Socioeconomic Influence on Speech Rehabilitation After Total Laryngectomy

Abstract

ObjectiveSpeech rehabilitation following a total laryngectomy significantly impacts the quality of life. Indwelling prosthetic voice restoration provides optimal outcomes; however, the long‐term maintenance of these devices carries considerable financial costs, which are not universally covered by insurance. This investigation aimed to analyze associations between socioeconomic factors and outcomes in postlaryngectomy speech rehabilitation.Study DesignRetrospective cohort analysis.SettingAcademic tertiary‐care center from May 2014 to September 2021.MethodsIn patients undergoing total laryngectomy, the incidence of tracheoesophageal puncture with indwelling vocal prostheses (TEP‐VP) placement within the first postoperative year was compared among household income, demographic factors, and disease characteristics. Functional and maintenance outcomes served as secondary endpoints.ResultsSeventy‐seven patients were included. Forty‐five (58%) underwent indwelling TEP‐VP (41 primaries). Eighty‐nine percent of patients with annual incomes greater than $50k underwent TEP‐VP compared to only 35% with incomes less than $50k/year. TEP‐VP was performed in 85% of patients with commercial insurance, 70% with Medicare, 42% with Medicaid, and 0% with no insurance. On multivariate analysis, annual household incomes greater than $50k were predicted for TEP‐VP placement (odds ratio: 12.7 [2.45‐65.8], p = .002). The utilization of postoperative speech therapy and functional communication outcomes were similar among socioeconomic groups. Twelve patients were unable to afford supplies within the first year, with differences noted among insurance (p = .015) and income status (p = .003).ConclusionDisparities in vocal and speech rehabilitation following laryngectomy may disproportionally affect underserved patients.

Machine learning approach to predict tracheal necrosis after total pharyngolaryngectomy

“…We defined tracheostoma stenosis as a condition requiring silicone tracheal tube placement to maintain the lumen within 6 months postoperatively and investigated its incidence in patients who developed tracheal necrosis. Tracheoesophageal puncture with voice prosthesis placement is currently the gold standard for postoperative speech rehabilitation 13 . Tracheostoma stenosis causes inadequate space for placement and maintenance of voice prosthesis, 14 thus the rate of postoperative voice prosthesis insertion was examined in the cases with tracheal necrosis.…”

Evidence-Based Recommendations in Primary Tracheoesophageal Puncture for Voice Prosthesis Rehabilitation

“…Additionally, a minimum level of visual capacity is needed for prosthesis care if there is no adequate social or family support [ 54 , 58 ] (4, C). Patient motivation for prosthesis management and self-care is fundamental for rehabilitative success [ 55 , 56 , 59 , 64 , 66 , 67 , 68 ] (3a, B), and having good social/family support is helpful [ 16 , 54 , 69 ] (3a, B).…”

“…Additionally, a minimum level of visual capacity is needed for prosthesis care if there is no adequate social or family support [54,58] (4, C). Patient motivation for prosthesis management and self-care is fundamental for rehabilitative success [55,56,59,64,[66][67][68] (3a, B), and having good social/family support is helpful [16,54,69] (3a, B). Finally, the experience of the hospital center in the technique and having the necessary resources for follow-up, both from the healthcare system and the patient, is key to rehabilitative success [16,54,64,65,70] (2b, C).…”