Device Life of the Tracheoesophageal Voice Prosthesis Revisited

Abstract

Importance-Voice prosthesis (VP) device life is a limiting factor of tracheoesophageal (TE) voice restoration that drives patient satisfaction, health care costs, and overall burden. Historic data suggest that TE VPs have an average device life of generally 3 to 6 months, but these data are typically derived from small samples using only 1 or 2 devices.Objective-To reexamine current device life in a large, contemporary cancer hospital in the United States that uses a wide assortment of VPs. Main Outcomes and Measures-Tracheoesophageal voice-related outcomes were: (1) device life duration to VP removal, and (2) treatment-related and prosthetic-related factors influencing device failure. Primary independent variables included treatment history (extent of surgery and radiation history), VP type (indwelling vs nonindwelling, size, specialty features), and reason for removal (leakage, complication, other). Duration was examined using Kaplan-Meier analysis. Disease, treatment, and patient-specific factors were analyzed as predictors of duration.Results-Overall, 3648 VPs were placed in the 390 patients (median [range] age, 62 [34-92] years). Indwelling prostheses accounted for more than half (56%) of the devices placed (55%, 20-Fr diameter; 33%, 8-mm length). More than two-thirds (69%) of prostheses were removed because of leakage, while the rest were removed for other reasons. Median device life was 61 days for all prostheses. Indwelling and nonindwelling VPs had median device lives of 70 and 38 days, respectively. There was no significant difference between specialty prostheses compared with standard devices (median duration, 61 vs 70 days, respectively). The Provox ActiValve (Atos HHS Public AccessAuthor manuscript JAMA Otolaryngol Head Neck Surg. Author manuscript; available in PMC 2018 January 01. Conclusions and Relevance-Our data suggest that VP duration demonstrates a lower durability than historically reported. This may reflect the intensification of treatment regimens that complicate TEP management in an era of organ preservation; however, further investigation is needed.

Biofilm Growth Causes Damage to Silicone Voice Prostheses in Patients after Surgical Treatment of Locally Advanced Laryngeal Cancer

“…Central and lateral leakage of fluids by the tracheoesophageal fistula is the most common and potentially life-threatening dysfunction. It might lead to aspiration pneumonia [ 24 , 25 , 26 ]. The average lifetime of a single Provox voice prosthesis is about 4–6 months, but there are individual variations of the time of exploitation [ 27 ].…”

Evaluation of combined growth media for in vitro cultivation of oropharyngeal biofilms on prosthetic silicone

“…1a ). Recent clinical studies have shown a decreasing device lifetime of modern VPs from 3–5 to approximately 2 months [ 5 ]. This puts emphasis on the demand for more durable prosthetic materials, antibiofilm coatings or bioactive surfaces for VPs [ 6 , 7 ].…”

Postlaryngectomy prosthetic voice rehabilitation outcomes in a consecutive cohort of 232 patients over a 13‐year period

“…4,7 These studies have, however, been conducted in a time where primary TL was the gold standard in advanced larynx and hypopharynx cancer treatment. [9][10][11] In 2000, Op de Coul et al 4 published the long-term results of voice rehabilitation with the first Provox VPs in the Netherlands Cancer Institute. 8 This has, however, also led to an increase in salvage TLs after failed (C)RT, which have been associated with more TE wall (TEP tract)-related problems and possibly a lower device lifetime of VPs.…”