**3. Esophagus and esophageal speech**

#### **3.1. History of the esophageal speech**

The use of esophagus as a speech tank for the purpose of rehabilitation of laryngectomized persons first occurs during the nineteenth century. In 1909, Gutzmann called this rehabilitation method an esophageal speech [17]. The method is the most natural way for the laryngectomized persons to have the alaryngeal phonation, which has made it the most commonly used method for many years. Although satisfying a number of factors is a prerequisite, Seeman considers the appropriate level of motivation to be the key factor for mastering the esophageal speech, and that most motivated patients successfully adopt this mode of substitution [17].

phonation, but it often results in a very weak intensity of the alaryngeal voice. As the voice of low intensity does not meet the daily communication requirements, the hypotonicity can be

The Role of Esophagus in Voice Rehabilitation of Laryngectomees

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In addition to the appropriate muscular tonus of the pharyngoesophageal segment, the person who will be rehabilitated with the esophageal speech must have a satisfactory level of certain cognitive abilities. Considered among the most important cognitive abilities are the appropriate intellectual status and the motivation of a person, but the conative factors are also significant. When choosing modality, psychosocial and socioeconomic factors are also important. The person who will learn the esophageal speech should be highly motivated for the process of rehabilitation, be patient enough, cognitively superior, and live in an empathetic and supportive family and social environment. Socioeconomic status should be as high as necessary for regular attendance at a speech-language therapy in continuity. Regarding the health status, people who will learn the esophageal speech should be of a good general health and somatic status, and the primary disease should be under good local control, which means removing any suspicion of local recurrence. Certainly, a significant influence on the possibility of this modality has the auditory status of the patient, and the level of hearing should be appropriate to the chronological age of the person, at the hearing level of 20–55 dB [5]. Any hearing impairment above 55 dB affects the communication function significantly and disables the adequate reception of the information from the speech-language therapist,

compensated by external compression or surgical intervention.

thereby making it difficult and slowing down the process of rehabilitation.

• the presence of psychological problems and psychopathology.

• inability to attend a therapy at least three times a week.

**3.3. Functional features of the esophageal speech**

[17, 21, 22]:

**1.** Certain physical factors

• local recurrence of illness.

**2.** Certain psychological status

**3.** Socioeconomic factors

**4.** The necessity of speaking

• extensive reconstruction operation.

Doyle classified contraindications for the learning of the esophageal speech in four categories

• immediately after laryngectomy, the necessity to speak loudly for a certain reason.

The acoustic parameters of the esophageal voice in the literature vary depending on the researchers, the selected research method, the measuring instrument, the measuring criteria, the sample of subjects, and the environmental and computer program conditions in which the measurement was performed. The fundamental frequency, or the height of the esophageal
