Voice Rehabilitation by Voice Prostheses After Total Laryngectomy: A Systematic Review and Network Meta-Analysis for 11,918 Patients

Abstract

Purpose Our aim was to assess the different voice prostheses (VPs) to identify the most efficient, safest, patient-tailored, longest lifetime, and inexpensive VPs and assess the different factors affecting their quality. Method In September 2017, 15 databases were searched to include all randomized controlled trials. A new search was done in May 2019 to include all other study design articles, which include all the new-era VPs subtypes. Network meta-analysis (NMA) was applied to all 27 outcomes, besides NMA overall and partial order setting was done by using Hasse scatter plots. p values were used in NMA, where the best VPs are approaching one and the least approaches zero. Meta-analysis was done for the rest of the outcomes. Results Two hundred one articles were eligible for inclusion in our study ( N = 11,918). Provox-2 was significantly the most efficient and safest device concerning the most patient preference (odds ratio [ OR ] = 33.88 [0.65, 1762.24]; p = .92), the least dislodgement (risk ratio [RR] = 0.27 [0.13, 0.57]; p = .79), the least airflow resistance (RR = 0.42 [0.08, 2.11]; p = .84), the least granulation formation (RR = 0.73 [0.02, 26.32]; p = .60), and the least VPs' inaccurate size (RR = 0.77 (0.23, 2.61); p = .66). Heat and moisture exchanger addition showed a significant increase in maximum phonation time and breathing experience, with p values (1 and .59), respectively. While heat and moisture exchanger addition showed a significant decline in stoma cleaning frequency, coughing frequency, forced expectoration, sputum production, sleeping problems, and loosening of adhesive, with p values (.99, .72, .69, .96, 1, and 0.96), respectively, Groningen low resistance and Nijdam were considered the worst devices with both overall mean p value of .44. Conclusions Provox-2 is considered the best choice as being the most preferable for patients, with the least airflow resistance, dislodgment, granulation formation, and prosthesis inaccurate size. Groningen low resistance and Nijdam were considered the worst devices according to our analysis. Supplemental Material https://doi.org/10.23641/asha.14802903

Primary tracheoesophageal puncture in stapler-assisted laryngeal closure: a surgical modification

“…A total laryngectomy (TL) remains the only option available for patients with advanced stages of laryngeal cancer, despite significant morbidities. The major concern after the procedure is related to loss of voice 1…”

“…Closure of the neopharynx during a TL is a crucial step, but the surgical stapler has made it much easier and faster 1. Additionally, the method seems to facilitate wound healing and provides a water-tight closure as well as prevents contamination of the surgical site with pharyngeal secretions 2.…”

Inhibition and Removal of Mature Mixed-Bacteria Biofilms on Voice Prostheses by Sodium Selenite

“…[1][2][3][4] Voice prostheses have become an important method for facilitating patients' vocalization after total laryngectomy due to advantages such as simple operation, smooth and clear pronunciation, and the ease of mastering pronunciation skills. 5,6 The formation of biofilm on a voice prosthesis can cause it to malfunction, which is an important reason for a shortened service life. Patients must have the voice prosthesis replaced with a new one every 3-4 months, which imposes considerable economic and psychological pressure on them.…”

Usage and long-term complications of voice prosthesis in patients with total laryngectomy – our approach to periprosthetic leakage

“…Primary prosthetic voice restoration at the time of surgery is the standard of care in patients treated with total laryngectomy for advanced laryngeal or hypopharyngeal cancer (1). Traheoesophageal puncture (TEP) can be performed at initial surgery (primary TEP) or after initial surgery (secondary TEP).…”