Analysis of Factors Affecting the Longevity of Voice Prosthesis Following Total Laryngectomy with a Review of Literature

Abstract

Tracheoesophageal voice puncture (TEP) coupled with the use of voice prosthesis has been considered as the gold standard for speech rehabilitation in patients of advanced laryngeal/hypopharyngeal carcinomas, who have undergone a total laryngectomy with or without partial pharyngectomy. Although prosthetic voice rehabilitation is commonly practiced worldwide including India, there is a paucity of published Indian data, more so in the current era of organ conservation. This study included 60 laryngectomized patients with a prosthetic voice rehabilitation at a tertiary cancer center in South India between January 1, 2010 and December 31, 2013. Among the 60 patients, the primary site of cancer was the larynx in 43 patients and hypopharynx in the remaining 17. All patients had undergone a primary TEP insertion, 55 in the upfront setting and five in the salvage (post-radiation/chemo-radiation) setting. The ability to retain a successful trachea-esophageal speech on follow-up (median 15.5 months) in our series was around 82%. The mean device life of voice prosthesis in our patient cohort was 16 months. There was surprisingly no significant difference in the prosthesis device life on correlation with age, co-morbidities, habitat, literacy status, pre-operative tracheostomy, setting of surgery, and the extent of surgery. Our series has successfully demonstrated the safety and feasibility of using primary TEP coupled with the use of voice prosthesis for voice rehabilitation in properly selected and motivated patients of advanced laryngeal and hypopharyngeal carcinomas across all clinical settings. A mean device life of 16 months makes prosthetic voice rehabilitation, an attractive as well as a financially viable option for patients in a resource constrained setting.

The Multidisciplinary Team (MDT) Approach and Quality of Care

“…Airflow through the esophageal structure will generate a new fundamental tone that, as with the esophageal voice, will later be converted into speech sounds. The use of a voice prosthesis for communication requires daily maintenance and needs to be replaced approximately every 6 months, (130)(131)(132) The rate of complications can range from 15 to 72% (132), being the most frequent the leak through de voice prosthesis and the leak around the tracheoesophageal prosthesis.…”

Voice rehabilitation with phonatory prosthesis after total laryngectomy and pharyngolaryngectomy: comparison of functional outcomes between primary and secondary puncture

“…Device lifetime in our study was similar to other studies, which report a mean device lifetime between 2 and 14 months. 5,11,21,34,35 Bozec et al reported a median device lifetime of 7.6 months (ranging from 1.2 to 39.5 months).…”

Analysis of Factors Affecting the Longevity of Voice Prosthesis Following Total Laryngectomy with a Review of Literature

“…Regarding the article by Krishnamurthy et al on 60 laryngectomized patients with prosthetic voice rehabilitation (Mar. 9 issue) [1], 82% of patients preserve successful tracheaesophageal speech. These data agree with the existing literature [2].…”