Tracheoesophageal Voice Prosthesis Outcomes: Success or Insucess? (original) (raw)
Related papers
European Archives of Oto-Rhino-Laryngology, 2010
The aims of this retrospective study were to evaluate prosthetic voice restoration by tracheoesophageal puncture (TEP) in laryngectomized patients and to identify clinical factors correlated with functional outcomes. Between 2000 and 2008, 103 patients who underwent total laryngectomy or pharyngolaryngectomy (TPL) were included in our study. Functional outcomes were recorded 6 months postoperatively, and results were scored from 0 to 2 for oral diet and speech intelligibility. Lifetime of voice prosthesis and early and late complications were recorded. The impact of several clinical factors on functional outcomes, prosthetic valve lifetime and complications was assessed in univariate analysis. A total of 87 patients (84%) underwent TEP and speech valve placement (79 primary and 8 secondary punctures). Hypopharyngeal tumors (P = 0.005), circular TPL (P = 0.003) and use of a pectoralis major myocutaneous Xap (P = 0.0003) were signiWcantly associated with secondary TEP. Successful voice rehabilitation was obtained by 77 of 82 evaluable patients (82%). A high level of comorbidity (ASA score¸3; P = 0.003) was correlated to speech rehabilitation failure. The median device lifetimes were 7.6 and 3.7 months for Provox I and II speech valves, respectively. Minor leakage around the valve occurred in 26% of the patients. Late complications occurred in 14 patients (16%) including: severe enlargement of the Wstula (n = 3), prosthesis displacement (n = 7) and granulation tissue-formation (n = 4). In conclusion the use of voice prosthesis showed a high success rate of vocal rehabilitation with an acceptable complication rate.
The Israel Medical Association journal : IMAJ, 2013
Voice restoration following total laryngectomy is an important part of patients' rehabilitation and long-term quality of life. To evaluate the long-term outcome of indwelling voice prostheses inserted during (primary procedure) or after (secondary procedure) total laryngectomy. The study group included 90 patients who underwent total laryngectomy and tracheoesophageal puncture (TEP) with placement of voice prosthesis at a tertiary medical center during the period 1990-2008. Background, clinical and outcome data were collected by medical file review. Findings were compared between patients in whom TEP was performed as a primary or a secondary procedure. TEP was performed as a primary procedure in 64 patients and a secondary procedure in 26. Corresponding rates of satisfactory voice rehabilitation were 84.4% and 88.5% respectively. There was no association of voice quality with either receipt of adjuvant radiation/chemoradiation or patient age. The average lifetime of the voice pr...
Otolaryngology-head and Neck Surgery, 2005
To evaluate the long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). The influence of the timing (primary or secondary) of tracheoesophageal puncture (TEP), use of radiotherapy (xRT), patient age, and length of follow-up were studied to evaluate the success rate of VP use. STUDY DESIGN AND SETTING: Prospective clinical study in a tertiary referral center. Seventy-one patients were submitted to TL and rehabilitated with indwelling VP. All patients were evaluated for vocal functional issues by an otolaryngologist and a speech pathologist at 1 month, then at every 3 months up to 1 year, and then at every 6 months after 1 year of follow-up. The relative data on time of placement of VP, time of VP use, xRT, age, length of follow-up, and life span of each VP were recorded during the follow-up. RESULTS: Eighty-seven percent of the patients underwent primary and 13%, secondary TEP. The follow-up varied from 12 to 87 months, with an average of 38 months for primary and 51 months for secondary TEP. Fifty-nine percent of the patients were submitted to xRT. The general rate of success was 94%, with 97% for primary and 78% (P ϭ 0.07) for secondary TEP; after 2 years, the success rate was 96% for primary and 75% for secondary (P ϭ 0.07) TEP. The use of xRT and patient age had no influence on the success of VP use for primary and secondary TEP, independently of the length of follow-up. CONCLUSIONS: The success rate of voice rehabilitation with VP was 94%. In primary TEP, the success rate was 97%, whereas in secondary TEP it was 78%; 2 years later, it was 96% and 75%, respectively. A tendency for a higher success rate in voice rehabilitation after TL was observed in primary TEP. The use of xRT and age of patient had no influence on the success rate.
Speech results with tracheoesophageal voice prosthesis after total laryngectomy
JPMA. The Journal of the Pakistan Medical Association, 2005
To assess the success rate of tracheoesophageal voice prosthesis as the primary mode of voice rehabilitation in patients after total laryngectomy. Medical record files of 35 patients subjected to total laryngectomy were reviewed for determining success or failure of the voice prosthesis. The indicators used were quality of speech and utility of the device. Subsequent complications that developed were also assessed. In addition other factors taken into consideration were pharyngeal myotomy, use of radiation, and timing of replacement. All thirty five patients (n=35) had prosthesis placed at the time of laryngectomy. The success rate at one month and four months follow up was 85.18%. Of note, 3 patients were lost to follow-up, 3 patients died of disease and 2 had recurrence of disease. Our results confirm the effectiveness, longevity and safety of the tracheoesophageal voice prosthesis for speech rehabilitation following total laryngectomy.
Long-term Results with Tracheoesophageal Voice Prosthesis: Primary versus secondary TEP
European Archives of Oto-Rhino-Laryngology, 2007
The aim of this study was to evaluate the inXuence of timing of tracheoesophageal puncture (TEP) with indwelling voice prosthesis insertion regarding long-term success rate and postoperative complication. We conducted a retrospective clinical study at tertiary academic center. There were 75 patients with primary TEP (80.6%) and 18 with secondary TEP (19.3%). Long-term success rate was 81.7%, with 80.0% in primary TEP and 88.9% in secondary TEP. No signiWcant diVerence in Harrison-Robillard-Schultz Rating Scale success assessment were observed between patients with primary and secondary TEP (P = 0.596). The use of postoperative radiotherapy did not signiWcantly inXuence the success rate. The age of patients who were older or younger than 60 years signiWcantly inXuence the success rate in primary TEP (P = 0.012). The higher rate of complications in primary TEP was not statistically signiWcant. These Wndings suggest that primary and secondary TEP are equally safe and eVective procedures. Primary TEP should be prefered because of avoiding a second surgical intervention and allowing early voice restoration with a considerable psychological impact.
American Journal of Otolaryngology, 1997
Prosthetic voice restoration is an increasingly popular method of postlaryngectomy voice rehabilitation. Despite its success in non-tonal languages, the efficacy of tracheoesophageal speech in tonal languages was largely unknown. The aim of the present study was to evaluate the long-term results of voice rehabilitation using a Blom-Singer valve (BSV) in the tonal language of Cantonese. Patients and Methods: The records of 159 patients who underwent total laryngectomy and primary tracheoesophageal puncture (TEP) between May 1985 and December 1994 were retrospectively reviewed. Tracheoesophageal speech was regarded as functional if effective communication could be made during face-to-face conversation and telephone conversation. Any TEP-related complications were noted. Perioperative factors that might contribute to nonfunctional speech were subjected to statistical analysis. Results: Six hospital mortalities were excluded from speech analysis. Of the remaining 153 patients, the median follow-up was 25 months, ranging from 3 to 113 months. Seventy-three patients had closure of tracheoesophageal fistulae (TEF), and the main causes were ineffective voice production, dislodgment, and tracheostomal stenosis. Only 15 of them acquired functional speech before closure. The other 80 patients used a BSV as the chief modality of voice rehabilitation, with functional results achieved in 64 patients. None of the perioperative factors were found to be statistically significant in relation to nonfunctional speech. Conclusion: Primary TEP is an established method of voice rehabilitation after total laryngectomy. In our series, 52% patients achieved functional tracheoesophageal speech using a BSV.
Prosthetic voice rehabilitation after total laryngectomy
Indian journal of surgical oncology, 2010
Loss of voice is a major concern after total laryngectomy. Tracheo-esophageal prosthesis was described in 1980 by Blom and Singer as a method of postlaryngectomy voice rehabilitation. Since then it has seen many phases of developments. Now it has evolved into highly effective method with success rates more than 90% and better quality of voice than other modalities. It also gives good quality of life and voice related quality of life. Though it is associated with some complications, they are easy to manage. All these have made tracheo-esophageal prosthesis the 'Gold Standard' of post-laryngectomy voice rehabilitation.
2012
Surgical procedures, especially total laryngectomy, used for treatment of advanced laryngeal carcinoma, have a profound adverse effect on the patient's physical, functional, and emotional health, and almost always decrease quality of life. There are three main types of voice rehabilitation after surgery. They are: esophageal speech techniques, the use of artificial larynx devices and tracheoesophageal puncture with the insertion of various types of voice prostheses. Voice prosthesis was inserted in 100 patients in the ENT Department, University Hospital Center Zagreb, from January 2004 until February 2011, and 91 of these patients were included in our study. The prosthesis was inserted secondary at 71 patients, while in other 20 it was inserted primary, i.e. immediately after laryngectomy as a part of the same procedure. Voice rehabilitation was initiated 10th day after primary insertion and 1st-3rd day after secondary insertion. The postoperative voice quality was compared with...
International Journal of Phonosurgery & Laryngology, 2019
Aim: To assess the preference of the different modalities of post-laryngectomy speech rehabilitation in patients and review the outcome parameters of esophageal speech and tracheoesophageal puncture (TEP) prosthesis modalities in comparison with the corresponding existing data. Materials and methods: A longitudinal prospective study conducted over a period of 1 year in the Department of ENT and Head-Neck Surgery in a tertiary care hospital. Patients of advanced laryngeal malignancies that were planned for total laryngectomy were included in this surgery. Based on the patients' choice different modalities were adopted and the patients were followed up with regular training. Maximum takers were for esophageal speech followed by TE puncture and prosthesis insertion, and the outcomes in these two modalities were evaluated in detail. Six outcome parameters were assessed for the patients and consolidated. Then they were compared with the corresponding values obtained from previous studies to arrive at the results. Results: A total of ten cases of total laryngectomy was studied during the period of study. It was found that greater patient preference was for the TEP prosthesis modality. The mean frequency of phonation, mean intensity for vowels, and word production per minute in the TEP prosthesis were almost 80% of that seen in the esophageal prosthesis group. The most significant difference was in mean maximum phonation time which was only 37% of that seen in the TEP prosthesis group. Conclusion: In the present scenario until more advanced modalities of post-laryngectomy speech rehabilitation become more easily accessible to and affordable for the economically weaker sections of the society, esophageal speech modality is a dependable alternative. Further with proper training and follow-up, results with esophageal prosthesis are promising.
Surgical voice restoration after total laryngectomy: long-term results
European Archives of Oto-Rhino-Laryngology, 2001
Tracheoesophageal puncture (TEP) with a voice prosthesis has been the preferred treatment for speech rehabilitation of total laryngectomies at the Dr. Peset Hospital since 1984. This study reviews 350 consecutive patients over a 15-year period. There were 334 patients with primary and 16 with secondary TEP. Long-term tracheoesophageal speech was achieved in approximately 70% of our patients. Problems related to or affecting TEP for voice restoration were studied. The different types of problems identified occurred in proportions ranging from 0.6% to 18%. Most of them were easily managed, but problems such as salivary leakage and dislodging of the prosthesis led to tracheoesophageal tract closure in 30% of the patients.