Applications of the Voice Prosthesis during Laryngectomy

With the recent introduction of the voice prosthesis for alaryngeal speech rehabilitation, its application in the early postlaryngectomy period is gaining acceptance. One hundred twenty-eight patients received a tracheoesophageal puncture and adjunctive pharyngeal constrictor relaxation during laryngectomy. The voice prosthesis was applied as early as 10 days after surgery, and the results of a 9-year experience are presented. Eighty percent of the population achieved a durable voice, and the complications were infrequent. The results support the primary use of tracheoesophageal phonation as a relatively safe and reliable alternative to total laryngectomy alone.

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Periprosthetic Leakage in Tracheoesophageal Prosthesis: Proposal of a Standardized Therapeutic Algorithm

Otolaryngology ◽

10.1177/0194599820983343 ◽

2021 ◽

pp. 019459982098334

Author(s):

Claudio Parrilla ◽

Ylenia Longobardi ◽

Jacopo Galli ◽

Mario Rigante ◽

Gaetano Paludetti ◽

...

Keyword(s):

Total Laryngectomy ◽

Retrospective Cohort ◽

Voice Prosthesis ◽

Management Algorithm ◽

Therapeutic Algorithm ◽

Periprosthetic Leakage ◽

Tracheoesophageal Puncture ◽

The University ◽

The Voice

Objective Periprosthetic leakage represents the most demanding long-term complication in the voice prosthesis rehabilitation. The aim of this article is to discuss the various causes of periprosthetic leakage and to propose a systematic management algorithm. Study Design Retrospective cohort study. Setting Otolaryngology clinic of the University Polyclinic A. Gemelli–IRCCS Foundation. Methods The study included 115 patients with voice prosthesis who were treated from December 2014 to December 2019. All patients who experienced periprosthetic leakage were treated with the same step-by-step therapeutic approach until it was successful. Incidence, management, and success rate of every attempt are analyzed and discussed. Results Periprosthetic leakage was reported 330 times by 82 patients in 1374 clinic accesses. Radiotherapy, timing of tracheoesophageal puncture, and type of total laryngectomy (primary or salvage) did not influence the incidence of periprosthetic leakage. Salvage total laryngectomy increases the risk of more clinically relevant leakages. Conclusion By using a systematic algorithm with a step-by-step standardized approach, periprosthetic leakage management could become a less treacherous issue.

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Insertion of Provox®2 voice prosthesis using the anterograde technique immediately after the secondary tracheoesophageal puncture

The Journal of Laryngology & Otology ◽

10.1258/002221505775010850 ◽

2005 ◽

Vol 119 (12) ◽

pp. 988-990 ◽

Cited By ~ 6

Author(s):

Raymond W M Ng ◽

Paul Lam ◽

Birgitta Y H Wong

Keyword(s):

General Anaesthesia ◽

Local Anaesthesia ◽

Total Laryngectomy ◽

Second Generation ◽

Voice Prosthesis ◽

Neck Stiffness ◽

Neck Extension ◽

Second Stage ◽

Tracheoesophageal Puncture ◽

The Voice

Insertion of a voice prosthesis through the tracheoesophageal puncture (TEP) is one way to restore the voice after total laryngectomy. The second generation Provox® voice prosthesis is presently one of the most popular devices. Although TEP can be done primarily, there are many centres that prefer it to be done at a second stage for various reasons. However, secondary TEP for retrograde replacement of prosthesis can be difficult and general anaesthesia is very often necessary. Moreover, the presence of neck stiffness and fibrosis from the surgery or previous radiotherapy could affect the neck extension for proper positioning of the trocar. Similarly, it is difficult to insert the prosthesis if there is stenosis at the pharyngoesophageal segment. We describe a technique in which creation of secondary TEP and insertion of Provox®2 is done with local anaesthesia under the same setting. The procedure is well tolerated and can be safely performed on an out-patient basis.

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Aspirated Voice Prosthesis: A Unique Complication of Post Total Laryngectomy Voice Rehabilitation

International Journal of Phonosurgery & Laryngology ◽

10.5005/jp-journals-10023-1034 ◽

2012 ◽

Vol 2 (1) ◽

pp. 41-45 ◽

Cited By ~ 1

Author(s):

Sudhir M Naik

Keyword(s):

Case Report ◽

Total Laryngectomy ◽

Voice Prosthesis ◽

Voice Rehabilitation ◽

Wide Field ◽

Wide Angle ◽

Puncture Site ◽

History Of ◽

Tracheoesophageal Puncture ◽

The Voice

ABSTRACT Background/objectives Prosthetic voice rehabilitation after total laryngectomy has proven to be successful in restoring proper speech function in over 90% of patients. The possibility of achieving effective speech using the voice prosthesis is superior to esophageal speech and electrolarynx. Setting Department of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru. Case report A 75-year-old female who had undergone wide field laryngectomy 14 months back came with history of lost voice prosthesis which was later found aspirated. It was removed by the bronchoscopic forceps under topical anesthesia by visualizing it by a nasal 0° wide angle endoscope. The puncture site was cleaned and allowed to cicatrize and narrow down. The fistula was closed by topical application of silver nitrate. Conclusion Tracheoesophageal puncture and prosthesis rehabilitation has emerged as the standard voice rehabilitation of laryngectomized patients. Patient education regarding maintenance of the prosthesis and the care for the tracheostoma is important in reducing the complications. How to cite this article Naik SM. Aspirated Voice Prosthesis: A Unique Complication of Post Total Laryngectomy Voice Rehabilitation. Int J Phonosurg Laryngol 2012;2(1):41-45.

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’The holiday plug‘: a temporary solution to the problem of the leaking voice prosthesis

The Journal of Laryngology & Otology ◽

10.1017/s0022215100125514 ◽

1993 ◽

Vol 107 (12) ◽

pp. 1149-1150

Author(s):

Simon N. Rogers ◽

Andrew Batch ◽

David Powell ◽

Kaye Radford

Keyword(s):

Total Laryngectomy ◽

Voice Prosthesis ◽

Short Paper ◽

Patient Visit ◽

Temporary Solution ◽

The Voice

AbstractTracheo-oesophageal prostheses are commonly inserted in patients following total laryngectomy to improve the quality of the voice. Unfortunately the device eventually fails and requires replacement. A valve change, although well tolerated by patients, necessitates an out-patient visit and delay in its replacement can lead to problems of pneumonia or dehydration. In this short paper we describe a simple temporary solution for a leaking valve and recommend its use in patients who are delayed in returning to the unit for example when on holiday.

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Conversion from a non-indwelling to a Provox®2 indwelling voice prosthesis for speech rehabilitation: comparison of voice quality and patient preference

The Journal of Laryngology & Otology ◽

10.1258/002221503770716278 ◽

2003 ◽

Vol 117 (10) ◽

pp. 815-820 ◽

Cited By ~ 7

Author(s):

A. C. Vlantis ◽

R. T. Gregor ◽

H. Elliot ◽

M. Oudes

Keyword(s):

Patient Satisfaction ◽

Prospective Study ◽

Patient Preference ◽

Acoustic Analysis ◽

Voice Quality ◽

Voice Prosthesis ◽

Technical Aspects ◽

Speech Rehabilitation ◽

Perceptual Difference ◽

The Voice

This prospective study assessed the advantages and problems associated with converting a patient using an older generation non-indwelling voice prosthesis to a newer generation indwelling voice prosthesis, in this case the Provox®2. The voice characteristics of each patient were measured using the old and then the new voice prosthesis. Technical aspects of the insertion of the indwelling prosthesis were noted. Each patient completed a questionnaire after a period of use with the indwelling prosthesis.Changing the prosthesis was simple and uncomplicated in 15 of 17 patients. Acoustic analysis showed improved parameters with the indwelling prosthesis, but no perceptual difference between the two prostheses. The questionnaire revealed that most patients preferred the indwelling prosthesis.Replacing a non-indwelling with an indwelling prosthesis is technically simple, leading to improvement in voice quality and patient satisfaction. It may be reasonable to offer this choice to patients currently using an older generation non-indwelling voice prosthesis.

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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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Customization of the voice prosthesis to prevent leakage from the enlarged tracheoesophageal puncture: Results of a prospective trial

The Laryngoscope ◽

10.1002/lary.23368 ◽

2012 ◽

Vol 122 (8) ◽

pp. 1767-1772 ◽

Cited By ~ 17

Author(s):

Jan S. Lewin ◽

Katherine A. Hutcheson ◽

Denise A. Barringer ◽

Lindsay E. Croegaert ◽

Asher Lisec ◽

...

Keyword(s):

Prospective Trial ◽

Voice Prosthesis ◽

Tracheoesophageal Puncture ◽

The Voice

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Closure of Tracheoesophageal Puncture after Total Laryngectomy

Otolaryngology ◽

10.1177/0194599819842159 ◽

2019 ◽

Vol 161 (2) ◽

pp. 368-370

Author(s):

Giuseppe Riva ◽

Federico Dagna ◽

Eugenia Ricci ◽

Andrea Luigi Cavalot

Keyword(s):

Total Laryngectomy ◽

Voice Prosthesis ◽

Effective Technique ◽

Vocal Function ◽

Tracheoesophageal Puncture ◽

Rehabilitation Time

Tracheoesophageal puncture with voice prosthesis placement is used to restore vocal function after total laryngectomy. However, closure of the fistula is sometimes needed. At our department, a simple and effective technique for closure was developed. It does not require interposed tissues or materials. Moreover, our procedure allows for a short rehabilitation time for swallowing and a short hospitalization. We describe advantages, pitfalls, and errors to avoid. This technique should not be performed for patients who are irradiated and those with large fistulas.

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Tyrosine Kinase Inhibitor Use and Wound Healing in Tracheoesophageal Punctures

Ear Nose & Throat Journal ◽

10.1177/0145561319839805 ◽

2019 ◽

Vol 98 (8) ◽

pp. 510-512 ◽

Cited By ~ 1

Author(s):

Christopher J. Britt ◽

Jonathon O. Russell

Keyword(s):

Wound Healing ◽

Tyrosine Kinase ◽

Total Laryngectomy ◽

Kinase Inhibitors ◽

Kinase Inhibitor ◽

Thyroid Malignancy ◽

Speech Rehabilitation ◽

Local Disease Control ◽

Tracheoesophageal Puncture ◽

Tki Treatment

Tyrosine kinase inhibitors (TKIs) aid in prolonging life in patients with advanced locoregional thyroid malignancy. Such patients may undergo total laryngectomy for local disease control and tracheoesophageal puncture (TEP) for speech rehabilitation. Enlargement of TEP fistulas is usually attributed to wound healing issues and leads to major complications. Four laryngectomies with TEP were performed between 2015 and 2016 and subsequently placed on a TKI. Three patients developed a complication after TKI treatment, and 2 patients had a tracheoesophageal fistula. Patients should be counseled about possible wound healing risks associated with TKIs.

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