Laryngektomierte Stimmprothesenträger

Kj, Lorenz; Grieser, Laura; Ehrhart, Theresa; Maier, H.

doi:10.1007/s00106-010-2222-7

Cited by 7 publications

(2 citation statements)

References 26 publications

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“…An ample 6 month study from the University of Ulm, under the coordination of K. Lorenz, performed on 60 total laryngectomy patients who had vocal prostheses, analyzed the 24h pHmetry before and after 6 months of PPI therapy. Results showed that patients with supra-esophageal reflux treated with PPI had a 10 times lower risk to develop enlargement of the fistula and the complications that derive from it [23]. Similar results were reported by the teams led by Cocuzza [24] and Pattani [25] the difference being that this paper took into consideration radiotherapywhich was demonstrated to be another independent risk factor in developing complications of tracheoesophageal speech rehabilitation.…”

Section: Resultssupporting

confidence: 80%

Gastro-Esophageal Reflux Disease and Its Impact on Tracheo-Esophageal Speaking Valve Rehabilitation After Total Laryngectomy

Nicolaescu

Berteșteanu

Grigore

et al. 2019

JSS

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Gastro-esophageal reflux disease (GERD) is a pathological entity in which the mixture of gastric contents (with low pH because of the high content of HCl acid) and biliary juice (rich in proteolytic enzymes like pepsin and trypsin) causes lesions on the mucosa lining the esophagus. A higher prevalence of GERD was discovered in patients who had a total laryngectomy. Concerning laryngectomies with tracheo-esophageal speaking valves, it has been demonstrated that GERD is an independent risk factor for failure of this method of speech rehabilitation. The authors performed an analysis of English language articles found following a search of the major medical scientific databases (NCBI®, EMBASE®, Cochrane®) containing the following keyword string: vocal prosthesis, total laryngectomy, GERD, acid reflux, tracheo-esophageal fistula, failure. Studies showed that exposure to the protelolytic enzymes from the reflux juice increases the diameter of the tracheo-esophageal fistula and permits local granulation tissue to form. Progressively, the increasing fistula diameter leads to complications ranging from microaspiration of liquids and saliva to speaking valve expulsion or ingestion and temporary incapacity of oral feeding. Medical therapy in the postoperative period as well as long-term (6 months or more) correction of GERD (PPI therapy, H2 blockers, prokinetics) is also demonstrated to reduce the complication rate in this category of patients. GERD has a high prevalence in the total laryngectomy population of patients and it has multiple etiologic factors. In patients with tracheoesophageal vocal prostheses, GERD causes an increase in the fistula diameter – with important consequences that affect the patient's quality of life - his ability to phonate and his ability to swallow. These complications come with added costs because of the need to more frequently change the vocal prostheses with ones increasing in diameter, as well as multiple hospitalizations (even surgery to recalibrate or close the tracheo-esophageal fistula). Recognizing and treating this condition therefore decreases the risk of complications following vocal prosthesis speech rehabilitation.

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Section: Resultssupporting

confidence: 80%

Gastro-Esophageal Reflux Disease and Its Impact on Tracheo-Esophageal Speaking Valve Rehabilitation After Total Laryngectomy

Nicolaescu

Berteșteanu

Grigore

et al. 2019

JSS

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“…Precisely, pathological supraesophageal reflux correlates with the onset of fistula complications and the consecutive rehabilitation degree, inducing the onset of periprosthetic leakage [ 26 ]. In this regard, Lorenz et al found higher VHI scores (up to 64.1 ± 9.6) with reflux severity ( p = 0.025) and total quality of life scores were worse in patients with highly pathological reflux ( p = 0.007).…”

Section: Discussionmentioning

confidence: 99%

Voice-Related Quality of Life in Post-Laryngectomy Rehabilitation: Tracheoesophageal Fistula’s Wellness

Cocuzza

Grillo

Ferlito

et al. 2020

IJERPH

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(1) Introduction: Laryngeal cancer is one of the most common types of cancer affecting the upper aerodigestive tract. Despite ensuring good oncological outcome in many locoregionally advanced cases, total laryngectomy is associated with relevant physical and psychological sequelae. Treatment through tracheo-esophageal speech, if promising, can lead to very variable outcomes. Not all laryngectomee patients with vocal prosthesis benefit from the same level of rehabilitation mainly due to the development of prosthetic or fistula related problems. The relating sequelae in some cases are even more decisive in the patient quality of life, having a higher impact than communicational or verbal skills. (2) Material and Methods: A retrospective study was conducted on 63 patients initially enrolled with a history of total laryngectomy and voice rehabilitation, treated at the University Hospital of Catania from 1 January 2010 to 31 December 2018. Quality of life (QoL) evaluation through validated self-administrated questionnaires was performed. (3) Results: The Voice-Related Quality of Life questionnaire revealed significantly better outcomes in both socio-emotional and functional domains of the tracheoesophageal patient group compared to the esophageal group (p = 0.01; p = 0.01, respectively), whereas in the Voice Handicap Index assessment, statistically significant scores were not achieved (p = 0.33). (4) Discussion: The significant differences reported through the V-RQOL and Voice Handicap Index scales in the presence of fistula related problems and device lifetime reduction when compared to the oesophageal speech group have demonstrated, as supported by the literature, a crucial role in the rehabilitative prognosis. (5) Conclusions: The criteria of low resistance to airflow, optimal tracheoesophageal retention, prolonged device life, simple patient maintenance, and comfortable outpatient surgery are the reference standard for obtaining good QoL results, especially over time. Furthermore, the correct phenotyping of the patient based on the main outcomes achieved at clinical follow-up guarantees the primary objective of the identification of a better quality of life.

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Stimmrehabilitation nach totaler Laryngektomie

Lorenz

2015

HNO

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Four different categories of voice rehabilitation can be identified: external (electrical) devices, esophageal speech, and tracheoesophageal shunts either with or without fistula valves/voice prosthesis. During the past three decades, fistula valves/voice prostheses have become the state of the art, with some patients still using esophageal speech or external devices as a back-up method in case of prosthesis failure.

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Laryngektomierte Stimmprothesenträger

Cited by 7 publications

References 26 publications

Gastro-Esophageal Reflux Disease and Its Impact on Tracheo-Esophageal Speaking Valve Rehabilitation After Total Laryngectomy

Gastro-Esophageal Reflux Disease and Its Impact on Tracheo-Esophageal Speaking Valve Rehabilitation After Total Laryngectomy

Voice-Related Quality of Life in Post-Laryngectomy Rehabilitation: Tracheoesophageal Fistula’s Wellness

Stimmrehabilitation nach totaler Laryngektomie

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