Primary tracheoesophageal prosthetic speech is the gold standard for speech rehabilitation in patients undergoing total laryngectomy. However, despite a high success rate, the speech outcome can be suboptimal in 5-15% of these patients. The most frequent cause being hypertonicity of the pharyngoesophageal segment. We elaborate a simple clinical technique that can be performed in an outpatient clinic to identify the hypertonic pharyngoesophageal segment in patients with PES.

All these patients (13 males and 1 female) had undergone total laryngectomy and primary tracheoesophageal puncture followed by postoperative radiotherapy. Even after rigorous speech therapy, these patients had failed to develop fluent speech. The mean duration following surgery was 8 months (range 4-20 months). A simple clinical technique is elaborated utilizing the dermal ballooning effect observed in the cervical region to ascertain the site of pharyngo esophageal spasmodic segment.

Using this technique we have been able to identify the hypertonic segment successfully in 13 of the 14 patients with PES. In these patients the trial lignocaine block was injected specifically at these points medial to the carotid vessels. Improvement in speech following the block was observed, and was further confirming using a videofluroscopy.

This technique serves as a simple and useful clinical tool to map the spasmodic segment and to guide the injection site for trial lignocaine block and as well for botulinum a toxin. In addition, it also prevents inadvertent injection to the normal segments.