Postlaryngectomy Voice Restoration Using a Voice Prosthesis: A Single Institution's Ten-Year Experience

Abstract

We describe the speech rehabilitation outcome of patients treated with total laryngectomy or total laryngopharyngectomy and insertion of Provox voice prostheses (Atos Medical AB, Hörby, Sweden) at the Helsinki University Central Hospital. We performed a retrospective chart review of 95 patients (88 men and 7 women; mean age, 63.5 years) who underwent insertion of a voice prosthesis in the period 1992 to 2002. Eighty-one percent (77/95) of the patients underwent a primary prosthesis insertion at the time of laryngectomy. A head and neck surgeon, a laryngologist, and a speech therapist rated the long-term tracheoesophageal speech of 78% (74/95) of the patients as good or average. The main causes for replacement of the device were obstruction, leakage or inadequate size of the prosthesis, and granulation or leakage around the fistula. According to our 10-year experience, use of the Provox prosthesis is an effective method of postlaryngectomy voice rehabilitation, and it continues to be our preferred method of voice restoration in the majority of cases.

Postlaryngectomy Vocal Rehabilitation: Assessment Using a Validated Questionnaire in 51 Patients

“…These leakages were of little issue to the patients presumably because they had been adequately informed and were well aware of how to deal with this problem. The average life expectancy of the valves in this study was consistent with previous studies in the literature [3,[5][6][7][12][13][14] . No correlation was found between leakage and diameter/gauge of the valve which was again consistent with our previous study [4] .…”

“…However, problems related to the voice prosthesis and tracheo-oesophageal fistula continue to challenge multidisciplinary health care professionals [6,7] .…”

Pharyngolaryngectomy with free jejunal autograft reconstruction and tracheoesophageal voice restoration: Indications for replacements, microbial colonization, and indwelling times of the Provox 2 voice prostheses

“…In comparison to other studies, the mean indwelling time of both groups was longer than in reports using solely the Provox 2 prostheses (69 days and 96 days) but shorter than in studies using only the Provox 1 or both the Provox 1 and Provox 2 prostheses (between 141 days and 311 days), [22][23][24][25][26]34,35 mainly due to the generally longer device lifetime of the Provox 1 prosthesis. [23][24][25] The median indwelling time observed in patients after laryngectomy in this study was similar to results published recently by other authors (92 days and 3.7 months).…”

“…Patients after laryngectomy and patients after pharyngolaryngectomy with jejunal autograft reconstruction in this study had slightly lower rates of granulation tissue formation and periprosthetic leakage than patients in 2 recent reports of other authors. 23,26 Candida spp. and bacterial commensals of the upper respiratory tract were found with similar frequencies in both patient groups.…”

“…[21][22][23][24][25][26] Formation of granulation tissue can lead to prosthesis overgrowth with loss of valve function and to partial or total shunt closure. Atrophy and necrosis due to local infection or tissue compression may result in shunt widening with periprosthetic leakage or even dislocation of the prosthesis.…”