Total laryngectomee requires some form of alaryngeal speech for communication. Generally, esophageal speech isregarded as the most avilable and comfortable technique for alaryngeal speech. But esophageal speech is difficultto train, so many patients are unable to attain esophageal speech for communication. To understand mechanism ofesophageal speech on total laryngectomee, evaluation of anatomical change of the pharyngoessophageal segment isvery important. We used video fluoroscopy for evaluation of pharyngesophageal segment during esophageal speech.Eighteen total laryngectomees were evaluated with video fluoroscopy from Dec. 1986 to May 1987 at Y.U.M.C. Ourresults were as follows: 1. Peseudogottis is the most important factor for esophageal speech, which is visualized in 7 cases among 8 cases of excellent esophageal speech group. 2. Two cases of longer A-P diameter at thepseudoglottis have the best quality of esophageal speech than other. 3. Two cases of mucosal vibration at thepharyngoesophageal segment can make excellent esophageal speech. 4. The causes of failed esophageal speech arepoor aerophagia in 6 cases, abscence of pseudoglottis in 4 cases and poor air ejection in 3 cases. 5. Aerophagiasynchronized with diaphragmatic motion in 8 cases of excellent esophageal speech.