**1. Introduction**

The esophagus is a long, flexible muscular tube that starts as the continuation of the pharynx with the upper esophageal sphincter and ends with the lower esophageal sphincter as the junction with the stomach. Topographically, it is divided into three regions: cervical, thoracic and abdominal [1].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The function of the upper esophageal sphincter is to prevent breathed air from entering into the esophagus and to stop reflux of esophageal content into the pharynx to prevent airway aspiration, and the function of lower esophageal sphincter is to prevent gastroesophageal reflux.

**2.1. Voice rehabilitation after laryngectomy**

Total laryngectomy leaves a number of significant and permanent anatomic and physiologicalfunctional changes. One of them is the impossibility of loud laryngeal speech. Laryngectomy is the removal of vocal cords which are the vibrating source of sound, and it causes changes in the anatomic structures of the resonator, whereas tracheotomy prevents the use of the lungs as a physiological source of energy for the phonation. Patient is temporarily socially deprived which diminishes the quality of life and brings with it the limitations in other life spheres. Postoperatively, achieved by rehabilitation, a future alaryngeal voice will be created in the area where esophagus transitions into hypopharynx, under the influence of the airflow that causes the mucosa vibration [5]. This area is called neoglottis or pseudoglottis, and it is a pharyngoesophageal segment, anatomical structure in the area of the upper aerodigestive tract [7]. Rehabilitation of voice after removal of larynx has been known for more than 150 years [8]. The first well-known description of the possible way of producing alaryngeal voice was given by Czermak in 1859. He established an alaryngeal voice by redirecting the airflow from the endotracheal tube through a tube into the mouth of the laryngectomized patient [9]. After Billroth performed his first laryngectomy in 1873, his assistant, Gussenbauer, equipped the patient with a pneumatic device which had the function of a speech machine [8, 10, 11]. In the mid-nineteenth century, rehabilitation was discovered by establishing an esophageal voice. At the same time, various mechanical devices were used to transmit vibrations and thus allowed loud speech [12, 13]. In the mid-twentieth century, the first tracheoesophageal fistula was made, which allowed the air stream to reach the upper part of the esophagus and the pharynx [14]. A few years later, a voice prothesis was developed according to the principle of a one-way permeable valve that allows the airflow from the trachea into the esophagus and

The Role of Esophagus in Voice Rehabilitation of Laryngectomees

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prevents the passage of food and fluid from the esophagus into the trachea.

cial and socioeconomic status of the patient [15].

**2.** Production of an esophageal voice.

**3.1. History of the esophageal speech**

**3. Esophagus and esophageal speech**

Patients have three methods of substitute voice and speech:

**3.** Use of mechanical generators of acoustic vibrations [16].

Back a few decades, the world trend is the earliest possible rehabilitation of voice and speech after laryngectomy. The beginning and type of rehabilitation depend on the health, psychoso-

**1.** Production of tracheoesophageal voice by insertion of a tracheoesophageal prosthesis.

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

The function of the esophagus is very simple: to actively transport solids and liquids from the pharynx to the stomach. It has no digestive, absorptive, metabolic, or endocrine functions, but in some people, esophagus takes another very important function [2]. These people are laryngectomized persons. Namely, after total laryngectomy, the lower respiratory tract is permanently separated from the upper respiratory tract. The breathing function begins and ends in the permanent tracheostoma, and the upper respiratory tract loses its function [3]. In such anatomical condition, the esophagus has a key function in two of three primary approaches to speech rehabilitation of laryngectomized patients: esophageal and tracheoesophageal speech therapy method. The upper part of the esophagus gets the function as some kind of air activator, and the pharyngoesophageal segment gets the function of the voice generator, thus allowing the function of the voice resonators.
