1
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Pires RC, Gama RR, da Silveira Júnior PS, Teixeira FM, Santos CR, de Castro Capuzzo R. Analysis of durability and replacement of vocal prostheses in total laryngectomy patients at a head and neck surgery referral center. Eur Arch Otorhinolaryngol 2024; 281:351-357. [PMID: 37776343 DOI: 10.1007/s00405-023-08180-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/07/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE The use of tracheoesophageal prostheses has become the gold standard in vocal rehabilitation of patients undergoing total laryngectomy. However, this method also has limitations, such as the need for frequent replacement of prostheses due to leakage or other complications. We have designed a study to access the clinical profile of patients using tracheoesophageal prostheses as vocal rehabilitation after total laryngectomy and to determine the average rate of changes, as well as the main causes of prostheses replacement. METHODS A retrospective cohort study was performed based on patients who underwent rehabilitation with voice prostheses after total laryngectomy between 2008 and 2017. RESULTS The sample consisted of 93 patients and 432 vocal prostheses replacement events. The median change of prostheses per patient was 210.25 days, (range 57.33 to 651.50). The most frequent cause of prostheses replacement was leakage through the prostheses, 218 (50.46%). Lower level of education was associated to higher prostheses replacement rate. CONCLUSION The results of this study show that the median of prostheses durability is higher than that presented in the literature, the main cause of replacement was protheses leakage and that low educational level is associated to higher replacement rate.
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Affiliation(s)
- Rafael Cardoso Pires
- Head and Neck Surgery Department, Amazonia Cancer Hospital, Rodovia BR 364, Km 15, S/N, Área Rural, Porto Velho, Rondônia, Brazil.
| | - Ricardo Ribeiro Gama
- Head and Neck Surgery Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Paulo Sérgio da Silveira Júnior
- Head and Neck Surgery Department, Amazonia Cancer Hospital, Rodovia BR 364, Km 15, S/N, Área Rural, Porto Velho, Rondônia, Brazil
| | | | - Carlos Roberto Santos
- Head and Neck Surgery Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Stanisce L, McGlone M, Koshkareva Y, Swendseid B, Lawrence I, Kubicek GJ, Gaughan JP, Solomon DH, Ahmad N. Socioeconomic Influence on Speech Rehabilitation After Total Laryngectomy. Otolaryngol Head Neck Surg 2023; 169:1499-1505. [PMID: 37422889 DOI: 10.1002/ohn.412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Speech rehabilitation following a total laryngectomy significantly impacts the quality of life. Indwelling prosthetic voice restoration provides optimal outcomes; however, the long-term maintenance of these devices carries considerable financial costs, which are not universally covered by insurance. This investigation aimed to analyze associations between socioeconomic factors and outcomes in postlaryngectomy speech rehabilitation. STUDY DESIGN Retrospective cohort analysis. SETTING Academic tertiary-care center from May 2014 to September 2021. METHODS In patients undergoing total laryngectomy, the incidence of tracheoesophageal puncture with indwelling vocal prostheses (TEP-VP) placement within the first postoperative year was compared among household income, demographic factors, and disease characteristics. Functional and maintenance outcomes served as secondary endpoints. RESULTS Seventy-seven patients were included. Forty-five (58%) underwent indwelling TEP-VP (41 primaries). Eighty-nine percent of patients with annual incomes greater than $50k underwent TEP-VP compared to only 35% with incomes less than $50k/year. TEP-VP was performed in 85% of patients with commercial insurance, 70% with Medicare, 42% with Medicaid, and 0% with no insurance. On multivariate analysis, annual household incomes greater than $50k were predicted for TEP-VP placement (odds ratio: 12.7 [2.45-65.8], p = .002). The utilization of postoperative speech therapy and functional communication outcomes were similar among socioeconomic groups. Twelve patients were unable to afford supplies within the first year, with differences noted among insurance (p = .015) and income status (p = .003). CONCLUSION Disparities in vocal and speech rehabilitation following laryngectomy may disproportionally affect underserved patients.
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Affiliation(s)
- Luke Stanisce
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
| | - Mick McGlone
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Yekaterina Koshkareva
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
| | - Brian Swendseid
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
| | - Ian Lawrence
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
- Division of Speech and Language Pathology, Cooper University Health Care, Camden, New Jersey, USA
| | - Gregory J Kubicek
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
- Department of Radiation Oncology, Cooper University Health Care, Camden, New Jersey, USA
| | - John P Gaughan
- Cooper Research Institute, Cooper University Health Care, Camden, New Jersey, USA
| | - Donald H Solomon
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
| | - Nadir Ahmad
- Division of Otolaryngology-Head and Neck Surgery, Cooper University Health Care, Camden, New Jersey, USA
- Cooper Medical School at Rowan University, Camden, New Jersey, USA
- MD Anderson Cancer Center at Cooper, Head and Neck Cancer Center, Camden, New Jersey, USA
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Haring CT, Farlow JL, Leginza M, Vance K, Blakely A, Lyden T, Hoesli RC, Neal MEH, Brenner MJ, Hogikyan ND, Morrison RJ, Casper KA. Effect of Augmentative Technology on Communication and Quality of Life After Tracheostomy or Total Laryngectomy. Otolaryngol Head Neck Surg 2022; 167:985-990. [PMID: 34060949 DOI: 10.1177/01945998211013778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Surgical procedures that render patients acutely aphonic can cause them to experience significant anxiety and distress. We queried patient perceptions after tracheostomy or laryngectomy and investigated whether introducing augmentative technology was associated with improvement in patient-reported outcomes. METHODS Participants included hospitalized patients who acutely lost the ability to speak due to tracheostomy or total laryngectomy from April 2018 to December 2019. We distributed questions regarding the patient communication experience and relevant questions from the validated V-RQOL questionnaire (Voice-Related Quality of Life). Patients were offered a tablet with the electronic communication application Verbally. Pre- and postintervention groups were compared with chi-square analyses. RESULTS Surveys were completed by 35 patients (n = 18, preintervention; n = 17, postintervention). Prior to using augmentative technology, 89% of patients who were aphonic reported difficulty communicating, specifically noting breathing or suctioning (56%), treatment and discharge plans (78%), or immediate needs, such as pain and using the bathroom (39%). Communication difficulties caused anxiety (55%), depression (44%), or frustration (62%), and 92% of patients were interested in using an electronic communication device. Patients reported less trouble communicating after the intervention versus before (53% vs 89%, P = .03), including less difficulty communicating about treatment or discharge plans (35% vs 78%, P < .01). V-RQOL scores were unchanged. DISCUSSION Acute loss of phonation arising from surgery can be highly distressing for patients, and use of augmentative technology may alleviate some of these challenges by improving communication. Further studies are needed to identify what additional strategies may improve overall well-being. IMPLICATIONS FOR PRACTICE Electronic communication devices may benefit patients with acute aphonia.
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Affiliation(s)
- Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Janice L Farlow
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Marie Leginza
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Kaitlin Vance
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Anna Blakely
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Teresa Lyden
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Molly E Heft Neal
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert J Morrison
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Secondary tracheoesophageal puncture with a flexible transillumination device: a new technique and its outcomes. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S65-S69. [PMID: 34716110 DOI: 10.1016/j.bjorl.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This study aims to describe a new secondary tracheoesophageal puncture technique with voice prosthesis insertion under local anesthesia with a low-cost device and evaluate its outcome. METHODS With a transoral flexible transillumination device of aluminum of 2.3 mm with fiberoptic light, the esophagus's anterior wall is visualized through the tracheostomy. A tracheoesophageal fistula is made with a blade and passed through the fistula. Then a bent trocar is introduced into the lumen using the device as a guidewire. Once in the lumen, a thin guide wire is passed through up to the mouth. The voice prosthesis is positioned with retrograde insertion. Then, the patient is discharged without hospitalization. RESULTS 15 patients submitted to this technique had a successful surgical outcome. There were no complications as pneumothorax, esophageal perforation, bleeding, or hospitalization. CONCLUSION The new device is feasible under local anesthesia.
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Iype EM, Janardhanan D, Patil S, Suresh S, Varghese BT, Thomas S. Voice Rehabilitation After Laryngectomy: A Regional Cancer Centre Experience and Review of Literature. Indian J Otolaryngol Head Neck Surg 2020; 72:518-523. [PMID: 33088785 DOI: 10.1007/s12070-019-01707-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022] Open
Abstract
Alaryngeal speech in laryngectomees has revolutionized the patient outlook toward the morbid procedure and the concept of permanent stoma unlike olden era when stigma of stoma with loss of voice was rampant. To analyse acceptance of voice rehabilitation options and their success and management of complications in a tertiary care centre. All patients who underwent laryngectomy from August 2014 to 2018 June at our institution were included in the study. The voice rehabilitation options like oesophageal speech, tracheao-oesophageal puncture and voice prosthesis insertion (TEP), and electrolarynx were explained to the patients. The options put forward to the patients, the importance of Taub test, Interval between treatment and secondary TEP insertion, life span of the prosthesis, Patients acceptance and success rates and the troubleshooting were noted. A total of 96 patients underwent total laryngectomy, 72 patients were willing for rehabilitation. 15% (11) patients had primary TEP, 22% (16) had secondary TEP insertion, esophageal speech in 36% (26) patients and 27% (19) patients opted for the electrolarynx. The rest 24 patients were not keen on any further interventions after laryngectomy. Speech rehabilitation is an integral part in surgical management of carcinoma of the larynx. Alaryngeal speech in laryngectomees have revolutionized the patient outlook towards the morbid procedure. Esophageal speech is the least successful method of rehabilitation but still the cheapest method and requires a lot of motivation. Primary and Secondary TEP insertions have similar success rates. Successful treatment for cancer of larynx ends with successful voice rehabilitation.
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Affiliation(s)
- Elizabeth Mathew Iype
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
| | - Deepak Janardhanan
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
| | - Shirish Patil
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
| | - Sandeep Suresh
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
| | - Bipin T Varghese
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
| | - Shaji Thomas
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
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Tong JY, Pasick LJ, Benito DA, Sataloff RT. Complications associated with tracheoesophageal voice prostheses from 2010 to 2020: A MAUDE study. Am J Otolaryngol 2020; 41:102652. [PMID: 32711236 DOI: 10.1016/j.amjoto.2020.102652] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Tracheoesophageal puncture with voice prosthesis placement remains the gold standard for voice restoration following total laryngectomy, but may cause various complications. This study aims to summarize patient-related and device-related adverse events associated with tracheoesophageal puncture and voice prosthesis placement. MATERIALS AND METHODS The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for reports of adverse events related to tracheoesophageal puncture with voice prosthesis placement from January 1, 2010, to April 30, 2020. Data were extracted from reports pertaining to tracheoesophageal prostheses. RESULTS Seventy-seven reports involving tracheoesophageal voice prostheses were identified, from which 111 adverse events were extracted. Of these, 58 (52.3%) were patient-related, while 53 (47.7%) were device-related. The most frequently reported patient-related adverse events were aspirated prosthesis (24 [41.4%]), foreign body during placement (11 [19.0%]), aspiration pneumonia (9 [15.5%]), and aspirated brush tip (8 [13.8%]). The most common device-related adverse events were detached brush tip (15 [28.3%]), leak (14 [26.4%]), and torn esophageal flange (11 [20.8%]). CONCLUSIONS While tracheoesophageal puncture with voice prosthesis placement has revolutionized voice rehabilitation following total laryngectomy, the procedure may be associated with adverse events both at the time of placement and later. Interventions aimed at improving both physician and patient education may help reduce adverse events attributed to improper use. Further research is needed to clarify optimal approaches to education.
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Cocuzza S, Maniaci A, Grillo C, Ferlito S, Spinato G, Coco S, Merlino F, Stilo G, Santoro GP, Iannella G, Vicini C, La Mantia I. Voice-Related Quality of Life in Post-Laryngectomy Rehabilitation: Tracheoesophageal Fistula's Wellness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124605. [PMID: 32604875 PMCID: PMC7344397 DOI: 10.3390/ijerph17124605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Abstract
(1) Introduction: Laryngeal cancer is one of the most common types of cancer affecting the upper aerodigestive tract. Despite ensuring good oncological outcome in many locoregionally advanced cases, total laryngectomy is associated with relevant physical and psychological sequelae. Treatment through tracheo-esophageal speech, if promising, can lead to very variable outcomes. Not all laryngectomee patients with vocal prosthesis benefit from the same level of rehabilitation mainly due to the development of prosthetic or fistula related problems. The relating sequelae in some cases are even more decisive in the patient quality of life, having a higher impact than communicational or verbal skills. (2) Material and Methods: A retrospective study was conducted on 63 patients initially enrolled with a history of total laryngectomy and voice rehabilitation, treated at the University Hospital of Catania from 1 January 2010 to 31 December 2018. Quality of life (QoL) evaluation through validated self-administrated questionnaires was performed. (3) Results: The Voice-Related Quality of Life questionnaire revealed significantly better outcomes in both socio-emotional and functional domains of the tracheoesophageal patient group compared to the esophageal group (p = 0.01; p = 0.01, respectively), whereas in the Voice Handicap Index assessment, statistically significant scores were not achieved (p = 0.33). (4) Discussion: The significant differences reported through the V-RQOL and Voice Handicap Index scales in the presence of fistula related problems and device lifetime reduction when compared to the oesophageal speech group have demonstrated, as supported by the literature, a crucial role in the rehabilitative prognosis. (5) Conclusions: The criteria of low resistance to airflow, optimal tracheoesophageal retention, prolonged device life, simple patient maintenance, and comfortable outpatient surgery are the reference standard for obtaining good QoL results, especially over time. Furthermore, the correct phenotyping of the patient based on the main outcomes achieved at clinical follow-up guarantees the primary objective of the identification of a better quality of life.
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Affiliation(s)
- Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
- Correspondence:
| | - Calogero Grillo
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
| | - Salvatore Ferlito
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
| | - Giacomo Spinato
- Section of Otorhinolaryngology, University of Padova, 31100 Treviso, Italy;
| | - Salvatore Coco
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
| | - Federico Merlino
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
| | - Giovanna Stilo
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
| | - Giovanni Paolo Santoro
- Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
| | - Giannicola Iannella
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, 47121 Forlì, Italy; (G.I.); (C.V.)
- Department of Organi di Senso, University “Sapienza”, 00185 Rome, Italy
| | - Claudio Vicini
- Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, 47121 Forlì, Italy; (G.I.); (C.V.)
- Department of Otolaryngology, Head and Neck Surgery, University of Ferrara, 44121 Ferrara, Italy
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95100 Catania, Italy; (S.C.); (C.G.); (S.F.); (S.C.); (F.M.); (G.S.); (I.L.M.)
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Krishnamurthy A, Khwajamohiuddin S. Analysis of Factors Affecting the Longevity of Voice Prosthesis Following Total Laryngectomy with a Review of Literature. Indian J Surg Oncol 2018; 9:39-45. [PMID: 29563733 PMCID: PMC5856693 DOI: 10.1007/s13193-017-0700-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 08/28/2017] [Indexed: 10/18/2022] Open
Abstract
Tracheoesophageal voice puncture (TEP) coupled with the use of voice prosthesis has been considered as the gold standard for speech rehabilitation in patients of advanced laryngeal/hypopharyngeal carcinomas, who have undergone a total laryngectomy with or without partial pharyngectomy. Although prosthetic voice rehabilitation is commonly practiced worldwide including India, there is a paucity of published Indian data, more so in the current era of organ conservation. This study included 60 laryngectomized patients with a prosthetic voice rehabilitation at a tertiary cancer center in South India between January 1, 2010 and December 31, 2013. Among the 60 patients, the primary site of cancer was the larynx in 43 patients and hypopharynx in the remaining 17. All patients had undergone a primary TEP insertion, 55 in the upfront setting and five in the salvage (post-radiation/chemo-radiation) setting. The ability to retain a successful trachea-esophageal speech on follow-up (median 15.5 months) in our series was around 82%. The mean device life of voice prosthesis in our patient cohort was 16 months. There was surprisingly no significant difference in the prosthesis device life on correlation with age, co-morbidities, habitat, literacy status, pre-operative tracheostomy, setting of surgery, and the extent of surgery. Our series has successfully demonstrated the safety and feasibility of using primary TEP coupled with the use of voice prosthesis for voice rehabilitation in properly selected and motivated patients of advanced laryngeal and hypopharyngeal carcinomas across all clinical settings. A mean device life of 16 months makes prosthetic voice rehabilitation, an attractive as well as a financially viable option for patients in a resource constrained setting.
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Affiliation(s)
- Arvind Krishnamurthy
- Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Rd, Adyar, Chennai, 600036 India
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9
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Graville DJ, Palmer AD, Chambers CM, Ottenstein L, Whalen B, Andersen PE, Wax MK, Cohen JI. Functional outcomes and quality of life after total laryngectomy with noncircumferential radial forearm free tissue transfer. Head Neck 2017; 39:2319-2328. [DOI: 10.1002/hed.24902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/29/2017] [Accepted: 06/28/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Donna J. Graville
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
| | - Andrew D. Palmer
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
| | | | | | - Breanne Whalen
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
| | - Peter E. Andersen
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
| | - Mark K. Wax
- Department of Otolaryngology - Head and Neck Surgery; Oregon Health & Science University; Portland Oregon
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10
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Chone CT, Gripp FM, Spina AL, Crespo AN. Primary versus Secondary Tracheoesophageal Puncture for Speech Rehabilitation in Total Laryngectomy: Long-Term Results with Indwelling Voice Prosthesis. Otolaryngol Head Neck Surg 2016; 133:89-93. [PMID: 16025059 DOI: 10.1016/j.otohns.2005.02.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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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Affiliation(s)
- Carlos T Chone
- Department of Otorhinolaryngology-Head and Neck, State University of Campinas, São Paulo, Brazil.
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11
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Pellicani AD, Ricz H, Iqueda APD, Aguiar-Ricz L. Effect of the tracheoesophageal voice resistance test in total laryngectomees. Laryngoscope 2016; 127:405-410. [PMID: 27107400 DOI: 10.1002/lary.26031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/20/2016] [Accepted: 03/21/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To analyze tracheoesophageal voice resistance in laryngectomized patients by comparing the acoustic, perceptive-auditory and self-evaluation measures before and after the voice resistance test. STUDY DESIGN An observational, experimental study with a quantitative and descriptive approach. METHODS Nineteen total laryngectomees were submitted for capture of vocal intensity, self-assessment of signs and symptoms of voice fatigue using a visual analogue scale, and perceptive-auditory and acoustic analysis of the tracheoesophageal voice before and after the voice resistance test, which consisted of continuous repeated counting from one to 100. RESULTS The mean time of execution of the test was 33.68 minutes. Type II sound signal, voice intensity, voice quality, degree of severity of dysphonia, and the pitch and loudness parameters were maintained after the test. There were no changes in signs and symptoms of vocal fatigue. CONCLUSIONS Most of the total laryngectomees performed the voice resistance test for less than 30 minutes. However, the voice resistance test did not induce significant changes in the quality of tracheoesophageal voice of total laryngectomees or in the signs and symptoms of vocal fatigue. LEVEL OF EVIDENCE 4 Laryngoscope, 2016 127:405-410, 2017.
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Affiliation(s)
- Ariane D Pellicani
- Department of Speech Therapy, Federal University of Sergipe, Lagarto, Brazil
| | - Hilton Ricz
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Adriana P D Iqueda
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Lílian Aguiar-Ricz
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Kress P, Schäfer P, Schwerdtfeger FP, Rösler S. Are modern voice prostheses better? A lifetime comparison of 749 voice prostheses. Eur Arch Otorhinolaryngol 2014; 271:133-40. [PMID: 23812585 PMCID: PMC3889693 DOI: 10.1007/s00405-013-2611-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 06/18/2013] [Indexed: 11/29/2022]
Abstract
The aim of the study was to compare device life of more recent indwelling voice prostheses Provox Vega and Blom-Singer Dual Valve to device life of well-known standard devices (Provox 2, Blom-Singer Classic). In a prospective, non-randomised study, device life of Blom-Singer Classic, Blom-Singer Dual Valve, Provox2, Provox Vega and Provox ActiValve voice prostheses was recorded in a group of 102 laryngectomised patients. In total 749 voice prosthesis were included. Average overall life time was 108 days, median 74 days. The prosthesis with the longest dwell time was the Provox ActiValve (median 291 days). Provox Vega had longer device life compared with Provox2 (median 92 days vs 66 days; p = 0.006) and compared with Blom-Singer Classic (median 92 days vs 69 days; p = 0.004). In conclusion, device lifetimes of Provox Vega and ActiValve were better than those of Provox2 and the Blom-Singer Classic. New voice prostheses, with a defined valve opening pressure (Provox Vega, Provox ActiValve, Blom-Singer Dual Valve) had longer lifetimes than prostheses without a defined opening pressure (Blom-Singer Classic and Provox 2).
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Affiliation(s)
- P. Kress
- Klinikum Mutterhaus der Borromaerinnen, Feldstrasse 16, 54290 Trier, Germany
| | - P. Schäfer
- Klinikum Mutterhaus der Borromaerinnen, Feldstrasse 16, 54290 Trier, Germany
| | - F. P. Schwerdtfeger
- Klinikum Mutterhaus der Borromaerinnen, Feldstrasse 16, 54290 Trier, Germany
| | - S. Rösler
- University of Applied Science Esslingen, Esslingen, Germany
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Zimmer-Nowicka J, Morawiec-Sztandera A. [Causes and indwelling times of multiple voice prosthesis replacements in patients after total laryngectomy--analysis of 184 replacements in 42 patients]. Otolaryngol Pol 2012; 66:322-7. [PMID: 23036121 DOI: 10.1016/j.otpol.2012.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 06/11/2012] [Accepted: 06/27/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Implantation of the indwelling voice prosthesis has become the preferred method of voice rehabilitation after total laryngectomy. Frequent prosthesis dysfunction remains the major problem. AIM Analysis of the indwelling time and indications for multiple voice prosthesis replacements. METHODS Forty two patients after total laryngectomy due to laryngeal cancer (6 women and 36 men, mean age 62.1 ± 6.7 years) were included. 184 voice prosthesis replacements were analyzed (1271 patient-months). RESULTS Mean time between replacements was 260 ± 150 days. The indwelling time decreased from 267 days to the first replacement to 100-160 days at eighth and subsequent exchanges (p < 0.01). Most frequent indications for replacement were leakage of fluids through the prosthesis, phonation problems caused by mucosal overgrowth around the prosthesis, inaccurate sizing, deformation, and spontaneous extrusion. The lifetime of voice prostheses was positively correlated with patients' age. Mycological culture of the smear taken from tracheoesophageal fistula at first replacement was positive in 34/41 cases, at the second in 29/31 cases, the third in 29/31, and at the fourth and subsequent replacements in all specimens. Most patients indicated the following factors as possible causes of a shortened lifetime of the prosthesis: use of alcohol and coffee (34% of responders), inappropriate dietary habits (sweets and tough foodstuff - 17%), cleaning of voice prosthesis discordant with the recommendations of the manufacturer (14%). CONCLUSIONS Although our results confirm common indications for voice prosthesis replacement we also showed that the time between exchanges is gradually getting shorter. This observation could have implications for the current reimbursement practices.
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Affiliation(s)
- Joanna Zimmer-Nowicka
- Klinika Chirurgii Nowotworów Głowy i Szyi, II Katedra Otolaryngologii Uniwersytetu Medycznego w Łodzi, Poland
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Hancock K, Ward E, Lawson N, van As-Brooks CJ. A prospective, randomized comparative study of patient perceptions and preferences of two types of indwelling voice prostheses. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2012; 47:300-309. [PMID: 22512515 DOI: 10.1111/j.1460-6984.2011.00109.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Technical and device life issues are frequently the focus of post-laryngectomy rehabilitation studies examining indwelling voice prostheses. Patient perceptions and preferences are considered less often. AIMS To determine patient perceptions of two indwelling voice prostheses across parameters relating to device use and maintenance and to determine what factors contribute to patient preferences. METHODS & PROCEDURES In a randomized, cross-over study, 31 laryngectomy patients completed a 3-week trial of both the new indwelling Provox Vega and a comparator device, the Blom-Singer Classic Indwelling. Patient perceptions of the insertion process, cleaning and care, and voicing were explored after each trial. At the end, overall preference and factors influencing device preference were examined. OUTCOME & RESULTS At the conclusion of the crossover trial, a significantly higher proportion of patients felt voice effort, overall voicing, bloating, and ease and effectiveness of cleaning were superior for the Provox Vega. No preference was noted for insertion processes. Overall device preference was influenced by improved voicing followed by cleaning and care. CONCLUSIONS & IMPLICATIONS Patients do not perceive all indwelling devices as equal and should have the opportunity to trial different devices to find the best device for their needs.
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Affiliation(s)
- Kelli Hancock
- Speech Pathology Department, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Queensland, Australia.
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Graville DJ, Palmer AD, Andersen PE, Cohen JI. Determining the efficacy and cost-effectiveness of the activalve: Results of a long-term prospective trial. Laryngoscope 2011; 121:769-76. [DOI: 10.1002/lary.21380] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 10/05/2010] [Indexed: 11/11/2022]
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Reumueller A, Leonhard M, Mancusi G, Gaechter JN, Bigenzahn W, Schneider-Stickler B. Pharyngolaryngectomy with free jejunal autograft reconstruction and tracheoesophageal voice restoration: Indications for replacements, microbial colonization, and indwelling times of the Provox 2 voice prostheses. Head Neck 2010; 33:1144-53. [DOI: 10.1002/hed.21590] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 07/16/2010] [Accepted: 07/26/2010] [Indexed: 11/08/2022] Open
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Leonhard M, Moser D, Reumueller A, Mancusi G, Bigenzahn W, Schneider-Stickler B. Comparison of biofilm formation on new Phonax and Provox 2 voice prostheses - a pilot study. Head Neck 2010; 32:886-95. [PMID: 19862824 DOI: 10.1002/hed.21276] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND In voice rehabilitation for laryngectomized patients, voice prosthetic biofilm formation is still an unsolved problem. Design and materials of voice prostheses have been altered by manufacturers to improve function and extend the lifetime of devices. The goal of the study was to investigate biofilm formation on Provox 2 and Phonax, recently introduced voice prostheses made of thermoplastic polyurethane. METHODS Five laryngectomized patients were equipped with both Phonax and Provox 2 voice prostheses. Microbial colonization was analyzed using standard microbiological methods. Biofilm formation and material infiltration were illustrated using scanning electron microscopy, fluorescence microscopy, and thin-section light microscopy. RESULTS Although no differences in quality or quantity of microbial colonization were assessed, microscopic imaging revealed differences in material surfaces, biofilm composition, and infiltration morphologies; the polyurethane material seems to destabilize biofilm architecture by inhibition of hypheal Candida growth forms. CONCLUSIONS Polyurethane material for voice prostheses seems to reduce biofilm stability and infiltrative processes.
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Affiliation(s)
- Matthias Leonhard
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria.
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Bolzoni A, Peretti G, Piazza C, Farina D, Nicolai P. Cervical spondylodiscitis: A rare complication after phonatory prosthesis insertion. Head Neck 2006; 28:89-93. [PMID: 16320361 DOI: 10.1002/hed.20311] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Tracheoesophageal puncture has excellent voice rehabilitation after total laryngectomy. However, despite its easy insertion and use, severe complications have been reported. METHODS We report a case of cervical spondylodiscitis, occurring in a 67-year-old woman submitted to phonatory prosthesis insertion. After 1 month, she complained of severe cervicalgia associated with fever. Spondylodiscitis involving C6, C7, and the intervening vertebral disk with medullary compression was detected by means of imaging studies. RESULTS A right cervicotomy with drainage of necrotic tissue was performed, and a de-epithelialized fasciocutaneous deltopectoral flap was interposed between the neopharynx-esophagus and the prevertebral fascia to protect the neurovascular axis. MR performed 1 month later showed a complete resolution of the infectious process. CONCLUSIONS Severe neck pain after tracheoesophageal puncture should alert the physician about the possibility of a cervical spondylodiscitis. MR is the most useful imaging technique for preoperative and postoperative evaluation. When neurologic symptoms are detected, surgical exploration of the neck is mandatory.
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Affiliation(s)
- Andrea Bolzoni
- Department of Otorhinolaryngology, University of Brescia, Spedali Civili, Piazza Spedali Civili 1, 25123 Brescia, Italy
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Hancock K, Houghton B, Van As-Brooks CJ, Coman W. First clinical experience with a new non-indwelling voice prosthesis (Provox NID) for voice rehabilitation after total laryngectomy. Acta Otolaryngol 2005; 125:981-90. [PMID: 16109676 DOI: 10.1080/00016480510043486] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSION The new Provox NID non-indwelling voice prosthesis investigated in this study provides a good option for laryngectomized patients using non-indwelling voice prostheses and can potentially improve safety and increase patients' satisfaction with their voice and speech. OBJECTIVE To investigate the feasibility of and patient satisfaction with the Provox NID non-indwelling voice prosthesis. MATERIAL AND METHODS Pre- and post-study questionnaires were used to evaluate the patients' former voice prosthesis and the Provox NID voice prosthesis. In addition, measurements of pull-out force, maximum phonation time and loudness were made for both voice prostheses. In vitro measurements of airflow characteristics were also made. Following a 6-week trial, all patients provided feedback on the new voice prosthesis and the results were used to further improve the Provox NID. This final version of the new voice prosthesis was subsequently trialled and evaluated by 10 patients 6 months later. RESULTS Overall results showed that patient satisfaction with the Provox NID non-indwelling voice prosthesis was favourable. The pull-out force for the new prosthesis was significantly higher than that for the formerly used prosthesis and its aerodynamic characteristics were better.
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Affiliation(s)
- Kelli Hancock
- Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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Chone CT, Spina AL, Crespo AN, Gripp FM. Reabilitação vocal pós-laringectomia total: resultados em longo prazo com prótese fonatória Blom-Singer® de longa permanência. ACTA ACUST UNITED AC 2005. [DOI: 10.1590/s0034-72992005000400018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Avaliar o uso em longo prazo de próteses fonatórias (PF) para reabilitação fonatória de pacientes submetidos à laringectomia total (LT). Foram estudados a influência do tempo de realização da punção tráqueo-esofágica (PTE), o uso de radioterapia pós-operatória (RTXpos-op), idade e seguimento do paciente, sobre a taxa de sucesso de uso da PF. FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODOS: Setenta e um pacientes submetidos à LT e reabilitados com PF de longa permanência. Todos foram avaliados por otorrinolaringologista e fonoaudióloga, quanto aos aspectos funcionais vocais, durante o seguimento. Os dados relativos a tempo de colocação da PF, tempo de utilização da PF, uso de RTXpos-op, idade do paciente, tempo de seguimento e tempo de duração de cada PF foram anotados. RESULTADOS: Houve 87% de pacientes com PTE primária e 13% com secundária. O tempo de seguimento variou de 12 a 87 meses, com média de 38 meses para a PTE primária e 51 meses para a secundária. Houve 59% de pacientes submetidos a RTXpos-op. A taxa de sucesso geral foi de 94%. Na PTE primária foi de 97% e na secundária 78% (p=0,07) e, após dois anos, foi de 96% na PTE primária e 75% na secundária (p=0,07). Utilização de RTXpos-op e idade do paciente não influenciaram no sucesso de utilização de PF, independentemente do tempo de seguimento. CONCLUSÕES: Houve tendência de maior sucesso na reabilitação vocal de pacientes submetidos à LT com a PTE primária. O uso de RTXpos-op e idade não influenciou nesta taxa de sucesso.
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Chone CT, Spina AL, Crespo AN, Gripp FM. Speech rehabilitation after total laryngectomy: long-term results with indwelling voice prosthesis Blom-Singer®. Braz J Otorhinolaryngol 2005; 71:504-9. [PMID: 16446968 PMCID: PMC9441969 DOI: 10.1016/s1808-8694(15)31207-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
UNLABELLED To evaluate long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). We studied the influence of time of performance of tracheo-esophageal puncture (TEP), use of radiotherapy (XRT), patients' age and length of follow-up, on the rate of success of use of VP. STUDY DESIGN Clinical prospective. MATERIAL AND METHOD Seventy-one patients were submitted to TL and rehabilitated with indwelling VP. Both otolaryngologist and speech pathologist evaluated all patients for the vocal functional issues during the follow-up. The relative data on time of placement of VP, time of use of PF, use of XRT, age, length of follow-up and interval of duration of each VP were recorded during the follow-up. RESULTS There was 87% of patients with primary TEP and 13% with secondary. The follow-up varied from 12 to 87 months, with average of 38 months for primary and 51 months for secondary TEP. There were 59% of patients submitted to XRT. The general rate of success was of 94%. In primary TEP it was of 97% and in the secondary, it was 78% (p=0.07) and after two years, the success rate was of 96% in primary TEP and 75% in secondary TEP (p=0.07). The use of XRT and patient age did not influence the success of use of VP among primary and secondary TEP, independently of length of follow-up. CONCLUSION Tendency to greater success rate in voice rehabilitation after TL with primary TEP was observed. Postoperative XRT and age did not influence success rate.
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Free RH, Van der Mei HC, Elving GJ, Van Weissenbruch R, Albers FWJ, Busscher HJ. Influence of the Provox Flush, blowing and imitated coughing on voice prosthetic biofilms in vitro. Acta Otolaryngol 2003; 123:547-51. [PMID: 12797592 DOI: 10.1080/0036554021000028118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study investigates the effect of regular airflow, as an isolated single factor, through Groningen and Provox2 voice prostheses on biofilm formation. MATERIAL AND METHODS Groningen and Provox2 voice prostheses were placed in a modified Robbins device and inoculated with the total microflora from an explanted Groningen voice prosthesis. After 3 days, prostheses were either flushed 3 times per day with the Provox flush, treated with an airflow using an increasing order of air pressure (10, 15 and 20 cmH2O) or vigorously perfused by means of imitated coughing (air pressure 20 cmH2O). As a control, prostheses were left undisturbed to promote biofilm growth. Following flushing, blowing or coughing, each artificial throat was perfused with 200 ml of phosphate-buffered saline. This procedure was repeated three times a day for 9 days. At the end of each day, the artificial throats were filled with growth medium for 30 min and left empty during the night after draining. After 12 days the microflora on each voice prosthesis was quantified by plating on blood agar for bacteria and on de Man, Rogosa and Sharpe agar for yeasts. RESULTS The use of the Provox flush reduced bacterial prevalence on Groningen and Provox2 voice prostheses to 71% and 45% of the control values, respectively, without affecting the number of yeasts. Increasing airflows and imitated coughing yielded reductions of 45-70% in bacterial and yeast prevalence on Provox2 voice prostheses. On the Groningen voice prostheses the effects of increasing airflows and imitated coughing were less pronounced: reductions in bacterial and yeast prevalence of 56-87% were observed. CONCLUSION This study shows that use of the Provox flush has a cleansing effect, especially on Provox2 voice prostheses, and furthermore suggests that daily airflow through voice prostheses as part of a daily maintenance scheme reduces biofilm formation and can be expected to prolong the life of these devices.
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Affiliation(s)
- R H Free
- Department of Otorhinolaryngology, University Hospital Groningen, Groningen, The Netherlands.
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Elving GJ, van Der Mei HC, Busscher HJ, van Weissenbruch R, Albers FW. Air-flow resistances of silicone rubber voice prostheses after formation of bacterial and fungal biofilms. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2002; 58:421-6. [PMID: 11410901 DOI: 10.1002/jbm.1037] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Laryngectomized patients use silicone rubber voice prostheses to rehabilitate their voice. However, biofilm formation limits the lifetime of voice prostheses by causing leakage or an increased air-flow resistance and the prosthesis has to be replaced. To determine which bacterial or yeast strains, isolated from explanted voice prostheses, contribute most to increases in air-flow resistance of silicone rubber voice prostheses, biofilms consisting of either a bacterial or a yeast strain were grown on voice prostheses in the artificial throat model. The effects of these biofilms on air-flow resistances were determined by calculating the difference in air-flow resistance of the individual voice prosthesis as covered with a 7-day-old biofilm with the situation prior to biofilm formation. Conspicuously, voice prosthetic biofilms formed by the bacterial strains Staphylococcus aureus GB 2/1 and Rothia dentocariosa GBJ 41/25B and their excreted organic matter showed larger increases in air-flow resistance (more then 30 cm H(2)O.s/L) than biofilms formed by Candida species. This is contrary to the literature, where there seems to be agreement that Candida species are mainly responsible for clinical failure of silicone rubber voice prostheses.
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Affiliation(s)
- G J Elving
- Department of Biomedical Engineering, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Morton RP, Chaplin JM. Where are we with clinical outcomes in head and neck cancer? Curr Opin Otolaryngol Head Neck Surg 2000. [DOI: 10.1097/00020840-200004000-00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Elving GJ, van der Mei HC, Busscher HJ, van Nieuw Amerongen A, Veerman EC, van Weissenbruch R, Albers FW. Antimicrobial activity of synthetic salivary peptides against voice prosthetic microorganisms. Laryngoscope 2000; 110:321-4. [PMID: 10680938 DOI: 10.1097/00005537-200002010-00027] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate whether synthetic salivary antimicrobial peptides have an inhibitory effect on the growth of bacteria and yeasts isolated from used silicone rubber voice prostheses. METHODS The antimicrobial activities of six synthetic salivary peptides (histatin 5, dhvarl, dhvar4, dhvar5, lactoferrin b 1730 [LFb 17-30], and cystatin S1-15) at concentrations of 2 and 4 mg/mL were determined against different oropharyngeal yeast (four) and bacterial (eight) strains and against a "total microflora" isolated from explanted voice prostheses using agar diffusion tests. The spectrum of susceptible microorganisms was determined qualitatively. RESULTS Histatin 5 and cystatin S1-15 did not show any antimicrobial activity against the microorganisms involved in this study. Dhvar1 was active against some of the oropharyngeal microorganisms tested, including the yeast strains, but not against Rothia dentocariosa, Staphylococcus aureus, Escherichia coli, and the total microflora Dhvar4 was active against all microorganisms tested, including the total microflora. Dhvar5 lacked activity against E coli and the total microflora LFb 1730 did not inhibit the growth of any of the yeast strains involved and showed only minor activity against some of the bacterial strains. LFb 1730 slightly inhibited the growth of the total microflora from an explanted prosthesis. CONCLUSIONS The synthetic salivary peptide dhvar4 has a broad antimicrobial activity against all microorganisms that are commonly isolated from explanted voice prostheses, including yeasts. Therewith, it may represent a useful drug, as an alternative for antibiotics and antimycotics employed in various ways to prolong the lifetime of voice prostheses in laryngectomees.
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Affiliation(s)
- G J Elving
- Department of Biomedical Engineering, University Hospital of Groningen, The Netherlands
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