Long Term Results of Speech Rehabilitation in Total Laryngectomy Patients: Primary Versus Secondary Tracheoesophageal Punctures

AbstractNear total laryngectomy with cricohyoepiglottopexy (CHEP) allows cure of glottic carcinomas with voice preservation. The subject of this study was to evaluate CHEP in terms of tumour control and functional result in T1 and T2 glottic carcinomas.This study reviewed retrospectively 55 consecutive cases of CHEP performed between January 1, 1981 and September 1, 1992 with the exclusion of post-radiotherapy salvage surgery. CHEP was indicated for a T1a limit to the anterior commissure and/or with dysplasia of the other vocal fold (10 cases), T1b (11 cases) and T2 (34 cases) glottic carcinomas. All our patients have a follow-up of more than five years.The post-operative course after this surgery was generally uneventful. The median time to decannulation was 18 days, to removal of the nasogastric tube was 15 days and to discharge from hospital was 23 days. No significant difference was observed according to the preservation of one or both arytenoid cartilages. The long-term functional result can be considered to be good in three-quarters of cases, with normal oral swallowing and an easily understood voice. The remaining one quarter had a whispery voice and sometimes episodes of aspiration when swallowing liquids. In terms of oncological results, the five-year recurrence-free survival rate was 94 per cent for T1 and 84 per cent for T2. The ultimate tumour control (taking into account four cases of total laryngectomy) was 94 per cent for T1 and 93 per cent for T2.Primary surgery by CHEP therefore appears to be a good option for early glottic carcinomas. The main problem remains that voice recovery is mediocre in one quarter of patients.

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Long-term results of vocal rehabilitation after total laryngectomy with the low-resistance, indwelling ProvoxTMVoice prosthesis system

Clinical Otolaryngology ◽

10.1111/j.1365-2273.1993.tb00627.x ◽

1993 ◽

Vol 18 (6) ◽

pp. 517-523 ◽

Cited By ~ 73

Author(s):

FRANS J. M. HILGERS ◽

ALFONS J. M. BALM

Keyword(s):

Total Laryngectomy ◽

Long Term Results ◽

Vocal Rehabilitation ◽

Low Resistance

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Long-term Results of the Blom-Singer Speech Rehabilitation Procedure

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.1985.00800040070009 ◽

1985 ◽

Vol 111 (2) ◽

pp. 106-109 ◽

Cited By ~ 22

Author(s):

S. J. Wetmore ◽

K. Krueger ◽

K. Wesson ◽

M. L. Blessing

Keyword(s):

Long Term Results ◽

Speech Rehabilitation

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Long-Term Follow-up of Tracheoesophageal Puncture Results

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949610500701 ◽

1996 ◽

Vol 105 (7) ◽

pp. 501-503 ◽

Cited By ~ 21

Author(s):

James A. Geraghty ◽

Bonnie E. Smith ◽

Barry L. Wenig ◽

Louis G. Portugal

Keyword(s):

Low Socioeconomic Status ◽

Total Laryngectomy ◽

Success Rates ◽

Vocal Rehabilitation ◽

Speech Rehabilitation ◽

Long Term Follow Up ◽

Tracheoesophageal Speech ◽

Tracheoesophageal Puncture

Since its introduction by Blom and Singer in 1980, tracheoesophageal puncture with a voice prosthesis has become the most frequently recommended choice for speech rehabilitation of total laryngectomees. Many studies have reviewed the initial speech acquisition success rates following tracheoesophageal puncture; however, long-term follow-up in these initial successes has been lacking. In addition, factors predictive of long-term success with tracheoesophageal speech have not been defined. Over a 10-yearperiod, we retrospectively reviewed all total laryngectomy patients, including those who have undergone primary or secondary tracheoesophageal puncture, at the University of Illinois Hospital and Clinics and the Westside Veterans Administration Hospitals. Survival in the total laryngectomy cohort of 202 patients ranged from 35% to 50%. Forty of these patients underwent tracheoesophageal puncture, in whom survival was 75%. Short-term success with tracheoesophageal speech was approximately 70% for our patients, while long-term success was achieved in 66%. Despite low socioeconomic status and relatively high alcoholism rates, successful maintenance of tracheoesophageal speech was achieved in the majority of cases. Tracheoesophageal speech should therefore be considered as a primary method of vocal rehabilitation in all patients undergoing total laryngectomy.

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Long-term results of provox voice prosthesis for voice rehabilitation after total laryngectomy “A seven years experience”

International Congress Series ◽

10.1016/s0531-5131(03)01015-x ◽

2003 ◽

Vol 1240 ◽

pp. 871-877

Author(s):

A Tantawy

Keyword(s):

Total Laryngectomy ◽

Voice Prosthesis ◽

Long Term Results ◽

Voice Rehabilitation ◽

Provox Voice Prosthesis

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Improving Hands-free Speech Rehabilitation in Patients With a Laryngectomy: Proof-of-Concept of an Intratracheal Fixation Device

Otolaryngology ◽

10.1177/0194599820982634 ◽

2021 ◽

pp. 019459982098263

Author(s):

Maartje Leemans ◽

Maarten J.A. van Alphen ◽

Richard Dirven ◽

Gijsbertus J. Verkerke ◽

Edsko E.G. Hekman ◽

...

Keyword(s):

Free Speech ◽

Total Laryngectomy ◽

Voice Rehabilitation ◽

Proof Of Concept ◽

Fixation Device ◽

Short Term ◽

Concept Study ◽

Speech Rehabilitation ◽

Further Development

Permanent hands-free speech with the use of an automatic speaking valve (ASV) is regarded as the optimal voice rehabilitation after total laryngectomy. Due to fixation problems, regular ASV use in patients with a laryngectomy is limited. We have developed an intratracheal fixation device (ITFD) composed of an intratracheal button augmented by hydrophilic foam around its shaft. This study evaluates the short-term effectiveness and experienced comfort of this ITFD during hands-free speech in 7 participants with a laryngectomy. We found that 4 of 7 participants had secure ASV fixation inside the tracheostoma during hands-free speech for at least 30 minutes with the ITFD. The ITFD’s comfort was perceived positively overall. The insertion was perceived as being mildly uncomfortable but not painful. This proof-of-concept study demonstrates the feasibility of the ITFD that might improve stomal attachment of ASVs, and it provides the basis for further development toward a prototype suitable for long-term daily use.

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Near-Total Laryngectomy With Epiglottic Reconstruction: Long-term Results

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.1989.01860350075018 ◽

1989 ◽

Vol 115 (11) ◽

pp. 1341-1344 ◽

Cited By ~ 31

Author(s):

H. M. Tucker ◽

M. S. Benninger ◽

J. K. Roberts ◽

B. G. Wood ◽

H. L. Levine

Keyword(s):

Total Laryngectomy ◽

Long Term Results

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Primary versus Secondary Tracheoesophageal Puncture for Speech Rehabilitation in Total Laryngectomy: Long-Term Results with Indwelling Voice Prosthesis

Otolaryngology ◽

10.1016/j.otohns.2005.02.014 ◽

2005 ◽

Vol 133 (1) ◽

pp. 89-93 ◽

Cited By ~ 50

Author(s):

Carlos T. Chone ◽

Flávio M. Gripp ◽

Ana L. Spina ◽

Agricio N. Crespo

Keyword(s):

Success Rate ◽

Total Laryngectomy ◽

Voice Prosthesis ◽

Long Term Results ◽

Voice Rehabilitation ◽

Patient Age ◽

Patient Âgé ◽

Tracheoesophageal Puncture

OBJECTIVE: To evaluate the long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). The influence of the timing (primary or secondary) of tracheoesophageal puncture (TEP), use of radiotherapy (xRT), patient age, and length of follow-up were studied to evaluate the success rate of VP use. STUDY DESIGN AND SETTING: Prospective clinical study in a tertiary referral center. Seventy-one patients were submitted to TL and rehabilitated with indwelling VP. All patients were evaluated for vocal functional issues by an otolaryngologist and a speech pathologist at 1 month, then at every 3 months up to 1 year, and then at every 6 months after 1 year of follow-up. The relative data on time of placement of VP, time of VP use, xRT, age, length of follow-up, and life span of each VP were recorded during the follow-up. RESULTS: Eighty-seven percent of the patients underwent primary and 13%, secondary TEP. The follow-up varied from 12 to 87 months, with an average of 38 months for primary and 51 months for secondary TEP. Fifty-nine percent of the patients were submitted to xRT. The general rate of success was 94%, with 97% for primary and 78% ( P = 0.07) for secondary TEP; after 2 years, the success rate was 96% for primary and 75% for secondary ( P = 0.07) TEP. The use of xRT and patient age had no influence on the success of VP use for primary and secondary TEP, independently of the length of follow-up. CONCLUSIONS: The success rate of voice rehabilitation with VP was 94%. In primary TEP, the success rate was 97%, whereas in secondary TEP it was 78%; 2 years later, it was 96% and 75%, respectively. A tendency for a higher success rate in voice rehabilitation after TL was observed in primary TEP. The use of xRT and age of patient had no influence on the success rate.

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