Implantation of an Artificial Larynx after Total Laryngectomy

Abstract Background Speech impairment occurs in 34-70% of head and neck oncologic patients. Management of this impairment is through surgical and nonsurgical methods. Progress in voice rehabilitation following total laryngectomy has over the last 30 years, made an enormous difference in the whole concept of the management of laryngeal cancers. Objective To explore the outcome of different options of voice rehabilitation after total laryngectomy and the advantages and disadvantages of each method in order to improve the quality of life of laryngectomized patients and the suggestion of future directions for research. Patients and Methods The Aim of this work is to provide cumulative data about the efficacy and safety of the outcome of different modalities of voice rehabilitation following total laryngectomy. This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) statement guidelines. Results Voice rehabilitation is one of the most important determinants of the quality of life after total laryngectomy. Recent advances in prosthetic voice devices have made such devices the gold standard for voice rehabilitation. They are thus preferred and used more often than old methods (esophageal speech and artificial larynx). Conclusion Although, no single method is considered to be the best for every patient, the tracheoesophageal puncture has become the most preferred method in the past decade. But it is not always possible in all patients, the results of this study indicate that ES, when achievable, is a viable option that should be considered by surgeons when making intervention decisions on patients, and should be revived when indicated. But we need much more studies.

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Voice Rehabilitation After Total Laryngectomy and Postoperative Radiation Therapy

Journal of Clinical Oncology ◽

10.1200/jco.2002.07.047 ◽

2002 ◽

Vol 20 (10) ◽

pp. 2500-2505 ◽

Cited By ~ 40

Author(s):

William M. Mendenhall ◽

Christopher G. Morris ◽

Scott P. Stringer ◽

Robert J. Amdur ◽

Russell W. Hinerman ◽

...

Keyword(s):

Radiation Therapy ◽

Total Laryngectomy ◽

Voice Rehabilitation ◽

Postoperative Radiation ◽

Postoperative Radiation Therapy ◽

Artificial Larynx ◽

Postoperative Irradiation ◽

Tracheoesophageal Puncture

PURPOSE: The purpose of this study was to evaluate voice rehabilitation after laryngectomy and postoperative irradiation for patients with squamous cell carcinoma of the larynx and hypopharynx. PATIENTS AND METHODS: Between December 1983 and December 1998, 173 patients underwent a total laryngectomy and postoperative irradiation and had follow-up from 3 to 188 months (median, 38 months). Three patients were lost to follow-up at 63, 39, and 4 months after treatment. All other living patients had follow-up for 2 years or longer. Twelve (7%) patients had incomplete data pertaining to voice rehabilitation. RESULTS: Data pertaining to voice rehabilitation were available at 2 to 3 years and longer and 5 years and longer after treatment for 118 and 69 patients, respectively. The methods of voice rehabilitation at 2 to 3 years and longer and 5 years and longer were as follows: tracheoesophageal, 27% and 19%; artificial larynx, 50% and 57%; esophageal, 1% and 3%; nonvocal, 17% and 14%; and no data, 5% and 7%, respectively. CONCLUSION: The most common form of voice rehabilitation after total laryngectomy and postoperative radiation therapy is the artificial larynx. Although the tracheoesophageal puncture is a technique frequently promoted by clinicians as a superior method, a relatively small subset of patients are successfully rehabilitated long-term. However, of those who undergo a tracheoesophageal puncture, approximately half will use this method of voice rehabilitation long term.

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Laryngeal replacement with an artificial larynx after total laryngectomy: The possibility of restoring larynx functionality in the future

Head & Neck ◽

10.1002/hed.23621 ◽

2014 ◽

Vol 36 (11) ◽

pp. 1669-1673 ◽

Cited By ~ 25

Author(s):

Christian Debry ◽

Agnes Dupret-Bories ◽

Nihal E. Vrana ◽

Patrick Hemar ◽

Philippe Lavalle ◽

...

Keyword(s):

Total Laryngectomy ◽

Artificial Larynx ◽

The Future

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More on Implantation of an Artificial Larynx after Total Laryngectomy

New England Journal of Medicine ◽

10.1056/nejmc1701193 ◽

2017 ◽

Vol 376 (14) ◽

pp. e29 ◽

Cited By ~ 3

Keyword(s):

Total Laryngectomy ◽

Artificial Larynx

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An Intraoral Self-Contained Artificial Larynx

Otolaryngology ◽

10.1177/019459988209000213 ◽

1982 ◽

Vol 90 (2) ◽

pp. 208-214 ◽

Cited By ~ 1

Author(s):

Louis D. Lowry ◽

Philip A. Katz ◽

Henry S. Brenman ◽

Hal L. Schwartz

Keyword(s):

Clinical Trials ◽

Life Expectancy ◽

Sound Pressure Level ◽

Total Laryngectomy ◽

Sound Pressure ◽

Thomas Jefferson ◽

Pressure Level ◽

Artificial Larynx ◽

Multidisciplinary Group ◽

Continuous Use

It has been estimated that approximately one third to one half of persons undergoing total laryngectomy do not obtain a satisfactory voice. These patients remain aphonic or use artificial larynges to facilitate their communication. A multidisciplinary group at Thomas Jefferson University has developed a miniaturized artificial larynx that fits on a dental prosthesis or dental plate which has over a 100-dB sound pressure level output at the source and is powered by two hearing aid batteries with a life expectancy of over 100 hours of continuous use. Clinical trials have shown that persons using other artificial devices quickly adapt to this new artificial larynx, and the first person who began using the device, an Italian, commented that he could now use both hands, and felt that this was a great help because of his ethnic background.

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