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Pan C, Andrews LIB, Johnson E, Bhatt NK, Rizvi ZH. Factors associated with successful electrolarynx use after total laryngectomy, a multi-institutional study. Laryngoscope Investig Otolaryngol 2024; 9:e1212. [PMID: 38362175 PMCID: PMC10866577 DOI: 10.1002/lio2.1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024] Open
Abstract
Objective To identify characteristics associated with successful electrolarynx (EL) use after total laryngectomy (TL). Methods Records of 196 adults who underwent TL from 03/15/2012 to 03/15/2022 at the University of Washington and Puget Sound Veterans Affairs were reviewed. Characteristics included age, Charlson Comorbidity Index, social support, pre-operative radiation (RT) and chemoradiation (CRT), and 6-month post-TL swallow status. EL success was evaluated using pre-defined criteria of intelligibility, reliability, and independence with use. Poisson regressions and robust standard error estimates were used to estimate unadjusted risk ratios for each characteristic. Statistically significant characteristics were included in multivariate analysis (MVA) to estimate adjusted risk ratios. Results Median age was 64, median Charlson Comorbidity Index was 5, 170 (87%) were male, 159 (81%) had high social support, and 159 (81%) attained post-TL full-oral diet. Pre-operatively, 110 (56%) had RT, including 55 (28%) with CRT. Ninety-three (47%) met our criteria for EL success. Characteristics significantly associated with EL success included social support (p = .037) and post-TL full-oral diet (p = .037); both approached significance on MVA. EL success varied by pre-operative treatment on univariate (p = .005) and MVA (p = .014). Compared to no prior RT or CRT, the probability of EL success was 29% higher with prior RT and 29% lower with prior CRT in MVA, although these associations did not reach significance. Conclusions In this retrospective review, EL success correlated with high social support, post-TL full-oral diet, and pre-operative treatment history. These results warrant validation in a larger prospective study to help guide the choice of voice rehabilitation modalities or intensified speech therapy. Level of Evidence 4.
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Affiliation(s)
- Cassie Pan
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of WashingtonSeattleWashingtonUSA
| | - Leah I. B. Andrews
- Department of Biostatistics, School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Emily Johnson
- Department of Veterans AffairsPuget Sound Health Care SystemSeattleWashingtonUSA
| | - Neel K. Bhatt
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of WashingtonSeattleWashingtonUSA
| | - Zain H. Rizvi
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of WashingtonSeattleWashingtonUSA
- Department of Veterans AffairsPuget Sound Health Care SystemSeattleWashingtonUSA
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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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Parrilla C, Almadori A, Longobardi Y, Lattanzi W, Salgarello M, Almadori G. Regenerative Strategy for Persistent Periprosthetic Leakage around Tracheoesophageal Puncture: Is It an Effective Long-Term Solution? Cells 2021; 10:cells10071695. [PMID: 34359865 PMCID: PMC8305158 DOI: 10.3390/cells10071695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023] Open
Abstract
Autologous tissue-assisted regenerative procedures have been considered effective to close different types of fistula, including the leakage around tracheoesophageal puncture. The aim of this study was to retrospectively review 10 years of lipotransfer for persistent periprosthetic leakage in laryngectomized patients with voice prosthesis. Clinical records of patients who experienced periprosthetic leakage from December 2009 to December 2019 were reviewed. Patients receiving fat grafting were included. The leakage around the prosthesis was assessed with a methylene blue test. Twenty patients experiencing tracheoesophageal fistula enlargement were treated with fat grafting. At the one-month follow-up, all patients were considered improved with no leakage observed. At six months, a single injection was sufficient to solve 75% of cases (n 15), whereas 25% (n 5) required a second procedure. The overall success rate was 80% (n 16). Results remained stable for a follow-up of 5.54 ± 3.97 years. Fat grafting performed around the voice prosthesis, thanks to its volumetric and regenerative properties, is a valid and lasting option to solve persistent periprosthetic leakage.
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Affiliation(s)
- Claudio Parrilla
- Otolaryngology Unit, Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.P.); (Y.L.); (G.A.)
| | - Aurora Almadori
- Plastic Surgery Unit, Department of Women’s and Child Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College of London, London NW3 2QG, UK
- Correspondence:
| | - Ylenia Longobardi
- Otolaryngology Unit, Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.P.); (Y.L.); (G.A.)
| | - Wanda Lattanzi
- Applied Biology Unit, Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Marzia Salgarello
- Plastic Surgery Unit, Department of Women’s and Child Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giovanni Almadori
- Otolaryngology Unit, Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.P.); (Y.L.); (G.A.)
- Head & Neck Oncologic Unit, Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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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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Outcomes of tracheoesophageal puncture in twice-radiated patients. Am J Otolaryngol 2019; 40:102272. [PMID: 31445930 DOI: 10.1016/j.amjoto.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Previous research has demonstrated the safety of tracheoesophageal puncture voice prosthesis (TEP) placement in radiated patients; however, there is a growing population of twice-radiated patients with limited research on the outcomes of TEP-placement in this cohort. METHODS After Institutional Review Board approval, a retrospective review of 80 patients that underwent TEP from 2006 to 2017 at a single institution was conducted, of which 16 patients underwent two courses of radiation. Outcome measures include TEP removal, complication and duration of usage. RESULTS Half of twice-radiated patients had ultimate removal of their voice prosthesis with removal occurring at a median of 24.9 months after placement. Reasons for prosthesis removal included widening tracheoesophageal fistula, local recurrence, and dysphagia/esophageal stenosis. Nearly one-third of these patients required surgical intervention for closure of a widening fistula. In contrast, only 17% of once-radiated patients had their prosthesis removed with removal occurring at a median of 28.1 months. This was statistically fewer than the twice-radiated group (p = 0.02). Reasons for removal included patient preference, persistent leakage, recurrence of disease, enlarging tracheoesophageal fistula, poor voice, and dysphagia. Eleven percent of once-radiated patients required surgical intervention for TEP-related complications (p = 0.057). CONCLUSION In the twice-radiated patient cohort, there is a higher rate of TEP removal and need for surgical intervention for a voice prosthesis-related complication as compared to a once-radiated cohort.
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Song Y, Kiyosaki K, Damrose EJ. Epidural abscess and paraplegia: Delayed sequela of tracheoesophageal puncture. OTOLARYNGOLOGY CASE REPORTS 2017. [DOI: 10.1016/j.xocr.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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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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Lorenz KJ, Kraft K, Graf F, Pröpper C, Steinestel K. [Importance of cellular tight junction complexes in the development of periprosthetic leakage after prosthetic voice rehabilitation]. HNO 2015; 63:171-2, 174-8, 180-1. [PMID: 25515126 DOI: 10.1007/s00106-014-2951-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The use of voice prostheses is currently the gold standard in voice rehabilitation after total laryngectomy. This method combines low complication rates and excellent rehabilitation results; however, approximately 30% of patients show periprosthetic leakage or severe fistula enlargement after laryngectomy and prosthetic voice restoration within the first 4 years. The development of this enlargement is controversially discussed in the literature but recently published studies have shown that high esophageal reflux plays a key role in this process, which leads to an inflammatory reaction and disturbs the intercellular tight junctions in the sense of an epithelial mesenchymal transition (EMT). MATERIAL AND METHODS A total of 44 patients underwent 24 h pH monitoring, a sample biopsy from the region of the fistula and a subsequent biomolecular examination for intracellular junction proteins as well as a correlation between the severity of reflux and tracheoesophageal fistula problems before and after antireflux therapy with proton pump inhibitors (PPI). RESULTS Immunohistochemical staining revealed decreases in membrane E-cadherin and β-catenin and a significant increase in the cytoplasmic fraction, depending on the severity of inflammation in the fistula tissue. In patients with an improvement of clinical fistula problems under oral PPI treatment an increase of membrane E-cadherin could be shown, whereas patients with persisting fistula enlargement demonstrated a further decrease of E-cadherin. CONCLUSION The data indicate a central role of EMT in the development of fistula enlargement after total laryngectomy. Patients with periprosthetic leakage showed a loss of membrane bound E-cadherin and β-catenin with an up-regulation of vimentin expression. In patients with mild or no leakage problems EMT could be resolved by aggressive antireflux treatment, whereas patients without any effect of PPI treatment on the fistula showed no reversal of EMT. These data contribute to the understanding of treatment resistant fistula enlargement after total laryngectomy.
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Affiliation(s)
- K J Lorenz
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Chirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland,
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The development and treatment of periprosthetic leakage after prosthetic voice restoration. A literature review and personal experience part I: the development of periprosthetic leakage. Eur Arch Otorhinolaryngol 2014; 272:641-59. [PMID: 25404116 DOI: 10.1007/s00405-014-3394-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/07/2014] [Indexed: 01/04/2023]
Abstract
In the past 30 years, the use of a voice prosthesis has become the treatment of choice for the restoration of speech following laryngectomy. Not only is the placement of a voice prosthesis a simple surgical procedure, but it is also associated with a low rate of complications and an excellent success rate. Approximately, 20-30 % of all patients with voice prostheses, however, develop periprosthetic leakage with aspiration over time. Periprosthetic leakage is usually caused by an enlargement of the tracheo-oesophageal fistula and substantially affects the quality of life of the patients concerned. In a retrospective analysis of our patients, the incidence of periprosthetic leakage was 35.7 % in a total of 232 patients who underwent laryngectomy during a period of 20 years. Substantial enlargement of the tracheo-oesophageal fistula which required multiple treatments occurred in 12.5 % of the patients. In this review, the various causes of fistula enlargement are discussed on the basis of the literature and the experience that we have accumulated during the past 20 years in the management of patients with voice prostheses.
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Bozzo C, Meloni F, Trignano M, Profili S. Mediastinal abscess and esophageal stricture following voice prosthesis insertion. Auris Nasus Larynx 2014; 41:229-33. [DOI: 10.1016/j.anl.2013.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/18/2013] [Accepted: 09/20/2013] [Indexed: 11/24/2022]
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[Prosthetic voice restoration after laryngectomy: the management of fistula complications with anti-reflux medications]. HNO 2011; 58:919-26. [PMID: 20563542 DOI: 10.1007/s00106-010-2127-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Approximately 30% of all patients show periprosthetic leakage or severe fistula enlargement after laryngectomy and prosthetic voice restoration. In a prospective study, we investigated the role of aggressive anti-reflux therapy in fistula complications. PATIENTS AND METHODS A total of 48 patients were assigned to one of two groups. Group A consisted of 16 patients with recurrent periprosthetic leakage. Group B comprised 32 patients without periprosthetic leakage. The presence of reflux was objectively assessed using 24-h dual-probe pH monitoring. All patients with pathological reflux underwent proton pump inhibitor (PPI) therapy. After 6 months, patients were re-evaluated for fistula complications and objective reflux parameters. RESULTS The mean absolute number of reflux events was 202.8 (+/-44) before and 74.5 (+/-22.9) after PPI therapy (p=0.025). The reflux area index decreased from 419.5 (+/-112.5) before treatment to 105.8 (+/-54.7) after treatment (p=0.0005). The mean DeMeester score was 104.4 (+/-21.3) without PPIs and 43.5 (+/-9.3) after 6 months with PPIs (p=0.028). A risk analysis for patients with both periprosthetic leakage and pathological reflux (15 patients at the beginning of the study, four patients after therapy) showed that the relative risk of periprosthetic leakage decreased to 0.3 (p=0.0054) with PPI therapy. CONCLUSION Patients with recurrent periprosthetic leakage in the region of the fistula showed a significantly higher number of supra-oesophageal reflux episodes. Rigorous anti-reflux treatment can help manage or prevent leakage problems in a large proportion of patients.
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Terada T, Saeki N, Uwa N, Sagawa K, Mohri T, Sakagami M. [Voice restoration and long-term progress in voice rehabilitation using the Provox2 voice prosthesis after total laryngectomy]. NIHON JIBIINKOKA GAKKAI KAIHO 2010; 113:838-843. [PMID: 21174730 DOI: 10.3950/jibiinkoka.113.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
From January 2000 to December 2008, we conducted voice rehabilitation using the Provox2 voice prosthesis total-laryngectomy subjects. Of these, 36 attained restoration of 90.0%. Mean maximum phonation time (MPT) was 14.5s, ranging from MPT was not influenced by age, radiotherapy use, primary tumor site, or reconstructive surgery use. Voice prosthesis replacement averaged 25 weeks (5.8 months), ranging from 9 to 74 weeks. Complications occurred in 16 caces (40.0%), mainly granulation tissue formation and prosthesis-site infection, also aspiration pneumonia, prosthesis-site salivary leakage, inability to replace the prosthesis, tracheomalacia, bodies in the trachea. Management rather than medical problems included cost, frequent hospital visits, and lack of motivation to use a prosthesis. The Provox2 voice prosthesis speech provides a higher rate of speech restoration, longer phonatory better intelligibility. Management problems, however, require that we work to understand subjects' living environments and family situations better for evaluating Provox2 voice prosthesis indication more effectively.
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Affiliation(s)
- Tomonori Terada
- Department of Otolaryngology, Hyogo College of Medicine, Nishinomiya
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[Surgical treatment of enlarged trachoesophageal puncture with and without supraesophageal reflux : case report and review of literature]. HNO 2009; 57:1317-24. [PMID: 19727622 DOI: 10.1007/s00106-009-1990-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Approximately a quarter of all patients who undergo prosthetic voice restoration develop periprosthetic leakage with aspiration symptoms within 1 to 4 years following surgery. Depending on the severity of fistula enlargement, treatment ranges from conservative approaches to surgical procedures. In some cases, however, these measures prove unsuccessful. The causes of treatment failure and fistula enlargement are not fully understood. There is growing evidence, however, that the presence of coexisting supraesophageal reflux can contribute to fistula complications. We report the case of two patients with voice prostheses and simultaneous severe reflux disease who underwent multiple failed attempts at fistula closure. After effective reflux therapy, the fistulas could eventually be closed successfully.
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Koinzidenz von Stimmfistelerweiterungen und supraösophagealem Reflux nach stimmprothetischer Versorgung bei Laryngektomie. HNO 2009; 57:1253-61. [PMID: 19727628 DOI: 10.1007/s00106-009-1956-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Malik T, Bruce I, Cherry J. Surgical complications of tracheo-oesophageal puncture and speech valves. Curr Opin Otolaryngol Head Neck Surg 2007; 15:117-22. [PMID: 17413414 DOI: 10.1097/moo.0b013e3280964dc8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Speech rehabilitation following total laryngectomy is central to future quality of life. Although other options exist, surgical voice restoration has emerged as the 'gold standard' management strategy in the majority of laryngectomees. Taking this into account, what are the complications of this technique and how should they be successfully managed? The purpose of this review is to provide a comprehensive review of the subject, with particular reference to technique, complications and outcome. RECENT FINDINGS As with any surgical intervention, complications may occur in the early postoperative period or later. The article provides a detailed explanation of the varying problems detailed in individual reports, and in case series. Primary or secondary tracheo-oesophageal puncture is also discussed, along with complications resulting from the speech valve itself. SUMMARY The positive impact of surgical voice restoration on quality of life in the alaryngeal patient considerably outweighs the complications commonly associated with the procedure. Greater knowledge of the potential problems should continue to reduce the complication rate. Primary puncture, in a patient selected and subsequently managed in a multidisciplinary environment, would appear to provide the best outcome for the patient.
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Affiliation(s)
- Tass Malik
- Department of Otolaryngology Head and Neck Surgery, Royal Blackburn Hospital, Blackburn, UK
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Terada T, Saeki N, Toh K, Uwa N, Sagawa K, Takayasu S, Sakagami M. Voice rehabilitation with Provox2™ voice prosthesis following total laryngectomy for laryngeal and hypopharyngeal carcinoma. Auris Nasus Larynx 2007; 34:65-71. [PMID: 17137738 DOI: 10.1016/j.anl.2006.09.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Revised: 05/17/2006] [Accepted: 09/15/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the effectiveness of the Provox2 voice prosthesis for voice rehabilitation following total laryngectomy. METHODS From September 2000 to December 2004, the Provox2 voice prosthesis was used for voice rehabilitation in 32 patients following total laryngectomy. The quality of speech with the Provox2 voice prosthesis was analyzed using the HRS rating scale, the maximum phonation time (MPT), incidence of complications and the in situ lifetime. The rate of speech restoration was further analyzed in 129 patients with total laryngectomy from 1996 to 2004. RESULT Twenty-nine of 32 patients were able to restore speech using the Provox2 voice prosthesis, a speech restoration rate of 90.6%. The maximum phonation time (MPT) was measured in 18 patients using the Provox2 voice prosthesis. The mean MPT was 15.1 s, with a range of 8-28 s. MPT was not influenced by age, concurrent radiotherapy treatment, the location of the primary tumor or use of reconstructive surgery. The average lifetime of the Provox2 in patients with laryngeal carcinoma (12 patients) and hypopharyngeal carcinoma (17 patients) was 27.2 and 16.6 weeks, respectively, which was significantly different (P=0.024, non-parametric Mann-Whitney's U-test). The rate of speech restoration by the use of esophageal speech, and insertion of an artificial larynx was 62.7% for laryngeal carcinoma (59 cases) and 38.6% for hypopharyngeal carcinoma (70 cases), which was also significantly different (P<0.01, chi-square test). CONCLUSION Provox2 voice prosthesis speech was very useful due to the higher rate of speech restoration, longer phonatory time, and better intelligibility. It was also thought that voice prosthesis speech was useful in conjunction with esophageal speech and an artificial larynx depending on the patient's condition or wishes.
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Affiliation(s)
- Tomonori Terada
- Department of Otolaryngology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo 663-8501, Japan.
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Poggioli NG, González-Botas JH, Vázquez Barro JC, Juiz VN, Vidal JM. Phonation Fistulas Today. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s2173-5735(07)70314-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Outcomes of Primary and Secondary Tracheoesophageal Puncture: A 16-year Retrospective Analysis. EAR, NOSE & THROAT JOURNAL 2006. [DOI: 10.1177/014556130608500417] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The current study retrospectively reviewed the cases of 68 patients who had undergone total laryngectomy and tracheoesophageal puncture (TEP) over a 16-year period. Fifty-one patients underwent primary TEP and 17 underwent secondary TEP. Nearly 80% of patients who received TEP at the time of laryngectomy achieved excellent voice quality perceptually. In contrast, only 50% of secondary TEP patients achieved excellent voice ratings. This difference was statistically robust (p = 0.03). Although both surgical and prosthesis-related complications occurred more frequently following primary TEP, statistically significant differences were not achieved. Neither pre- nor postoperative radiotherapy had any effect on voice restoration or complication rates. Based on these data, primary TEP may be preferable for several reasons, including a greater likelihood of successful voice restoration, a shorter duration of postoperative aphonia, and the elimination of the need for a second operation and interim tube feedings.
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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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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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de Oliveira IB, Costa CC, Chagas JFS, Rochetti ECG, de Oliveira LO. Comunicação oral de laringectomizados com prótese traqueoesofágica: análise comparativa pré e pós-treino. ACTA ACUST UNITED AC 2005; 17:165-74. [PMID: 16909526 DOI: 10.1590/s0104-56872005000200005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
TEMA: treinamento fonoaudiológico para pacientes laringectomizados totais com prótese traqueoesofágica. OBJETIVO: comparar a qualidade da comunicação oral de pacientes laringectomizados, com prótese traqueoesofágica antes e depois de treinamento fonoaudiológico. MÉTODO: foram analisadas amostras de voz e fala de 17 pacientes laringectomizados, antes e depois de treinamento de voz e fala. As amostras pré e pós-treino foram misturadas ao acaso e apresentadas a fonoaudiólogos para avaliação. RESULTADOS: observada melhora significativa (Teste da Binomial) no conjunto dos aspectos avaliados. CONCLUSÃO: pode-se considerar que o treino proposto melhorou os padrões de fala inclusive a melodia e do canto.
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Affiliation(s)
- Iára Bittante de Oliveira
- Fonoaudióloga, Doutora em Psicologia como Ciência e Profissão pela Pontifícia Universidade Católica - Campinas.
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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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Abstract
Tracheoesophageal voice restoration has gained worldwide acceptance over the past 24 years and is the preferred method of postlaryngectomy speech. Tracheoesophageal puncture is safe, reliable,and reproducible and should be considered in all patients undergoing total laryngectomy and in those who have failed to master other methods of alaryngeal speech. This article discusses patient selection, surgical technique and complications, quality of speech,and predictors of success. Improved prosthesis design has expanded the use of tracheoesophageal speech in laryngectomees.
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Affiliation(s)
- Anna M Pou
- Department of Otolaryngology, University of Texas Medical Branch, 301 University Blvd., JSA Rm. 7.104, Galveston, TX 77555-0521, USA.
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Köybaşioğlu A, Oz O, Uslu S, Ileri F, Inal E, Unal S. Comparison of pharyngoesophageal segment pressure in total laryngectomy patients with and without pharyngeal neurectomy. Head Neck 2003; 25:617-23. [PMID: 12884343 DOI: 10.1002/hed.10265] [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: 11/08/2022] Open
Abstract
BACKGROUND To compare pharyngoesophageal segment (PES) pressure values in total laryngectomy patients with and without pharyngeal neurectomy (PN) in the early postoperative period. METHODS Forty-five previously untreated laryngeal carcinoma patients were enrolled into this prospective randomized study. Twenty of them underwent total laryngectomy with PN, and 25 underwent total laryngectomy without PN. PES pressures were measured on the tenth postoperative day with a four-channel catheter. RESULTS Average PES pressures in patients with and without pharyngeal neurectomy were 12.82 +/- 6.11 mmHg and 17.40 +/-.72 mmHg respectively (p <.05). When compared with the critical point of 20 mmHg that is closely related to voice attainment in the group without pharyngeal neurectomy, 10 (40%) patients had pressure levels greater than 20 mmHg and in the other group only 1 (5%) patient had a pressure level greater than 20 mmHg. The difference between the groups with pressure levels greater than 20 mmHg was found to be statistically significant (p <.05). CONCLUSIONS Pharyngeal neurectomy results in a statistically significant decrease of PES pressures in total laryngectomy patients.
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Affiliation(s)
- Ahmet Köybaşioğlu
- Department of Otorhinolaryngology Head and Neck Surgery, Gazi University School of Medicine, Ankara, Turkey. Sokullu Cad. Nimet Sok. 16/12, 06450 Dikmen Ankara, Turkey.
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Périé S, Ming X, Dewolf E, St Guily JL. Autologous fat injection to treat leakage around tracheoesophageal puncture. Am J Otolaryngol 2002; 23:345-50. [PMID: 12430126 DOI: 10.1053/ajot.2002.126853] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate prospectively autologous fat injection as a treatment for leakage around tracheoesophageal puncture. PATIENTS AND METHODS For ten patients who exhibited leakage of saliva or liquid around their tracheoesophageal puncture, autologous fat injection was carried out into the tracheoesophageal wall around the maintained prosthesis. Short-term success was evaluated at one month, and long-term follow-up was continued as long as the patients remained alive. The effectiveness of the procedure was evaluated based on the presence or absence of leakage around the puncture as the patient swallowed methylene blue liquid. Patients were adjudged completely improved when no leakage of blue liquid was observed, partially improved when a slight stasis was evident, or unimproved when a marked leakage of blue liquid was noted. RESULTS Short-term success was achieved for 6 patients, 2 patients partially improved, and the procedure failed for 2 others. Long-term success (from 10 to 65 months) was achieved in all 4 of the completely improved patients who were free of disease, including 1 patient who required an additional injection. Removal of the puncture was later carried out in the 2 others for cervical node metastases or tracheal tumor. Definitive or transitional puncture closure or removal of the prosthesis was required in 3 partially or unimproved patients, whereas 1 partially improved patient died of lung metastasis 3 months later. CONCLUSIONS Fat injection around a voice prosthesis is a procedure that may be conducted as an alternative to other conservative techniques to decrease the size of the puncture. Close endoscopic observation is required however to eliminate secondary tumor that might expand the size of the puncture.
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Affiliation(s)
- Sophie Périé
- Service d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Faculté de Médecine Saint Antoine, Université Paris VI, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
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Mendenhall WM, Morris CG, Stringer SP, Amdur RJ, Hinerman RW, Villaret DB, Robbins KT. Voice rehabilitation after total laryngectomy and postoperative radiation therapy. J Clin Oncol 2002; 20:2500-5. [PMID: 12011128 DOI: 10.1200/jco.2002.07.047] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate voice rehabilitation after laryngectomy and postoperative irradiation for patients with squamous cell carcinoma of the larynx and hypopharynx. PATIENTS AND METHODS Between December 1983 and December 1998, 173 patients underwent a total laryngectomy and postoperative irradiation and had follow-up from 3 to 188 months (median, 38 months). Three patients were lost to follow-up at 63, 39, and 4 months after treatment. All other living patients had follow-up for 2 years or longer. Twelve (7%) patients had incomplete data pertaining to voice rehabilitation. RESULTS Data pertaining to voice rehabilitation were available at 2 to 3 years and longer and 5 years and longer after treatment for 118 and 69 patients, respectively. The methods of voice rehabilitation at 2 to 3 years and longer and 5 years and longer were as follows: tracheoesophageal, 27% and 19%; artificial larynx, 50% and 57%; esophageal, 1% and 3%; nonvocal, 17% and 14%; and no data, 5% and 7%, respectively. CONCLUSION The most common form of voice rehabilitation after total laryngectomy and postoperative radiation therapy is the artificial larynx. Although the tracheoesophageal puncture is a technique frequently promoted by clinicians as a superior method, a relatively small subset of patients are successfully rehabilitated long-term. However, of those who undergo a tracheoesophageal puncture, approximately half will use this method of voice rehabilitation long term.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, Health Science Center, University of Florida College of Medicine, PO Box 100385, Gainesville, FL 32610-0385, USA.
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Armstrong E, Isman K, Dooley P, Brine D, Riley N, Dentice R, King S, Khanbhai F. An investigation into the quality of life of individuals after laryngectomy. Head Neck 2000. [DOI: 10.1002/1097-0347(200101)23:1<16::aid-hed3>3.0.co;2-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sharp HM, List M, MacCracken E, Stenson K, Stocking C, Siegler M. Patients' priorities among treatment effects in head and neck cancer: evaluation of a new assessment tool. Head Neck 1999; 21:538-46. [PMID: 10449670 DOI: 10.1002/(sici)1097-0347(199909)21:6<538::aid-hed7>3.0.co;2-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patients with head and neck cancer may face decisions between surgery or radiation (with or without chemotherapy) which involve significant trade-offs in functional outcomes. This preliminary investigation is designed to examine patients' priorities among the effects of treatments for head and neck cancer. METHODS A new instrument designed to allow patients to rank personal priorities among 12 treatment effects was developed and tested. A cross section of patients (19) from pretreatment and posttreatment time periods and 23 controls participated. RESULTS Preliminary findings indicate high individual variability, with some differences between groups according to treatment time. Differences between patients and controls are evident. We report test-retest reliability and the limitations of this new tool. CONCLUSIONS The data suggest that measures of health state values should be conducted with patients rather than healthy volunteers. Patients' priorities may be influenced by treatment and some values may be more susceptible to change with experience of treatment effects. This new tool may provide insight into how patients' prioritize the anticipated and experienced effects of treatment for head and neck cancers.
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Affiliation(s)
- H M Sharp
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
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Wax MK, Touma BJ, Ramadan HH. Tracheostomal stenosis revision with simultaneous tracheoesophageal puncture. Laryngoscope 1998; 108:1509-13. [PMID: 9778291 DOI: 10.1097/00005537-199810000-00015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal rehabilitation of patients who have undergone laryngectomy is best accomplished by a tracheoesophageal puncture. Optimal function of the prosthesis requires an adequate stoma. Patients with tracheostomal stenosis require revision of the stoma if vocal rehabilitation is to take place. Revision and tracheoesophageal placement are usually done as two separate procedures. Creating a tracheoesophageal fistula at the time of stomal revision has not been addressed in the literature. STUDY DESIGN Prospective analysis and follow-up of 10 patients undergoing simultaneous tracheoesophageal puncture and stomal revision for tracheostomal stenosis between 1991 and 1996. METHODS Ten patients were reviewed. An inferiorly based V-Y advancement flap was used so as not to interfere with the tracheoesophageal puncture. All patients had received radiation prior to revision and tracheoesophageal puncture. Patients were followed for a minimum of 2 years (range, 2-6 y; median, 3 y). RESULTS All patients maintained an adequate stoma without stenting. Eight of ten patients (80%) developed and maintained good tracheoesophageal speech. Two patients had their speech fistulas removed. There were no intraoperative or postoperative complications. CONCLUSIONS Creation of a tracheoesophageal fistula at the time of stomal revision allows for vocal rehabilitation with a single visit to the operating room.
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Affiliation(s)
- M K Wax
- Department of Otolaryngology, Buffalo General Hospital, New York, USA
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Laccourreye O, Ménard M, Crevier-Buchman L, Couloigner V, Brasnu D. In situ lifetime, causes for replacement, and complications of the Provox voice prosthesis. Laryngoscope 1997; 107:527-30. [PMID: 9111385 DOI: 10.1097/00005537-199704000-00018] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
One hundred Provox voice prostheses consecutively inserted in 37 patients and replaced only when phonation was impaired or complications noted were analyzed for in situ lifetime, causes for replacement, and complications. The mean in situ lifetime was 311 days. Actuarial analysis (Kaplan-Meier method) of the in situ lifetime revealed that 65.9%, 23.7%, and 16.4% of the voice prosthesis were still in situ by the 6th, 12th, and 18th postinsertion month. Cause for replacement was salivary leakage through the prosthesis valve, salivary leakage around the prosthesis, deterioration of the prosthesis, and excessive crusting resulting in increased airflow resistance in 33%, 27%, 24%, and 16% of cases, respectively. Complications included granulation tissue formation, cervical cellulitis, necrosis of the tracheoesophageal puncture, tracheostomal stenosis, and swallowing impairment in six, two, one, three, and one patient, respectively.
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Affiliation(s)
- O Laccourreye
- Department of Otorhinolaryngology-Head & Neck Surgery, Läennec Hospital, Paris, France
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Blake Simpson C, Postma GN, Stone R, Ossoff RH. Speech Outcomes After Laryngeal Cancer Management. Otolaryngol Clin North Am 1997. [DOI: 10.1016/s0030-6665(20)30239-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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