Tracheoesophageal Voice Prosthesis Outcomes: Success or Insucess?

Abstract

Introduction: Total laryngectomy/pharingo-laryngectomy is a potentially aggressive surgery for advanced laryngeal/hypopharyngeal carcinomas, which results in important physical and functional changes that compromise some of the most vital functions, including speech communication. For these patients, tracheoesophageal speech is considered to be the gold standard for voice rehabilitation. Objectives: The purpose of the present study was to determinate the success rate of voice prosthesis rehabilitation, voice prosthesis lifetime and the rate of complications, and its related clinicopathologic factors. Material and Methods: Retrospective review of 92 patients who undergone tracheoesophageal puncture (TEP) performed between January 2007 and December 2012 at the Francisco Gentil Portuguese Institute of Oncology of Oporto. Age, primary disease, staging, the extent of surgical resection, radiotherapy treatment, timing of TEP, surgical and prosthesis-related complications were noted. The impact of these clinicpathological factors on functional outcome, complications of TEP and lifetime of prosthetic valves was assessed in univariate analysis. Vocal rehabilitation efficacy with voice prosthesis was assessed with the multidimensional Harrison-Robillard Shultz (HRS) Rating Scale. Lifetime of voice prosthesis and early and late complications were recorded. Results: A total of 83 patients met the study criteria, predominantly males (94%) with a mean age of 63.7 years. 77% of the patients underwent primary and 23% secondary TEP. 68.7% of patients achieved functional tracheoesophageal speech (HRS score ≥ 10) , 67.2% had performed primary TEP and 73.7% had performed secondary TEP. The mean device lifetime was 9.8 months for voice prosthesis. Prosthesis-related complications occurred in 81% of the patients and the most common issues were prosthesis leakage (76%) and displacement (22%). The most common surgical-related problem was a large and deep tracheostoma. Conclusions: Our success rate of voice rehabilitation was comparable to that reported in published literature with a satisfactory median device lifetime. Because of its safety and simplicity, tracheoe-sophageal puncture is considered to be an effective method for voice rehabilitation after total laryngectomy.

Analysis of Factors Affecting the Longevity of Voice Prosthesis Following Total Laryngectomy with a Review of Literature

“…The prosthesis device life can also vary across regions due to number of reasons, including diet, patient preference, reimbursement and voice expectations, and tolerance of periods of minor leakage prior to replacement. The life of the voice prosthesis has been reported to be anywhere between 2 and 14 months based on the different group of patients, devices, and regions studied [10,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] (Table 4).…”

“…Cornu et al who reported device life of 303 days in a South African patient population describe this phenomenon as patients taking Ba more conservative approach^and this may have contributed to longer mean device life [32]. In a review by Sara Cruz et al in Portugal, mean device life were 1-74 months for primary prosthesis and 1-24 months for secondary prosthesis [33]. Two Indian studies reported mean prosthesis longevity of 18 and 15 months, respectively [25,44].…”

The Multidisciplinary Team (MDT) Approach and Quality of Care

“…Airflow through the esophageal structure will generate a new fundamental tone that, as with the esophageal voice, will later be converted into speech sounds. The use of a voice prosthesis for communication requires daily maintenance and needs to be replaced approximately every 6 months, (130)(131)(132) The rate of complications can range from 15 to 72% (132), being the most frequent the leak through de voice prosthesis and the leak around the tracheoesophageal prosthesis.…”

Current aspects of treatment and rehabilitation of patients with pharyngeal cancer

“…Формирование трахеопищеводного шунта осу-ществляют как за счет собственных тканей пациента, так и с применением силиконовых эндопротезов [29,[51][52][53][54][55][56][57][59][60][61][62]. Разработка операций по трахеопище-водному шунтированию за счет аутотканей была на-правлена на формирование защитного клапанного механизма.…”

“…F. J. Hilgers приводит данные о том, что длительность эксплуатации первых протезов Provox составила от 6 нед до 2 лет, а средний срок службы -5 мес. Поэтому дальнейшие исследова-ния были направлены на увеличение сроков эксплуа-тации голосовых протезов путем механического удале-ния остатков пищи, мокроты, обработки протезов противогрибковыми и антисептическими препаратами [29,[51][52][53][54][55][56][57][58][59][60][61][62].…”