Changing trends of speech outcomes after total laryngectomy in the 21st century: A single‐center study

Moon, Seo; Raffa, Francesca; Ojo, Rosemary; Landera, Mario A.; Weed, Donald T.; Sargi, Zouka; Lundy, Donna S.

doi:10.1002/lary.24717

Cited by 35 publications

(52 citation statements)

References 21 publications

(49 reference statements)

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“…Results here are in concordance with other studies that found no significant difference in complication rates of primary and secondary TEP . Direct complications in the current study (64.6% and 60.9% for primary and secondary TEPs, respectively) were slightly higher than others reported, which may be explained by the comprehensive inclusion and prospective tracking of complications, long‐term follow‐up of 4.7 years, and high rate of radiotherapy (only 8.3% of this cohort did not require radiotherapy) .…”

Section: Discussionsupporting

confidence: 92%

“…Direct complications in the current study (64.6% and 60.9% for primary and secondary TEPs, respectively) were slightly higher than others reported, which may be explained by the comprehensive inclusion and prospective tracking of complications, long‐term follow‐up of 4.7 years, and high rate of radiotherapy (only 8.3% of this cohort did not require radiotherapy) . TEP outcomes, as measured by long‐term use of TEP (82% for primary and 85% for secondary TEPs) were slightly higher than other reported rates of 75% to 78% for primary TEP and 67% to 71% for secondary TEP that have been published since the recent trend of increased frequency of salvage laryngectomy . As reported in several other studies, there was no significant difference in success rate (as measured by TEP use or fluency) between patients who received radiation and those who did not .…”

Section: Discussioncontrasting

confidence: 80%

“…Therefore, no consensus currently exists regarding the strict indications for secondary TEP in salvage laryngectomy patients. Some surgeons still consider previous radiation as a contraindication for primary TEP, particularly for patients who require laryngopharyngeal resection and reconstruction . Furthermore, many studies have lacked sufficient power to address the question of previous radiation and its influence on the rate of postoperative complications in primary TEP.…”

Section: Introductionmentioning

confidence: 99%

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Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture

et al. 2016

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Background We evaluated impact of radiation, reconstruction and timing of tracheoesophageal puncture (TEP) on complications and speech outcomes. Methods Retrospective review identified 145 TEP patients between 2003–2007. Results Ninety-nine patients (68%) had primary and 46 (32%) secondary TEP, with complications occurring in 65% and 61% respectively (p=0.96). Twenty-nine patients (20%) had major complications (18 primary; 11 secondary, p=0.42). Ninety-four patients (65%) had pre-TEP radiation, 39 (27%) post-TEP radiation, and 12 (8%) no radiation. With patients grouped by TEP timing and radiation history, there was no difference in complications, fluency, or TEP use. With mean 4.7-year follow up, 82% primary and 85% secondary used TEP for primary communication (p=0.66). Free-flap patients used TEP more commonly for primary communication after secondary versus primary TEP (90% v 50%, p=0.02). Conclusions Primary and secondary tracheoesophageal speakers experience similar high rates of complications. Extent of pharyngeal reconstruction, rather than radiation, may be more important in selection of TEP timing.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

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Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture

et al. 2016

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“…In our study, the majority of all groups underwent primary TEP and the rate of fistula was no higher in the reconstruction group (24%) than in those who underwent primary total laryngectomy (25%). Like Moon et al, we also found no difference in long‐term TEP success rates between those who had undergone primary versus salvage total laryngectomy.…”

Section: Discussionsupporting

confidence: 82%

“…This flap is a vascularized portion of fasciocutaneous tissue harvested from the volar surface of the forearm . Although there are some data about the impact of a circumferential RFFTT flap on voice outcomes after total laryngopharyngectomy, the impact of a partial pharyngectomy and a noncircumferential “patch” reconstruction with RFFTT has received relatively little attention in the literature and there is a need for long‐term outcome studies using validated functional as well as quality of life (QOL) measures . When reconstruction is performed, the reconstructed portion of the pharynx will contain an inert, adynamic flap of tissue, which may have an impact on the performance of the pharynx for both voice and swallowing.…”

Section: Introductionmentioning

confidence: 99%

Functional outcomes and quality of life after total laryngectomy with noncircumferential radial forearm free tissue transfer

et al. 2017

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Association of Functional Outcomes in Tracheoesophageal Voicing With Intratracheal Pressures and Esophagram Findings

Evangelista

Andrews

Nativ‐Zeltzer

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCETracheoesophageal voice prosthesis (TEP) is a commonly used device for alaryngeal voicing following total laryngectomy. Variability in TEP voice and speech production may be reflected in differences in intratracheal pressures.OBJECTIVE To examine the association between intratracheal manometric pressure (IMP), speech function, and proximal esophageal abnormalities in patients with TEP. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was conducted at a single academic institution and included all patients with a history of total laryngectomy and TEP who completed a radiographic esophagram and intratracheal manometry between September 9, 2019, and December 4, 2019.MAIN OUTCOMES AND MEASURES Intratracheal manometric pressures during sustained phonation, conversational speech, and maximum loudness tasks were obtained for 22 patients. Pressure metrics, phonation duration time, and fluency of speech production were compared between patients with dysphagia with those without swallowing complaints. The association between pressure and speech metrics was also assessed. RESULTSOf 22 patients, 17 (77.2%) were men, 5 (22.7%) were women, and the mean (SD) age was 66.6 (8.8) years. The mean (SD) sustained phonation duration time was 9.3 (5.2) seconds, and the mean (SD) IMP during sustained phonation was 50.5 (21.4) cm H 2 0. The IMPs during sustained phonation were strongly correlated with conversational speech (r = 0.712; 95% CI, 0.384-1.039) and moderately correlated with maximum loudness tasks (r = 0.524; 95% CI, 0.127-0.921). The IMPs during conversational speech were moderately correlated with maximum loudness task (r = 0.538; 95% CI, 0.145-0.931). Increased IMP during sustained phonation was moderately correlated with decreased sustained phonation duration time (r = -0.450; 95% CI, -0.867 to -0.034) and conversational speech was moderately correlated with decreased sustained phonation duration time (r = -0.524; 95% CI, -0.921 to -0.127). Patients with subjective swallowing complaints and proximal esophagus abnormalities had a shorter maximum phonation time (mean [SD], 7.08 [5.03] seconds) compared with patients without subjective dysphagic complaints (mean [SD], 11.95 [4.40] seconds), with a large effect size (Cohen d = 1.031; 95% CI, 0.141-1.92). All patients with nonfluent TEP speech production had structural abnormalities of the proximal esophagus. No difference in pressure or speech metrics was observed for primary closure vs reconstructive flap type.CONCLUSIONS AND RELEVANCE This cohort study found that increased IMP and abnormalities of the proximal esophagus were associated with worse TEP speech quality. Evaluation of the esophagus should be considered in patients who are experiencing difficulties with TEP voicing. Further investigation of intratracheal manometry as a biofeedback tool to improve TEP voicing is needed.

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Changing trends of speech outcomes after total laryngectomy in the 21st century: A single‐center study

Abstract: 4.

Cited by 35 publications

References 21 publications

Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture

Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture

Functional outcomes and quality of life after total laryngectomy with noncircumferential radial forearm free tissue transfer

Association of Functional Outcomes in Tracheoesophageal Voicing With Intratracheal Pressures and Esophagram Findings

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