Role of Reflux in Tracheoesophageal Fistula Problems after Laryngectomy

Abstract

Objectives The purpose of this 2-year prospective nonrandomized study was to investigate the relationship between pathological supraesophageal reflux and the occurrence of speech fistula complications, especially severe fistula enlargement, in patients who underwent total laryngectomy and prosthetic voice restoration. Methods We objectively assessed the presence of reflux disease using 24-hour dual-probe pH monitoring in 60 laryngectomized patients, correlated the incidence of tracheoesophageal fistula complications with the severity of reflux, and assessed the risk of problems by determining the absolute number of reflux events at the level of the speech fistula, the reflux area index score, and the DeMeester score. Results All patients with fistula enlargement showed highly pathological results in the diagnostic tests for reflux disease. Depending on reflux severity, the relative risk of developing fistula complications was up to 10 times higher for these patients. Conclusions We found a significant correlation between the occurrence of tracheoesophageal fistula complications and the severity of supraesophageal reflux. Potential chronic irritation of the esophageal and tracheal mucosa can possibly contribute to the development of these problems. If the presence of reflux disease has been confirmed by 24-hour dual-probe pH monitoring, patients with fistula complications should be treated with proton pump inhibitors.

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

“…One hundred twenty patients (83%) had a postoperative complication (major or minor), including those that were directly related and those that were not related to the TEP (Table ) . Eighty‐nine patients (61%) had 2 or more complications.…”

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

“…4 This figure compares favorably with the 12% after 1 year in a recent study from Germany. Especially of interest in this respect is the study of Lorenz et al, 25 where these authors found that device lifetime was significantly associated with reflux. This concerns the role of the special problem-solving VPs Provox ActiValve Light and Strong in comparison to the regular VPs (Provox2 and Vega).…”

Effect of perioperative proton pump inhibitors on the incidence of pharyngocutaneous fistula after total laryngectomy: A prospective randomized controlled trial

“…Laryngectomy results in changes in pharyngeal plexus innervation and in esophageal motility; a pressure decrease at the level of the upper esophageal sphincter has been observed . Reflux is also recognized as a key factor in phonatory prosthesis problems in the context of postlaryngectomy speech rehabilitation …”