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OBJECTIVE: The shape of esophageal dilators has not changed in over 350 years. Clinical and animal research suggests that the upper esophageal sphincter (UES) is not round but approximates a kidney shape and that cylindrical dilators may be suboptimal. The Infinity UES Dilation System has been developed specifically for the anatomic configuration of the UES. This study evaluates the safety of the UES-specific Infinity Dilation System. METHODS: All patients undergoing dilation of the UES between January 1, 2022 and September 1, 2023 were included. Demographics, procedure indication, dilator type, minor adverse events, and major complications were abstracted. Minor adverse events, complications, and maximum dilation dimension (mm) were compared between groups. RESULTS: A total of 477 patients were included. Eight hundred and seventy-three total UES dilations were performed. The primary indications for UES dilation were cricopharyngeus muscle dysfunction (43%) and stenosis from radiation toxicity (40%). Twenty-three percent (202/873) of dilations were performed with an Infinity balloon, 31% (270/873) were performed using two conventional balloons placed side by side, and 46% (401/873) were performed with one singleton conventional balloon. The average maximum dilation dimension was 33 (±4.7) mm for Infinity balloons, 32 (±3.8) mm for two side-by-side balloons, and 18 (±3.4) mm for singleton balloons. There were three major complications with conventional balloons and none with Infinity balloons. There were no significant differences in minor adverse events between groups. CONCLUSIONS: A UES-specific esophageal dilator provides a greater maximum dilation dimension and appears to be at least as safe as dilation with a single cylindrical balloon designed to dilate the esophagus. LEVEL OF EVIDENCE: Level 3 Laryngoscope, 2024.

Objective: The shape of esophageal dilators has not changed in over 350 years. Clinical and animal research suggests that the upper esophageal sphincter (UES) is not round but approximates a kidney shape and that cylindrical dilators may be suboptimal. The Infinity UES Dilation System has been developed specifically for the anatomic configuration of the UES. This study evaluates the safety of the UES‐specific Infinity Dilation System. Methods: All patients undergoing dilation of the UES between January 1, 2022 and September 1, 2023 were included. Demographics, procedure indication, dilator type, minor adverse events, and major complications were abstracted. Minor adverse events, complications, and maximum dilation dimension (mm) were compared between groups. Results: A total of 477 patients were included. Eight hundred and seventy‐three total UES dilations were performed. The primary indications for UES dilation were cricopharyngeus muscle dysfunction (43%) and stenosis from radiation toxicity (40%). Twenty‐three percent (202/873) of dilations were performed with an Infinity balloon, 31% (270/873) were performed using two conventional balloons placed side by side, and 46% (401/873) were performed with one singleton conventional balloon. The average maximum dilation dimension was 33 (±4.7) mm for Infinity balloons, 32 (±3.8) mm for two side‐by‐side balloons, and 18 (±3.4) mm for singleton balloons. There were three major complications with conventional balloons and none with Infinity balloons. There were no significant differences in minor adverse events between groups. Conclusions: A UES‐specific esophageal dilator provides a greater maximum dilation dimension and appears to be at least as safe as dilation with a single cylindrical balloon designed to dilate the esophagus. Level of Evidence: 3 Laryngoscope, 135:66–72, 2025 [ABSTRACT FROM AUTHOR]

Abstract Objective This comprehensive review aims to explain the disease pathophysiology, clinical presentation, and management options. Methods A review was carried out in the following databases: Medline, Scopus, Web of Science, and Cochrane. The following terms were used alone and combined: Retrograde, Cricopharyngeus muscle, Dysfunction, Abelchia, and inability to burp. Results A total of 68 articles were identified, and only 11 were found to be relevant and included in writing this review. Retrograde cricopharyngeal dysfunction (R‐CPD) is a relatively new disease entity that has recently been described in clinical literature. It is caused by the inability of the cricopharyngeus muscle to relax. Unlike cricopharyngeal dysfunction (CPD), which is well‐known and characterized by dysphagia, R‐CPD is characterized by the inability to belch in almost all patients, which is considered diagnostic for the condition. Conclusions High‐resolution manometry (HRM) is the definitive diagnostic modality. Most patients reported in the literature responded well to treatment with botulinum toxin injection.

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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. [ABSTRACT FROM AUTHOR]

Although the precise etiology of cricopharyngeus muscle (CPM) dysfunction (CPMD) is uncertain, many have hypothesized that a hypertrophied CPM may develop as a protective compensation against gastroesophageal reflux disease (GERD). The purpose of this investigation was to evaluate the association between CPMD and the presence of hiatal hernia (HH) in an attempt to elucidate the potential etiology of CPMD. The charts of individuals who underwent video fluoroscopic esophagrams between 01/01/14 and 10/30/16 were reviewed from an electronic database. A group of 50 subjects with reported HH were identified and age- and gender-matched to an individual without HH. The prevalence of CPMD was compared between groups. The mean (± SD) age of the HH cohort was 64 (± 13.4) years and 64 (± 12.8) years for the group without HH (p > 0.05). Thirty-eight percent was male. The frequency of CPMD in the HH group was 78% versus 58% in the non-HH group (p < 0.05). Individuals with a HH were 2.57 times more likely to have evidence of CPMD (95% CI 1.07- 6.15). Although these data suggest an association between GERD and CPMD, further research is required before a causal relationship can be presumed. [ABSTRACT FROM AUTHOR]

Objective: Cricopharyngeal webs (CPW) are a frequent cause of solid food dysphagia. They are difficult to diagnose and are often missed on swallowing fluoroscopy. The prevalence of CPWs is uncertain. The purpose of this study was to determine the prevalence of CPWs in elderly cadavers.Methods: Direct laryngoscopy and cervical esophagoscopy were performed in 19 embalmed cadavers by independent two-clinician consensus. Cadaver demographics and the presence and laterality of a CPW were recorded. The prevalence of CPW was calculated, and the size of the cricopharyngeus muscle (CPM) was quantified.Results: The mean age of the cohort was 83 ( ± 12) years. Fifty-three percent were female, and the mean body mass index was 19.7 ( ± 3). The causes of death were cardiovascular disease (10 of 19), cancer (5 of 19), and respiratory failure (4 of 19). A CPW was present in 68% (13 of 19) of cadavers. Forty-seven percent (9 of 19) had a unilateral web, and 21% (4 of 19) had a bilateral web. There was no laterality predominance (P > 0.05). Forty-two percent (8 of 19) had no CPM prominence; 32% (6 of 19) had a small/moderate CPM prominence; and 26% (5 of 19) had a significant CPM prominence.Conclusion: The prevalence of cricopharyngeal webs in elderly cadavers is high (68%). The clinician should maintain a high index of suspicion for CPWs in patients with no other identifiable etiology of solid food dysphagia.Level Of Evidence: 3b Laryngoscope, 129:63-66, 2019. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the shape and area of the pharyngoesophageal segment (PES) during swallowing using 320-row area detector computed tomography, which can acquire a volume data set covering a 16-cm area in a single rotation. Methods: Twenty healthy subjects were scanned during swallowing 3, 10, and 20 mL of honey-thick barium (5% w/v). PES was identified using cross-sectional images of 0.5-mm slice thickness, and the area in each section was measured. Results: The PES opening area and the anteroposterior and lateral diameters of the PES were volume dependent. However, there was no statistical difference in anteroposterior and lateral diameters between 3- and 10-mL bolus swallowing. Conclusions: Three hundred twenty–row area detector computed tomography provided new information about PES. This technique will facilitate further understanding of the mechanisms of PES opening and swallowing physiology. [ABSTRACT FROM AUTHOR]

Background: Voice and swallowing problems are often seen in patients with advanced larynx cancer, after total laryngectomy (TL) and chemo/radiotherapy. The aim of this study was to determine the occurrence of voice and swallowing problems in patients who have been laryngectomised and investigate if these symptoms were related to age, time after TL, radiotherapy and TNM-classification. In addition, we studied how often the patients changed their voice prostheses and the need of therapeutic interventions after TL. Methods: Forty-five patients were included in the study and completed the Swedish version of the Sydney Swallow Questionnaire and the Voice Handicap Index-T. Results: Swallowing problems were reported by 89% of the patients and moderate-to-severe voice handicap was reported by 66%. Most of the subjects who had dysphagia also presented voice problems (rs=0.67 p≤.01). Additional therapeutic interventions to manage problems with voice and/or swallowing after TL were required in 62% of the patients. Conclusions: Swallowing and voice problems after TL are common. Thus, the preoperative information and assessment of these functions, as well as the treatment and the post-operative rehabilitation should be evaluated and optimised to provide better functional results after treatment of advanced larynx cancer. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To evaluate the efficacy of various techniques of laryngohyoid suspension in the elimination of aspiration utilizing a cadaveric ovine model of profound oropharyngeal dysphagia.Study Design: Animal study.Methods: The head and neck of a Dorper cross ewe was placed in the lateral fluoroscopic view. Five conditions were tested: baseline, thyroid cartilage to hyoid approximation (THA), thyroid cartilage to hyoid to mandible (laryngohyoid) suspension (LHS), LHS with cricopharyngeus muscle myotomy (LHS-CPM), and cricopharyngeus muscle myotomy (CPM) alone. Five 20-mL trials of barium sulfate were delivered into the oropharynx under fluoroscopy for each condition. Outcome measures included the penetration aspiration scale (PAS) and the National Institutes of Health (NIH) Swallow Safety Scale (NIH-SSS).Results: Median baseline PAS and NIH-SSS scores were 8 and 6, respectively, indicating severe impairment. THA scores were not improved from baseline. LHS alone reduced the PAS to 1 (P = .025) and NIH-SSS to 2 (P = .025) from baseline. LHS-CPM reduced the PAS to 1 (P = .025) and NIH-SSS to 0 (P = .025) from baseline. CPM alone did not improve scores. LHS-CPM displayed improved NIH-SSS over LHS alone (P = .003).Conclusions: This cadaveric model represents end-stage profound oropharyngeal dysphagia such as what could result from severe neurological insult. CPM alone failed to improve fluoroscopic outcomes in this model. Thyrohyoid approximation also failed to improve outcomes. LHS significantly improved both PAS and NIH-SSS. The addition of CPM to LHS resulted in improvement over suspension alone.Level Of Evidence: NA. Laryngoscope, 127:E422-E427, 2017. [ABSTRACT FROM AUTHOR]

Objective: This comprehensive review aims to explain the disease pathophysiology, clinical presentation, and management options., Methods: A review was carried out in the following databases: Medline, Scopus, Web of Science, and Cochrane. The following terms were used alone and combined: Retrograde, Cricopharyngeus muscle, Dysfunction, Abelchia, and inability to burp., Results: A total of 68 articles were identified, and only 11 were found to be relevant and included in writing this review. Retrograde cricopharyngeal dysfunction (R-CPD) is a relatively new disease entity that has recently been described in clinical literature. It is caused by the inability of the cricopharyngeus muscle to relax. Unlike cricopharyngeal dysfunction (CPD), which is well-known and characterized by dysphagia, R-CPD is characterized by the inability to belch in almost all patients, which is considered diagnostic for the condition., Conclusions: High-resolution manometry (HRM) is the definitive diagnostic modality. Most patients reported in the literature responded well to treatment with botulinum toxin injection., Competing Interests: The author declares no conflict of interest., (© 2023 The Authors. World Journal of Otorhinolaryngology ‐ Head and Neck Surgery published by John Wiley & Sons Ltd on behalf of Chinese Medical Association.)

The first part describes the procedure used at our workplace for training of esophageal voice. In the second part the author presents the results of a complete group of 54 patients after total laryngectomy having been in our care in the period of 2008 - 2012. Regular education care was attended by 41 patients, 7 women and 34 men. The whole education process was completed by 32 patients. The quality esophageal voice after education is used by 10 patients, i.e. 24% if those who began the regular care. [ABSTRACT FROM AUTHOR]

Conclusions: The slit-like trachea-esophagus puncture is a reliable procedure to restore the voice in the patient who has undergone a total laryngectomy. The new voice quality could be similar to normal and could meet the patient's daily needs. Objectives: We report a new method of tracheoneoesophageal (TE) voice rehabilitation. A slit-like trachea-esophagus puncture was made in the tracheoesophageal wall after the total laryngectomy. No voice prosthesis was used. The purpose of this study was to observe its aerodynamic characteristics. Methods: All 60 patients received voice rehabilitation with the slit-like fistula after total laryngectomy. All patients' voices were evaluated as excellent. The aerodynamic characteristics of trachea-esophagus voices were observed. Results: When a patient attempted to phonate, the upper esophagus was closed. Then, the hypopharyngeal cavity expanded. Just before phonating, the upper esophagus was full of air as a ball. The air flow escaped through the segment of the trachea-esophagus slit and entered the pharyngoesophageal segment (PES). The esophageal meatus opened. It was vibrated together with nearby mucus and mucosa to form the voice. The maximum phonation time of the slit-like fistula voice was not significantly different from the Blom-Singer prosthesis voice. Its sound intensity was similar to the normal voice. [ABSTRACT FROM AUTHOR]

Total laryngectomy is potentially a debilitative surgery resulting in compromise of some of the most basic functions of life including speech and swallowing. This may have a profound adverse effect on the patient's physical, functional, and emotional health, and may result in a decreased quality of life (QOL). Until the 1980s, total laryngectomy was regarded as a dreadful, but often, life-saving procedure for which there was little alternative, and was used as a last resort. At that time survival at any cost in terms of QOL was paramount and many laryngectomies were forced into an isolated life as a mute and dysphasic recluse. Most attempts at voice restoration produced inconsistent results and often techniques were laborious, expensive, and ineffective, particularly when carried out as a salvage procedure after failed radiotherapy. Progress in voice rehabilitation, following total laryngectomy, over the last 30 years, has made an enormous difference in the whole concept of the management of laryngeal cancers. Currently there are several options available for these patients, namely, esophageal speech, artifi cial larynx, and tracheoesophageal speech. The choice of speech rehabilitation varies from patient to patient, but tracheoesophageal voice has become the preferred method. This article provides a brief account of surgical voice restoration after total laryngectomy. Special emphasis has been given to the surgical technique, special considerations, complications, and the prevention / treatment of tracheoesophageal voice restoration. [ABSTRACT FROM AUTHOR]

Objectives: To use an electroglottography (EGG)-based videostroboscopy tool to assess the anatomical and morphologic characteristics of the pharyngoesophageal (PE) segment in tracheoesophageal (TO) speakers. Study design: Cross-sectional cohort study. Subjects: Fifty-two post-laryngectomy patients with no recurrence and using prosthetic (Blom-Singer) speech. Intervention: An electroglottography (EGG)-based videostroboscopy tool EGG-based rigid videostroboscopy as well as perceptual evaluation. outcome Measures: Stroboscopic protocol included nine subjective/visual parameters to evaluate the neoglottis and study correlation of the G (GRBAS scale) and the overall voice quality (OVQ) with the treatment variables. Results: Of the 52 laryngectomees, videostroboscopic recordings were possible in 46 patients (36 males and 10 females) with a mean age of 63.4 ±10.5 (SD) an electroglottography (EGG)-based videostroboscopy tool years. All used the Blom-Singer valve and the median time since Total Laryngectomy was 2 years. The neoglottis was assessable in 26 patients. We were able to strobe only 9 patients. There was excellent correlation between G and OVQ (Spearman rho > 0.9). Statistically significant correlation was found between G1 and saliva (P = 0.03) and between good OVQ and saliva (P = 0.02); similarly, there was significant correlation between G1 and LVV (P = 0.05) and between good OVQ and LVV (P = 0.03). Conclusions: This study is the first to examine the use of an EGG-based stroboscopy instrument to evaluate TO speech. Our observations suggest that from the standpoint of functional voice, saliva and the LVV had statistically significant effect in determining voice quality. [ABSTRACT FROM AUTHOR]

This study aimed to relate the results of physiological measurements of the pharyngoesophageal (PE) segment in subjects using tracheoesophageal (TE) or esophageal (E) speech with perceptual assessment of the speakers' voice quality and acoustic measurements of the voice function. It further aimed to investigate possible differences in appearance and placement of the voice source between TE and E speakers. Nine subjects who had undergone a laryngectomy (five TE speakers and four E speakers) participated in the study. They were videoradiographically examined during phonation and silence. Measurements were made of size and placement of the PE segment, the distance between the PE segment and the anterior wall, and the distance between the posterior and anterior esophageal walls beneath the segment. Five trained listeners perceptually assessed the subjects' voice quality, and acoustical analyses of fundamental frequency and sound pressure level were made. The physiological measurements of the nine subjects' individual PE segments varied in terms of appearance and placement during both phonation and silence, but all of the subjects showed a good closure at the PE segment level during phonation. Statistically significant results were found between all of the physiological measurements of the PE segment. Significant results were also found between the acoustical and perceptual assessments of the subjects' voices. No relations were found between the physiological measurements and the acoustic and perceptual results. The conclusion of this study was that there were no specified differences in the PE segment between TE speakers and E speakers, but that there were large individual differences within each speaker group. [ABSTRACT FROM AUTHOR]

Conclusions. Tracheoesophageal phonation appears to participate in early acquisition of esophageal phonation, which remains the preferred method of voice restoration among patients. Further studies into factors predicting and mechanisms underlying acquisition of esophageal phonation among alaryngeal patients may provide information facilitating superior quality of life. Objective. The aim of this study was to examine early acquisition of esophageal phonation following tracheoesophageal phonation, and underlying mechanisms and preferred phonatory methods for alaryngeal patients who master both tracheoesophageal and esophageal phonation. Patients and methods. Subjects comprised 44 alaryngeal patients and were divided into three groups: group A ( n =13), esophageal phonation alone; group B ( n =21), tracheoesophageal phonation alone; and group C ( n =10), patients who acquired esophageal phonation after learning tracheoesophageal phonation. Results. The results indicated that acquisition of tracheoesophageal phonation significantly accelerated acquisition of esophageal phonation to 59.3 days from 184.6 days. Patients in group C stopped tracheoesophageal phonation and predominantly used esophageal phonation. No factors predicting acquisition of esophageal phonation were identified among patients who had mastered tracheoesophageal phonation, including age at time of surgery, irradiation, neck dissection, acquisition time of tracheoesophageal phonation, and maximum phonation time of tracheoesophageal phonation. No evidence of air leakage through the shunt during esophageal phonation was noted in group C. [ABSTRACT FROM AUTHOR]

Although anteroposterior projections in videofluoroscopic examination of swallowing (VF) provide clinically important information, the laterality of swallowing in healthy subjects has not been examined fully to date. One hundred sixty-seven healthy volunteers were prospectively studied. The subjects were asked to swallow 5 ml of barium solution three times while X-ray images were taken that showed the pathway of the solution from the pharynx into the esophagus to assess the laterality of swallowing. We classified patterns of swallowing into three types according to passage in the pharyngoesophageal segment as indicated by width: RD (right-side-dominant flow), LD (left-side-dominant flow), and NL (no laterality in flow). Fifty-eight percent of the subjects were classified as NL, 35% as LD, and 7% as RD. The ratio of types in women was NL:LD:RD = 7:2:1. There were no significant differences among the groups according to age. Although classifications in young men (age = 20–30 years) tended to be the same as in women regardless of age, ratios of LD tended to increase with age; 71% of elderly adults (age = 51–75 years) were classified as LD. These results demonstrate laterality in normal swallowing and will be helpful in determining treatment strategies for the patients with dysphagia. [ABSTRACT FROM AUTHOR]

Objective --To gain insight into the clinical value of using the relatively new evaluation tool digital high-speed endoscopy in addition to the widely used method of videofluoroscopy for imaging of the neoglottis in tracheoesophageal speech after total laryngectomy. Material and Methods --Anatomical and morphologic characteristics of the neoglottis in 37 laryngectomized patients using tracheoesophageal speech were studied by means of visual assessment of digital high-speed endoscopy recordings and visual assessment and quantitative measures of videofluoroscopy recordings, using previously published protocols. Results --Digital high-speed endoscopy provides information complementary to that of videofluoroscopy with respect to the location of the vibration, presence of a mucosal wave, regularity of the vibration and closure of the neoglottis. The information provided by digital high-speed endoscopy overlaps with that provided by videofluoroscopy with respect to the amount of saliva (regurgitation of barium in videofluoroscopy) and the visibility of the origin of the neoglottis (presence of a neoglottic bar in videofluoroscopy). Additionally, relationships were found between the visual assessments of the high-speed recordings and some patient characteristics. Conclusion --Digital high-speed endoscopy provides additional insight into neoglottic characteristics that cannot be studied with videofluoroscopy. The application of both imaging methods enhances the insight into tracheoesophageal voicing. [ABSTRACT FROM AUTHOR]

Radiologic evaluation of patients with dysphagia relies on a meticulous and standardized technique. For assessment of function video recording is mandatory. A systematic approach for the description of function and dysfunction is necessary. The following describes such an approach focused on an easy and reproducible technique and a comprehensive description of radiologic events and morphology. [ABSTRACT FROM AUTHOR]

Pressure changes were registered with videomanometry (simultaneous manometry and barium swallow) in the pharynx and in the pharyngoesophageal segment (PES) during swallowing. A considerable longitudinal asymmetry was found. Peak pressure was highest in the PES, lower in the inferior constrictor area, and lowest at the level of the tongue base. The rate of pressure rise was highest at the level of the PES. The speed of propagation of the contraction wave was 13 (±2) cm/sec. There was no correlation between the measured variables (i.e., peak pressure, rate of pressure rise, and speed of contracting wave). Our findings can partly be explained by different mechanical constraints at different levels of the pharynx but may also reflect the organization of neural control of swallowing in the brainstem. Knowledge of transducer position and orientation is essential for the evaluation of pharyngeal pressure during swallowing. Such knowledge is best achieved by performing manometry simultaneously with fluoroscopy, i.e., videomanometry. [ABSTRACT FROM AUTHOR]

Muscle activity of isolated muscle strips from the middle pharyngeal constrictor, the inferior pharyngeal constrictor, the cricopharyngeal muscle, and the cervical esophagus of the rabbit was studied in organ baths in response to drugs and electrical field stimulation. These muscles of the pharyngoesophageal segment seem to lack an autonomic adrenergic and cholinergic innervation, as determined by responses to specific drugs. The nerve-evoked contractile responses of the two lower muscles of the segment were almost completely abolished by the curarelike drug gallamine, suggesting a somatic cholinergic nerve supply. However, in the two upper muscles, the major part of the response was resistant to gallamine, which suggests involvement of non-adrenergic, nonmuscarinic, nonnicotinic receptors in the transmission of nerve impulses in these muscles. These results suggest a differential innervation of the upper and lower pharyngeal muscles. [ABSTRACT FROM AUTHOR]

Masticatory efficiency was evaluated in 21 adults for four chewing parameters: mixing of a color-patterned chewing gum mass, shaping of a chewing gum mass, particle reduction of a silicone tablet, and number of chewing strokes before the first swallow of an almond. The results of these tests were correlated with the dimension of the pharyngoesophageal (PE) segment during swallow of liquid barium and solid meat. The transverse width of the PE segment during swallow of liquid barium correlated significantly with the chewing parameters. The sagittal width of the PE segment during swallow of liquid barium correlated only weakly with the chewing parameters. The PE segment dimension during swallow of a solid meat bolus did not correlate with the chewing parameters. The results suggest that there is feedback during chewing and swallowing between the PE segment and the oral cavity. [ABSTRACT FROM AUTHOR]

Summary Objectives This study compared whispering attempts by adults using tracheoesophageal (TE) speech with those by adults with a larynx. Comparisons were based on listener judgments, visual-perceptual assessment of spectrograms, and measures of the acoustic signal. Study Design This was a prospective, cross-sectional study. Methods Seventeen TE and 10 laryngeal speakers produced sentences in a whisper and in their spoken voice. Listeners judged sentences as whispered or spoken. Judges signal-typed the spectrograms based on presence-absence of a “voicing bar.” Speaking rate, articulation rate, percent pause, and dB sound pressure level were measured. Results Twenty-nine percent of TE speakers were perceived to be whispering on whisper attempts; most others were perceived to be using spoken voice while attempting to whisper. Spectrograms of TE whispering were most often categorized as “mostly voiced.” Speaking and articulation rates were slower for TE speakers. There was a significantly greater reduction in speaking rate from spoken to whisper for the TE group. Percent pause did not differ significantly between groups and speaking mode. TE speakers had a significantly smaller difference in dB sound pressure level between spoken and whisper modes. Conclusions Some individuals using TE speech can whisper based on auditory-perceptual judgment, but most were perceived to be speaking during these attempts. The fact that some TE participants could whisper indicates the behavior is possible and might be considered a therapeutic target if it is of importance to an individual. The percentage of TE speakers who can learn to whisper, and the optimal training approach, are yet to be determined. [ABSTRACT FROM AUTHOR]

The cricopharyngeus muscle (CPM) is a key component of the upper esophageal sphincter (UES). In dysphagia, cricopharyngeus muscle dysfunction (CPD) refers to the muscle's failure to appropriately and completely relax or expand during deglutition. A variety of disease processes may cause CPD, and the resultant clinical manifestation is solid food or solid and liquid dysphagia. Several diagnostic tools are available for dysphagia clinicians to distinguish CPD from other causes of UES dysfunction. For CPD, accurate diagnosis is paramount for the recommendation of appropriate treatment. In appropriately selected patients, intervention at the CPM may yield significant improvement in dysphagia., (Copyright © 2013 Elsevier Inc. All rights reserved.)