TITLE:
Tracheoesophageal Voice Prosthesis Outcomes: Success or Insucess?
AUTHORS:
Sara Cruz, Rita Viana, Joana Guimarães, João Fernandes, Joaquim Castro Silva, Eurico Monteiro
KEYWORDS:
Laryngeal Cancer; Total Laryngectomy; Tracheoesophageal Puncture; Tracheoesophageal Speech; Voice Prosthesis
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.3 No.1,
January
9,
2014
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, tracheoesophageal puncture is considered to be an
effective method for voice rehabilitation after total laryngectomy.