First clinical experience with a new non-indwelling voice prosthesis (Provox NID) for voice rehabilitation after total laryngectomy

Is Oral Microflora Related to Development of Malfunction in Patients Using Voice Prosthesis?

Background: this prospective study investigated the correlation between the oral bacterial microflora and the microflora found in voice prostheses (VPs) among 20 patients who had undergone laryngectomy. The aim was to explore the associations between the microflora's presence and the malfunction of VPs, along with the association between the predominant microorganism and the longevity of VPs. Methods: the research process included gathering medical histories, conducting ENT examinations, replacing VPs, and performing check-ups every four months for a period of 15.5 months. Additionally, microbiological examinations, blood tests, and voice change surveys were conducted. Results: a correlation between the microflora isolated from VPs and that from oral rinses was demonstrated in a large percentage of patients who experienced a loss of prosthetic functional efficiency. The correlation analysis between the type of microorganism and the lifespan of VPs showed a non-significant Pearson correlation coefficient (r = 0.043, p = 0.678). Conclusions: there is no significant linear correlation between the predominant microorganism and the average lifespan of VPs.

Voice-Related Quality of Life in Post-Laryngectomy Rehabilitation: Tracheoesophageal Fistula's Wellness

(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.

Double Blind Study Investigating the Effect of Different Voice Prostheses on Ease of Swallowing and Residue Post Laryngectomy

Voice prostheses have been examined for their effect on voice production but there is little datum on their effect on swallow function. This study investigated the difference between six commonly available voice prostheses in terms of swallowing. Laryngectomy patients had up to six voice prostheses placed in a random order over two visits. Swallowing was evaluated for each prosthesis using FEES (Fibreoptic Endoscopic Evaluation of Swallowing). After each prosthesis trial, patients self-evaluated their experience of swallowing. Three independent experts indicated which prosthesis they considered best for swallowing for each patient and judged residue on the voice prosthesis and in the upper esophagus. Raters were blinded to participant details, voice prosthesis type and scores of other raters. On patient self-evaluation, scores were equally distributed across all prostheses for swallowing. Experts most frequently chose the Blom Singer Low pressure and Blom Singer Classic Indwelling voice prostheses as best for swallowing but consensus was poor for most patients. Experts found that the Blom Singer Classic Indwelling and the Provox Vega had least residue on the voice prosthesis on thin liquid (p ≤ 0.001) and soft (p = 0.001), respectively. Experts also found that the Blom Singer Low Pressure had least residue in the upper esophagus on soft consistency (p ≤ 0.001). While self-evaluation by patients did not identify a consistently preferred prosthesis for swallow, many patients expressed personal preferences, suggesting benefits to involving patients in the choice of prosthesis. Some voice prostheses may be associated with lower levels of residue on the prosthesis and upper esophagus with certain consistencies.

Evaluating the effect of different voice prostheses on alaryngeal voice quality

OBJECTIVE

To investigate the difference between voice prostheses in terms of voice quality as experienced by patients and as judged by expert raters.

METHODS

Subjects had up to six voice prostheses placed in a random order. A voice sample was elicited for each patient on each prosthesis. Auditory perceptual voice analysis of each voice sample was undertaken by expert raters using the Sunderland Tracheoesophageal Voice Perceptual Scale (SToPS). Raters also identified the best overall prosthesis for voice for each patient. Raters were blinded to patient details, type of laryngectomy surgery, type of voice prosthesis, and scores of other raters. After each prosthesis trial, patients self-evaluated voice using a questionnaire developed for this purpose.

RESULTS

Expert raters were not able to identify a best overall voice prosthesis using SToPS. Expert raters most frequently chose the Blom-Singer Classic Indwelling (InHealth Technologies, Carpinteria, CA) as the overall best prosthesis for voice for each patient. Patient self-evaluation scores indicated a preference for the Blom-Singer Classic Indwelling Prosthesis (InHealth Technologies) for voice, whereas preference for best overall prosthesis was for the Provox NID (Atos Medical AB, Hörby, Sweden) CONCLUSION: Expert raters did not identify a best prosthesis for voice using SToPS, although the Blom-Singer Classic Indwelling (InHealth Technologies) was most frequently chosen as best for voice. Patient self-evaluation indicated a difference between preference of prosthesis for voice and preference for best overall voice prosthesis. Individual patients had their own personal preferences, suggesting they should be involved in the choice of their voice prosthesis.

LEVEL OF EVIDENCE

4. Laryngoscope, 2460-2466, 2018.

Clinical application of the Provox NiD voice prosthesis: a longitudinal study

OBJECTIVES/HYPOTHESIS

To evaluate the indications, complications, and device life of the Provox NiD in a large cohort at a tertiary US cancer center.

STUDY DESIGN

Longitudinal retrospective cohort study.

METHODS

We reviewed the records of patients who used the NiD prosthesis (2005-2011) for general indicators, device life, and complications.

RESULTS

One hundred eighty-six patients who used the NiD were included (median follow-up: 21.4 months). The NiD was placed at initial fit in 41 (22%) patients, whereas 145 (78%) tried an NiD after using another type of prosthesis. Most patients used the NiD similarly to an indwelling device. Median NiD device life was significantly longer than that of other nonindwelling prostheses (45 vs. 29 days, P=.0061), and did not significantly differ from that of standard indwelling devices (45 vs. 50 days, P=.4263). Thirty-eight percent (71 of 189) of NiD users had a history of early leakage (<8 weeks) using a different prosthesis before trying the NiD. Among patients with a pre-existing history of early leakage, almost 90% of NiD prostheses outperformed the device life of other products.

CONCLUSIONS

The NiD prosthesis offers satisfactory device life on a par with indwelling prostheses in our cohort of NiD users. Coupled with favorable published airflow characteristics and satisfactory tracheoesophageal voice, these data suggest that the NiD offers a durable, low-cost prosthetic alternative in contemporary practice. A unique indication for NiD may be improved device life in some patients with a history of early leakage.

LEVEL OF EVIDENCE

4.

A prospective, randomized comparative study of patient perceptions and preferences of two types of indwelling voice prostheses

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.

Clinical phase I/feasibility study of the next generation indwelling Provox voice prosthesis (Provox Vega)

CONCLUSIONS

Provox Vega prostheses demonstrate good short-term feasibility, and their optimized airflow-resistance design offers laryngectomy patients indwelling voice prostheses with more choices in outer diameters without sacrificing (too) much in voice quality.

OBJECTIVES

Technological progress enables improvement of in vitro airflow characteristics of voice prostheses and design of voice prostheses with smaller outer diameters. This could potentially improve voice quality in users of Provox2, and avoid diminished voice quality in users of prostheses with smaller outer diameters.

METHODS

This was a prospective clinical phase I/feasibility study of three newly designed indwelling voice prostheses (Provox Vega 22.5 (Provox2 successor), 20, and 17Fr). Assessments consisted of patients' self-reported voice and speech, perceptual evaluation, acoustic analysis, maximum phonation time, loudness, speech rate, pull-out force and adaptation of the tracheoesophageal (TE) puncture to smaller diameter voice prostheses. Vega 22.5 was assessed in 15 patients (all Provox ActiValve users, observation period 3 weeks), and 16 patients with Vega 20/17 (2 weeks each).

RESULTS

No voice prostheses problems were encountered. Half of the patients with Vega 22.5 preferred that for its better voice quality. Voice and speech were considered equal to Provox2 for Vega 20, but slightly less for Vega 17. Most TE punctures adapted well to the smaller diameter voice prostheses.