A Decade of Postlaryngectomy Vocal Rehabilitation in 318 Patients

• DOI: 10.1001/archotol.126.11.1320
• Publication Date: 2013-06-25T20:37:37Z
• Authors: B. M. R. Op de Coul; F. J. M. Hilgers; A. J. M. Balm; I. B. Tan; F. J. A. van den ...; H. van Tinteren
• Keywords: Adult; Aged, 80 and over; Male; Reoperation; Voice Quality; Hoofd-Halstumoren en Communicatie; Laryngectomy; Middle Aged; 3. Good health; 03 medical and health sciences; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Humans; Female; Larynx, Artificial; Laryngeal Neoplasms; Aged; Retrospective Studies

To assess long-term results with consistent use of indwelling voice prostheses (Provox; Atos Medical AB, Hörby, Sweden) for vocal rehabilitation after total laryngectomy.Retrospective clinical analysis.Comprehensive national cancer center.Three hundred eighteen patients (261 men and 57 women; mean age, 62 years) from November 1988, through May 1999.Standard wide-field total laryngectomy (287 patients) or total laryngectomy with circumferential pharyngeal resection (31 patients), and 2700 prosthesis replacements. Prostheses remained in situ during 364,339 days (1000 patient-years).Device lifetime, indications for replacement (device or fistula related), adverse events, and voice quality.Median patient-device follow-up was 67 months. Mean actuarial device lifetime for all indications for replacement was 163 days (median, 89 days). Main indications for replacement were device-related, ie, leakage through the prosthesis (73%) and obstruction (4%), or fistula-related, ie, leakage around the prosthesis (13%), and hypertrophy and/or infection of the fistula (7%). Adverse events occurred in 11% of all replacements in one third of the patients, mostly solvable by a shrinkage period, or adequate sizing and/or antibiotic treatment. Definitive closure of the tracheoesophageal fistula tract occurred in 5% of the patients. Significant clinical factors for increased device lifetime were no radiotherapy (P =.03), and age older than 70 years (P<.02). Success rate with respect to voice quality (ie, fair to excellent rating) was 88%, which was significantly influenced by the extent of surgery (P<.001).The consistent use of indwelling voice prostheses shows a high success rate of prosthetic vocal rehabilitation, in terms of the percentage of long-term users (95%), and of a fair-to-excellent voice quality (88% of patients).