba Hospital, Manipal (IEC No. 260/2018). The study was registered with Clinical Trials Registry of India (CTRI/2018/08/021018).

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Harsha Raj, G., Aithal, V.U. & Guddattu, V. Comparison of Pharyngoesophageal Segment Biomechanics Between Persons with Total Laryngectomy With and Without Dysphagia Using sEMG: A Multicentric Swallow Study. Dysphagia 35, 843–852 (2020).

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  • Surface electromyography
  • Total laryngectomy
  • Dysphagia
  • Deglutition problems
  • Pharyngoesophageal segment
  • Biomechanics