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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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2
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Parrilla C, Longobardi Y, Paludetti G, Marenda ME, D'Alatri L, Bussu F, Scarano E, Galli J. A one-year time frame for voice prosthesis management. What should the physician expect? Is it an overrated job? ACTA ACUST UNITED AC 2021; 40:270-276. [PMID: 33100338 PMCID: PMC7586190 DOI: 10.14639/0392-100x-n0587] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/24/2020] [Indexed: 11/23/2022]
Abstract
Management of late complications represents the main reason for reluctance in using voice prosthesis rehabilitation. The aim of this paper is to report our experience by describing the one-year management of a large cohort of patients in order to clarify how demanding management is in terms of burden on clinicians. Between June 2017 and June 2018, each access made at the Otolaryngology Clinic of our Institute for issues related to prosthesis by 70 laryngectomised patients rehabilitated by voice prosthesis was registered in a specific database. A review of the data provided information on the incidence, management and outcomes of adverse events encountered during the selected time frame. In addition, a T test was used to evaluate the differences between irradiated and non-irradiated patients and between primary and secondary tracheo-oesophageal-puncture. Leakage through the prosthesis was the most common cause for access (51.86%). The median number of accesses per patient per year was 3.47. The speech therapist autonomously managed 18.1% of accesses. The median number of accesses per patient per year needing a physician was 2.84. The median lifetime of the prosthesis was 4.85 months. Radiotherapy or modality (primary or secondary) of the puncture did not influence the number of accesses per year or the prosthesis lifetime. This retrospective analysis of results highlighted the most frequent issues and the most effective measures to deal with them, which allowed us to define a systematic algorithm to standardise and ease long-term outpatient management.
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Affiliation(s)
- Claudio Parrilla
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Ylenia Longobardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Gaetano Paludetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Maria Elisabetta Marenda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Lucia D'Alatri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Francesco Bussu
- Otolaryngology Division AOU, Sassari, Italy.,Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Emanuele Scarano
- Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
| | - Jacopo Galli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Otorinolaringoiatria, Rome, Italy
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3
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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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4
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Luu K, Chang B, Valenzuela D, Anderson D. Primary versus secondary tracheoesophageal puncture for voice rehabilitation in laryngectomy patients: A systematic review. Clin Otolaryngol 2018; 43:1250-1259. [DOI: 10.1111/coa.13138] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- K. Luu
- Division of Otolaryngology - Head & Neck Surgery; Department of Surgery; University of British Columbia; Vancouver BC Canada
| | - B.A. Chang
- Division of Otolaryngology - Head & Neck Surgery; Department of Surgery; University of British Columbia; Vancouver BC Canada
| | - D. Valenzuela
- Division of Otolaryngology - Head & Neck Surgery; Department of Surgery; University of British Columbia; Vancouver BC Canada
| | - D. Anderson
- Division of Otolaryngology - Head & Neck Surgery; Department of Surgery; University of British Columbia; Vancouver BC Canada
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5
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Primary versus secondary tracheoesophageal puncture: systematic review and meta-analysis. The Journal of Laryngology & Otology 2017; 132:14-21. [DOI: 10.1017/s0022215117002390] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Tracheoesophageal puncture represents the ‘gold standard’ for voice restoration following laryngectomy. Tracheoesophageal puncture can be undertaken primarily during laryngectomy or in a separate secondary procedure. There is no current consensus on which approach is superior. The current evidence comparing primary and secondary tracheoesophageal puncture was assessed.Methods:A systematic review and meta-analysis of articles comparing outcomes for primary and secondary tracheoesophageal puncture after laryngectomy were conducted. Outcome measures were: voice success, overall complication rate and pharyngocutaneous fistula rate.Results:Eleven case series met the inclusion criteria, two prospective and nine retrospective. Meta-analysis did not demonstrate statistically significant differences in overall complication rate or voice outcomes, though it suggested a significantly increased risk of pharyngocutaneous fistula in primary compared to secondary tracheoesophageal puncture.Conclusion:Primary tracheoesophageal puncture is a safe and efficient approach for voice rehabilitation. However, secondary tracheoesophageal puncture should be preferred where there is a higher risk of pharyngocutaneous fistula.
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Ferrandino R, Garneau J, Roof S, Pacheco C, Poojary P, Saha A, Chauhan K, Miles B. The national landscape of unplanned 30-day readmissions after total laryngectomy. Laryngoscope 2017; 128:1842-1850. [PMID: 29152760 DOI: 10.1002/lary.27012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/11/2017] [Accepted: 10/20/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Examine rates of readmission after total laryngectomy and determine primary etiologies, timing, and risk factors for unplanned readmission. STUDY DESIGN Retrospective cohort study. METHODS The Nationwide Readmissions Database was queried for patients who underwent total laryngectomy between January 2013 and November 2013. Patient-, procedure-, admission-, and institution-level characteristics were compared for patients with and without unplanned 30-day readmission. Outcomes of interest included rates, etiology, and timing of readmission. Multivariate logistic regression was used to identify predictors of 30-day readmission. RESULTS There were 2,931 total laryngectomies performed in 2013 with an unplanned readmission rate of 17.5%. Postoperative fistula accounted for 13.7% of readmissions. The odds of readmission were elevated for patients undergoing concurrent procedures, including primary tracheoesophageal fistulization (adjusted odds ratio [aOR]: 2.44, 95% confidence interval [CI]: 1.15-5.18, P = .02) and/or pedicle graft or flap procedures (aOR: 1.73, 95% CI: 1.13-2.66, P = .01). Additionally, patients with comorbid coagulopathy (aOR: 3.04, 95% CI: 1.13-8.22, P = .03), liver disease (aOR: 2.48, 95% CI: 1.08-5.71, P = .03), and valvular heart disease (aOR: 3.18, 95% CI: 1.20-8.41, P = .02) had increased risk for unplanned 30-day readmission. Private insurance and longer lengths of stay were associated with decreased odds of readmission. CONCLUSIONS Nearly one-fifth of total laryngectomy patients are readmitted to the hospital within 30 days of discharge. Risk factors identified in this nationally representative cohort should be carefully considered during the postoperative period to reduce preventable readmissions after total laryngectomy. LEVEL OF EVIDENCE 2c Laryngoscope, 1842-1850, 2018.
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Affiliation(s)
- Rocco Ferrandino
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Jonathan Garneau
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Scott Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Caitlin Pacheco
- Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Priti Poojary
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Aparna Saha
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Kinsuk Chauhan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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Serra A, Di Mauro P, Spataro D, Maiolino L, Cocuzza S. Post-laryngectomy voice rehabilitation with voice prosthesis: 15 years experience of the ENT Clinic of University of Catania. Retrospective data analysis and literature review. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 35:412-9. [PMID: 26900247 PMCID: PMC4755057 DOI: 10.14639/0392-100x-680] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study reports our 15-year experience, in Sicily, with the use of voice prostheses, analysing the different variables that have influenced the success or failure of speech rehabilitation. The retrospective clinical analysis was carried out by reviewing the clinical histories of 95 patients with laryngeal cancer, in whom a voice prosthesis had been placed by trachea-oesophageal puncture between 1998 and 2013. Age, type of tumour, type of surgery, use of prior radiation therapy, type of puncture, prosthesis used and its duration, number of replacements, complications and causes for prosthetic success or failure were analysed. The results showed a mean of Harrison-Robillard-Schultz (HRS) TEP rating scale of 11.8 in primary TEP and 12.6 in secondary TEP (P =0.613). PORT did not affect overall rehabilitation success. In these patients, the mean HRS rating scale was 11.2, with long-term success of 85% (P =0.582). In patients over 70 years old, long-term success was 82.5%, with 78% in primary and 86% in secondary TEP, the mean HRS was 11.2 in primary and 12 in secondary TEP (P =0.648). In total, long-term success was 87.5%, with 84% in primary and 91% in secondary TEP. The results obtained by retrospective analysis of 15 years of prosthetic rehabilitation in the Sicilian territory highlighted standard rehabilitation, in terms of intra and postoperative complications, fistula related pathology and overall success.
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Affiliation(s)
- A Serra
- Department of Medical Sciences, Surgical and Advanced Technologies G.F. Ingrassia, ENT Clinic, University of Catania, Italy
| | - P Di Mauro
- Department of Medical Sciences, Surgical and Advanced Technologies G.F. Ingrassia, ENT Clinic, University of Catania, Italy
| | - D Spataro
- Department of Medical Sciences, Surgical and Advanced Technologies G.F. Ingrassia, ENT Clinic, University of Catania, Italy
| | - L Maiolino
- Department of Medical Sciences, Surgical and Advanced Technologies G.F. Ingrassia, ENT Clinic, University of Catania, Italy
| | - S Cocuzza
- Department of Medical Sciences, Surgical and Advanced Technologies G.F. Ingrassia, ENT Clinic, University of Catania, Italy
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8
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Panwar A, Militsakh O, Lindau R, Coughlin A, Sayles H, Rieke KR, Lydiatt W, Lydiatt D, Smith R. Impact of Primary Tracheoesophageal Puncture on Outcomes after Total Laryngectomy. Otolaryngol Head Neck Surg 2017; 158:103-109. [DOI: 10.1177/0194599817722938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To identify differences in postoperative wound complications associated with a primary tracheoesophageal puncture (TEP) at the time of laryngectomy versus no TEP. Study Design Retrospective review of large national data set. Setting Academic and nonacademic health care facilities in United States, contributing de-identified, risk-adjusted clinical data to the American College of Surgeons National Surgical Quality Improvement Program. Subjects and Methods The National Surgical Quality Improvement Program data set for years 2006 to 2012 identified 430 patients who underwent total laryngectomy with or without a primary TEP. Patients who underwent a TEP at the time of laryngectomy (n = 68) were compared with patients who underwent laryngectomy without a TEP (n = 362). Postoperative wound complications and secondary outcomes, including medical complications and length of hospitalization, were compared between the groups. Results The incidence of “superficial” and “deep or organ space” surgical site infection, medical complications, return to the operating room, and length of hospitalization were similar between the groups. Patients in the TEP group had a higher overall wound complication rate (relative risk, 2.02; 95% CI = 1.06-3.84; attributable risk, 8.17%; number needed to harm, 12). Conclusions Performance of a primary TEP concurrent to total laryngectomy contributed to a small increase in attributable risk for overall wound complications but did not add substantial risk for “superficial” or “deep or organ space” surgical site infection, medical complications, or increased burden for resource utilization. These data may help inform patient choice and physician recommendations for primary alaryngeal speech rehabilitation.
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Affiliation(s)
- Aru Panwar
- Department of Head and Neck Surgery, Nebraska Methodist Hospital, Omaha, Nebraska, USA
- Division of Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Oleg Militsakh
- Department of Head and Neck Surgery, Nebraska Methodist Hospital, Omaha, Nebraska, USA
| | - Robert Lindau
- Department of Head and Neck Surgery, Nebraska Methodist Hospital, Omaha, Nebraska, USA
| | - Andrew Coughlin
- Department of Head and Neck Surgery, Nebraska Methodist Hospital, Omaha, Nebraska, USA
| | - Harlan Sayles
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Katherine R. Rieke
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - William Lydiatt
- Department of Head and Neck Surgery, Nebraska Methodist Hospital, Omaha, Nebraska, USA
| | - Daniel Lydiatt
- Department of Head and Neck Surgery, Nebraska Methodist Hospital, Omaha, Nebraska, USA
| | - Russell Smith
- Department of Head and Neck Surgery, Nebraska Methodist Hospital, Omaha, Nebraska, USA
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9
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Barauna Neto JC, Dedivitis RA, Aires FT, Pfann RZ, Matos LL, Cernea CR. Comparison between Primary and Secondary Tracheoesophageal Puncture Prosthesis: A Systematic Review. ORL J Otorhinolaryngol Relat Spec 2017; 79:222-229. [DOI: 10.1159/000477970] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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Robinson RA, Simms VA, Ward EC, Barnhart MK, Chandler SJ, Smee RI. Total laryngectomy with primary tracheoesophageal puncture: Intraoperative versus delayed voice prosthesis placement. Head Neck 2017; 39:1138-1144. [PMID: 28230917 DOI: 10.1002/hed.24727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/15/2016] [Accepted: 12/29/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Studies support using intraoperative voice prosthesis insertion performed at the time of primary tracheoesophageal puncture (TEP) during laryngectomy. However, none have compared intraoperative voice prosthesis insertion with delayed voice prosthesis insertion. The purpose of this study was to prospectively examine patient, services, and cost benefits of intraoperative versus delayed voice prosthesis placement. METHODS Voice prosthesis use, duration to the first voice prosthesis change, early communication, and costs were compared between 14 patients who underwent a laryngectomy and who received intraoperative voice prosthesis placement, and 10 patients who underwent initial catheter stenting and then delayed voice prosthesis insertion. RESULTS Intraoperative voice prosthesis placement was associated with significantly fewer early device changes (1.4 vs 2), voice prosthesis changes because of resizing (8% vs 80%), longer durations to initial voice prosthesis change (159.7 vs 24.5 days), earlier commencement of voice rehabilitation (13.2 vs 17.6 days), reduced length of hospital stay (17.2 vs 24.5 days), and cost savings of $559.83/person. CONCLUSION Superior clinical and patient benefits are associated with intraoperative voice prosthesis placement during primary TEP. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1138-1144, 2017.
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Affiliation(s)
- Rachelle A Robinson
- Department of Speech Pathology, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia
| | - Virginia A Simms
- Department of Speech Pathology, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, St. Lucia, Queensland, Australia.,Centre for Functioning and Health Research, Queensland Health, Buranda, Queensland, Australia
| | - Molly K Barnhart
- Department of Speech Pathology, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia.,The University of Queensland, School of Health and Rehabilitation Sciences, St. Lucia, Queensland, Australia
| | - Sophie J Chandler
- Department of Speech Pathology, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia
| | - Robert I Smee
- Comprehensive Cancer Centre, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia.,The Clinical Teaching School, University of New South Wales, Kensington, New South Wales, Australia.,Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, New South Wales, Australia
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11
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Gitomer SA, Hutcheson KA, Christianson BL, Samuelson MB, Barringer DA, Roberts DB, Hessel AC, Weber RS, Lewin JS, Zafereo ME. Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture. Head Neck 2016; 38:1765-1771. [PMID: 27394060 PMCID: PMC5118069 DOI: 10.1002/hed.24529] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/04/2016] [Accepted: 05/06/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We evaluated the impact of radiation, reconstruction, and timing of tracheoesophageal puncture (TEP) on complications and speech outcomes. METHODS Retrospective review identified 145 patients who underwent TEP between 2003 and 2007. RESULTS Ninety-nine patients (68%) had primary and 46 (32%) had secondary TEP, with complications occurring in 65% and 61%, respectively (p = .96). Twenty-nine patients (20%) had major complications (18 primary and 11 secondary; p = .42). Ninety-four patients (65%) had pre-TEP radiation, 39 (27%) post-TEP radiation, and 12 (8%) no radiation. With patients grouped by TEP timing and radiation history, there was no difference in complications, fluency, or TEP use. With mean 4.7-year follow-up, 82% primary and 85% secondary used TEP for primary communication (p = .66). Free-flap patients used TEP more commonly for primary communication after secondary versus primary TEP (90% vs 50%; p = .02). CONCLUSION Primary and secondary tracheoesophageal speakers experience similar high rates of complications. Extent of pharyngeal reconstruction, rather than radiation, may be more important in selection of TEP timing. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1765-1771, 2016.
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Affiliation(s)
- Sarah A. Gitomer
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Kate A. Hutcheson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Brandon L. Christianson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Madeleine B. Samuelson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Denise A. Barringer
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Dianna B. Roberts
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Amy C. Hessel
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Randal S. Weber
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Jan S. Lewin
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Mark E. Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
- Bobby R. Alford Department of Otolaryngology—Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
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12
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Glazer TA, Meraj T, Lyden TH, Spector ME. In-Office Secondary Tracheoesophageal Puncture with Immediate Prosthesis Placement. Otolaryngol Head Neck Surg 2016; 155:360-3. [DOI: 10.1177/0194599816642175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/10/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Tiffany A. Glazer
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Taha Meraj
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Teresa H. Lyden
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Matthew E. Spector
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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13
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Moon S, Raffa F, Ojo R, Landera MA, Weed DT, Sargi Z, Lundy D. Changing trends of speech outcomes after total laryngectomy in the 21st century: a single-center study. Laryngoscope 2014; 124:2508-12. [PMID: 24729127 DOI: 10.1002/lary.24717] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/15/2014] [Accepted: 04/08/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe the speech rehabilitation outcomes of patients undergoing total laryngectomy (TL) in the 21st century. STUDY DESIGN Retrospective chart review. SETTING Tertiary academic center SUBJECTS AND METHODS Retrospective review of 167 patients who underwent TL from June 2000 to February 2012. Demographics, disease variables, and surgical factors were reviewed. Primary alaryngeal speech modality, speech outcome, and tracheoesophageal puncture (TEP) complication rates were assessed. RESULTS Overall TEP speech success rate (primary or secondary) was 72%. Overall TEP speech success rate was 76% for those with primary TEP and was 68% for those with secondary TEP. TEP speech success rates at first, second, and beyond second year were 75%, 72%, and 70%, respectively. Success rates for primary TL, salvage TL, primary TL with pharyngeal reconstruction, or salvage TL with pharyngeal reconstruction groups were 71%, 72%, 73%, and 71%, respectively. TEP-related complications occurred in 43% of patients, with no difference in complication rates between primary versus salvage TL or primary versus secondary TEP. For those with complications, TEP success rate was 65%. CONCLUSION This study showed TEP speech-outcome success rates lower than what has been historically reported. There was no significant difference in TEP speech outcome between primary versus salvage TL or primary versus secondary TEP. Patients with TEP-related complications had TEP speech-outcome success rates comparable to those without any complication. TEP may continue to be a superior option as a mode of speech in patients with TL, including those undergoing salvage TL. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Seo Moon
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
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Sethi RKV, Kozin ED, Lam AC, Emerick KS, Deschler DG. Primary tracheoesophageal puncture with supraclavicular artery island flap after total laryngectomy or laryngopharyngectomy. Otolaryngol Head Neck Surg 2014; 151:421-3. [PMID: 24925312 DOI: 10.1177/0194599814539443] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The supraclavicular artery island flap (SCAIF) is increasingly employed for laryngectomy reconstruction with excellent success. Although tracheoesophageal puncture (TEP) with intraoperative prosthesis placement is also positively reported, this is not described in patients following SCAIF. We review our experience with primary TEP with prosthesis placement and voice outcomes in patients after SCAIF reconstruction. Seven patients underwent SCAIF with primary TEP after laryngectomy from 2011 to 2013. Five underwent total laryngectomy (TL) and 2 underwent TL with partial pharyngectomy. All patients had 16 French Indwelling Blom-Singer prostheses placed intraoperatively without complications. Six patients achieved tracheoesophageal voice (median time = 1.5 months). Two patients required cricopharyngeal segment Botox injections. One patient remained aphonic. One patient developed prosthesis leakage addressed with prosthesis replacement. Our preliminary data demonstrate that similar to free tissue transfer reconstruction, primary TEP with intraoperative placement of the voice prosthesis at the time of SCAIF reconstruction is safe and effective.
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Affiliation(s)
- Rosh K V Sethi
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Elliott D Kozin
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Allen C Lam
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Kevin S Emerick
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Cocuzza S, Bonfiglio M, Chiaramonte R, Serra A. Relationship between radiotherapy and gastroesophageal reflux disease in causing tracheoesophageal voice rehabilitation failure. J Voice 2013; 28:245-9. [PMID: 24094804 DOI: 10.1016/j.jvoice.2013.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective was to analyze the association of radiotherapy with gastroesophageal reflux as determinant of fistula related pathology, in voice prosthesis patients. STUDY DESIGN Retrospective study. METHODS Sixty-one laryngectomy patients were enrolled between 2005 and 2012. All patients underwent phonatory rehabilitation with voice prosthesis, along with evidence of gastroesophageal reflux disease, for which proton pump inhibitors (PPIs) were prescribed. We analyzed the occurrence of fistula-related problems among patients who received postoperative radiotherapy and those patients who did not. RESULTS We observed a higher rate of failure of speech rehabilitation in laryngectomy patients with gastroesphageal reflux: this occurred when they had a history of postoperative radiotherapy (45%) compared with patients who did not (17%) (P < 0.05), although all patients were treated with PPIs. CONCLUSION Our results seem to confirm the importance of postoperative radiotherapy with gastroesophageal reflux for the determinism of fistula-related problems.
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Affiliation(s)
- Salvatore Cocuzza
- Department of Medical Surgical Specialties, ENT Unit, University of Catania, Catania, Italy.
| | - Marco Bonfiglio
- Department of Medical Surgical Specialties, ENT Unit, University of Catania, Catania, Italy
| | - Rita Chiaramonte
- Department of Medical Surgical Specialties, ENT Unit, University of Catania, Catania, Italy
| | - Agostino Serra
- Department of Medical Surgical Specialties, ENT Unit, University of Catania, Catania, Italy
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Meerwein C, Laske R, Castiglioni K, Bohlender JE, Huber GF. Secondary voice prosthesis insertion in patients without direct access to the upper esophagus. Laryngoscope 2013; 124:469-71. [PMID: 23794164 DOI: 10.1002/lary.24273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/03/2013] [Accepted: 06/03/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Christian Meerwein
- Division of Otorhinolaryngology, University Hospital Zurich, Zurich, Switzerland
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Cocuzza S, Bonfiglio M, Grillo C, Maiolino L, Malaguarnera M, Martines F, Serra A. Post laryngectomy speech rehabilitation outcome in elderly patients. Eur Arch Otorhinolaryngol 2013; 270:1879-84. [PMID: 23519681 DOI: 10.1007/s00405-013-2430-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 02/27/2013] [Indexed: 11/30/2022]
Abstract
The aim of our work has been to evaluate the different options of tracheoesophageal voice rehabilitation in over 70-year-old patients, who had undergone laryngectomy, assessing advantages and drawbacks of this method of vocal recovery. A retrospective study has been carried out. This has included 40 subjects, all aged more than 70 years old, who have been referred to tracheoesophageal voice rehabilitation. It has been realized a phonatory fistula between trachea and esophagus with prosthesis positioning by means of a primary puncture in 18 cases and it has been realized a secondary puncture in 22 cases. The results gathered in these patients were compared with data obtained from a group made of 39 patients, less than 70 years of age that therefore represented our control group. In primary tracheoesophageal puncture (TEP), the short-term success was 67 %, while in the 22 cases who underwent secondary TEP, the short-term success was 64 %. After 2 years from TEP, the long-term success was 82.5 %. In the control group, the short-term success was 65 % in primary TEP and 73 % in secondary TEP. After 2 years from TEP, the long-term success was 77 %. The evaluation of the results has shown the absence of a statistically significant difference both as regards complications incidence, during and after surgery (p > 0.9) and as regards overall success ratio of prosthesis implants between the two groups (p > 0.7). The possibilities of tracheoesophageal recovery of elderly patients do not show dissimilarities in comparison with the results in younger subjects.
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Affiliation(s)
- Salvatore Cocuzza
- Department of Medical Surgical Specialties, ENT Clinic, University of Catania, Policlinico Universitario "Gaspare Rodolico", Via Santa Sofia, 68, 95125 Catania, Italy
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Johnson A, Grammer T, Medina J. Primary tracheoesophageal puncture in salvage laryngectomy patients. Laryngoscope 2013; 123:1227-30. [DOI: 10.1002/lary.24002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/20/2012] [Accepted: 12/24/2012] [Indexed: 11/07/2022]
Affiliation(s)
- Adam Johnson
- Department of Otorhinolaryngology; University of Oklahoma Health Sciences; Oklahoma City; Oklahoma; U.S.A
| | - Tracy Grammer
- Department of Speech Pathology; University of Oklahoma Health Sciences; Oklahoma City; Oklahoma; U.S.A
| | - Jesus Medina
- Department of Otorhinolaryngology; University of Oklahoma Health Sciences; Oklahoma City; Oklahoma; U.S.A
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Sinclair CF, Rosenthal EL, McColloch NL, Magnuson JS, Desmond RA, Peters GE, Carroll WR. Primary versus delayed tracheoesophageal puncture for laryngopharyngectomy with free flap reconstruction. Laryngoscope 2011; 121:1436-40. [DOI: 10.1002/lary.21836] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2011] [Indexed: 11/08/2022]
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20
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Wierzchowska M, Burduk PK. Powikłania wczesne i późne po implantacji protezy głosowej Provox 2 u chorych po laryngektomii całkowitej. Otolaryngol Pol 2011; 65:184-7. [DOI: 10.1016/s0030-6657(11)70672-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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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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Gultekin E, Yelken K, Garca MF, Develioglu ON, Kulekci M. Effects of neck dissection and radiotherapy on short-term speech success in voice prosthesis restoration patients. J Voice 2010; 25:245-8. [PMID: 20189345 DOI: 10.1016/j.jvoice.2009.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 10/23/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the short-term speech success of voice prosthesis (VP) among patients who underwent total laryngectomy or total laryngectomy in combination with neck dissection and those who received postoperative radiotherapy. MATERIALS AND METHODS Thirty-two male patients treated for laryngeal squamous cell carcinoma were included. Nine patients underwent total laryngectomy and 23 underwent total laryngectomy combined with neck dissection, and 17 of the 23 with neck dissection were managed with postoperative radiotherapy (45-75 Gy). All of the patients had indwelling intraoperative placement of the Provox VP (Atos Medical AB, Horby, Sweden; and Entermed BV, Woerden, The Netherlands) at the time of the primary tracheoesophageal puncture (TEP) completed in conjunction with total laryngectomy. Patients with pharyngoesophageal myotomy and pharyngeal plexus neurectomy were excluded. Patients' speech success was perceptually evaluated 3-4 weeks after the surgery and 3-4 weeks after the cessation of radiotherapy, using a 1-3 scale (1 = failure to develop speech (aphonia); 2=communicate with short phrases only; and 3 = communicate with fluency and long sentences). RESULTS No complications were noted with intraoperative prosthesis placement. No prostheses were dislodged in the postoperative period. Eighteen of 32 patients (56%) demonstrated successful speech (rating of 3). Nine patients (28%) demonstrated less successful speech (rating of 2). Five patients (16%) were found to be aphonic (P > 0.05). Of the nine patients who underwent total laryngectomy only, six were found to have successful speech (66.6%), one (11.1%) was found to have less successful speech quality, and two (22.2%) patients were aphonic (P > 0.05). Of the six patients who underwent total laryngectomy in combination with neck dissection, three had successful speech (50%), one (16.6%) had less successful speech, and two (33.3%) were aphonic (P > 0.05). Of the 17 patients who received postoperative radiotherapy, nine (52.9%) had successful speech, three (17.6%) had less successful speech, and five (29.4%) were aphonic (P > 0.05). CONCLUSION Neck dissection and postoperative radiotherapy have no significant influence on short-term speech success in VP restoration patients. Primary TEP should be preferred in patients who have laryngectomy in combination with neck dissection and/or will have postoperative radiation therapy, as it provides early and successful voice restoration without interfering with radiation treatment and avoids a second surgical intervention.
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Affiliation(s)
- Erdogan Gultekin
- Department of Otolaryngology, Namik Kemal University Medicine Faculty, Tekirdag, Turkey.
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Pighi GP, Barbieri F, Adami R, Fiorino F. Secondary tracheoesophageal puncture: Blind technique with a rigid hysterometer. Laryngoscope 2009; 119:1431-4. [DOI: 10.1002/lary.20518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Primary versus secondary tracheoesophageal puncture in salvage total laryngectomy following chemoradiation. Otolaryngol Head Neck Surg 2009; 140:386-90. [PMID: 19248948 DOI: 10.1016/j.otohns.2008.10.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 10/14/2008] [Accepted: 10/14/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the rate of postoperative wound-healing complications and voice fluency in primary vs secondary tracheoesophageal puncture (TEP) following chemoradiation. METHODS Between 1998 and 2005, 30 patients underwent laryngectomy after chemoradiation therapy. Twenty patients underwent primary TEP and 10 patients underwent secondary TEP. Comorbidities, postoperative complications, speech fluency, and time to speech fluency were evaluated in each patient. RESULTS Pharyngocutaneous fistula (PCF) occurred in 10 of 20 (50%) patients who underwent primary TEP and in 0 of 10 (0%) patients in the secondary TEP group (P < 0.05). Overall, 25 of 25 (100%) patients who had placement of a tracheoesophageal prosthesis achieved fluent speech. Median time to fluency was 63 days in the primary TEP group and 125 days in the secondary TEP group. CONCLUSION There is an increased risk of PCF in patients undergoing primary TEP compared with secondary TEP following chemoradiation. No difference in acquisition of speech fluency was identified between the two groups. Patients undergoing primary TEP achieved fluent speech 62 days sooner than their secondary TEP counterparts.
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Abstract
Treatment of laryngeal cancer has evolved, and newer methods of laryngeal conservation, both surgical and nonsurgical, are the primary treatment of choice. Nevertheless, total laryngectomy is not extinct and still plays an important role in primary therapy for advanced stage laryngeal cancers and as salvage therapy for failures of organ preservation strategies.
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Affiliation(s)
- Nishant Agrawal
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, JHOC 6th Floor, Baltimore, MD 21287, USA
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Boscolo-Rizzo P, Marchiori C, Gava A, Da Mosto MC. The impact of radiotherapy and GERD on in situ lifetime of indwelling voice prostheses. Eur Arch Otorhinolaryngol 2007; 265:791-6. [PMID: 18008081 DOI: 10.1007/s00405-007-0536-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 11/02/2007] [Indexed: 10/22/2022]
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Boscolo-Rizzo P, Zanetti F, Carpené S, Da Mosto MC. Long-term results with tracheoesophageal voice prosthesis: primary versus secondary TEP. Eur Arch Otorhinolaryngol 2007; 265:73-7. [PMID: 17713782 DOI: 10.1007/s00405-007-0423-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2007] [Accepted: 08/06/2007] [Indexed: 10/22/2022]
Abstract
The aim of this study was to evaluate the influence of timing of tracheoesophageal puncture (TEP)with indwelling voice prosthesis insertion regarding long-term success rate and postoperative complication. We conducted a Retrospective clinical study at tertiary academic center. There were 75 patients with primary TEP (80.6%) and 18 with secondary TEP (19.3%). Long-term success rate was 81.7%, with 80.0% in primary TEP and 88.9% in secondary TEP. No significant difference in Harrison-Robillard-Schultz Rating Scale success assessment were observed between patients with primary and secondary TEP (P = .596). The use of postoperative radiotherapy did not significantly influence the success rate. The age of patients who were older or younger than 60 years significantly influence the success rate in primary TEP (P = .012). The higher rate of complications in primary TEP was not statistically significant. These findings suggest that primary and secondary TEP are equally safe and effective procedures. Primary TEP should be preferred because of avoiding a second surgical intervention and allowing early voice restoration with a considerable psychological impact.
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Affiliation(s)
- Paolo Boscolo-Rizzo
- ENT Department and Regional Center for Head and Neck Cancer, University of Padua-School of Medicine, Treviso Regional Hospital, Treviso, Italy
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Doctor VS, Enepekides DJ, Farwell DG, Belafsky PC. Transnasal oesophagoscopy-guided in-office secondary tracheoesophageal puncture. The Journal of Laryngology & Otology 2007; 122:303-6. [PMID: 17655776 DOI: 10.1017/s0022215107000084] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:Tracheoesophageal puncture is recognised as an effective and reliable method for voice restoration following total laryngectomy. Several techniques have been described, ranging from rigid oesophagoscopy under general anaesthesia to more recent endoscopic techniques utilising intravenous sedation or local anaesthetic. We describe our technique for secondary tracheoesophageal puncture utilising unsedated transnasal oesophagoscopy in an office setting.Method:Retrospective review of all total laryngectomy patients undergoing in-office transnasal oesophagoscopy-assisted tracheoesophageal puncture between October 1 2004 and December 31 2006.Results:Eleven patients undergoing transnasal oesophagoscopy-guided tracheoesophageal puncture were identified. Successful tracheoesophageal puncture placement was achieved in 10 of 11 patients (91 per cent). In one patient tracheoesophageal puncture could not be performed due to anatomic constraints. One patient had bleeding from the puncture site requiring silver nitrate cautery. All patients tolerated the procedure well. Voice results were satisfactory in all cases.Conclusions:Transnasal oesophagoscopy-guided tracheoesophageal puncture provides a simple, safe option for secondary voice rehabilitation in laryngectomy patients.
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Affiliation(s)
- V S Doctor
- Department of Otolaryngology-Head and Neck Surgery, University of California at Davis, Sacramento, California, USA
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31
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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: 20] [Impact Index Per Article: 1.2] [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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Iwai H, Shimano T, Omae M, Kaneko T, Yamashita T. Early acquisition of esophageal phonation following tracheoesophageal phonation. Acta Otolaryngol 2006; 126:764-8. [PMID: 16803718 DOI: 10.1080/00016480500504168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSIONS Tracheoesophageal phonation appears to participate in early acquisition of esophageal phonation, which remains the preferred method of voice restoration among patients. Further studies into factors predicting and mechanisms underlying acquisition of esophageal phonation among alaryngeal patients may provide information facilitating superior quality of life. OBJECTIVE The aim of this study was to examine early acquisition of esophageal phonation following tracheoesophageal phonation, and underlying mechanisms and preferred phonatory methods for alaryngeal patients who master both tracheoesophageal and esophageal phonation. PATIENTS AND METHODS Subjects comprised 44 alaryngeal patients and were divided into three groups: group A (n=13), esophageal phonation alone; group B (n=21), tracheoesophageal phonation alone; and group C (n=10), patients who acquired esophageal phonation after learning tracheoesophageal phonation. RESULTS The results indicated that acquisition of tracheoesophageal phonation significantly accelerated acquisition of esophageal phonation to 59.3 days from 184.6 days. Patients in group C stopped tracheoesophageal phonation and predominantly used esophageal phonation. No factors predicting acquisition of esophageal phonation were identified among patients who had mastered tracheoesophageal phonation, including age at time of surgery, irradiation, neck dissection, acquisition time of tracheoesophageal phonation, and maximum phonation time of tracheoesophageal phonation. No evidence of air leakage through the shunt during esophageal phonation was noted in group C.
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Affiliation(s)
- Hiroshi Iwai
- Department of Otolaryngology, Kansai Medical University, Osaka, Japan.
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Kummer P, Chahoud M, Schuster M, Eysholdt U, Rosanowski F. Prothetische Stimmrehabilitation nach Laryngektomie. HNO 2006; 54:315-22. [PMID: 15870992 DOI: 10.1007/s00106-005-1259-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Indwelling voice prostheses are state of the art for post-laryngectomy voice rehabilitation. The aim of this study was to identify the impact of radiation prior to tracheoesophageal puncture on success rate and complications. PATIENTS AND METHODS We undertook a retrospective study of 145 patients who had undergone prosthetic voice restoration between 1990 and 2002 (Provox) and Provox2). Risks of functional failure and complications in 17 patients with previous radiation therapy were compared to those of 128 patients without such therapy. RESULTS Previous radiation increased not only the risk of functional failure by 2.9 (P=0.023), but also the risk of shunt-related complications such as aspiration around the prosthesis (1.51; P=0.046), widening of the shunt (2.32; P=0.014), esophageal (2.51; P=0.013) or tracheal (3.29; P=0.0023) dislocation of the prosthesis and spontaneous (2.51; P=0.047) or surgical closure (3.76; P=0.037) of the shunt. CONCLUSION Primary tracheoesophageal puncture during laryngectomy is recommended in cases without previous radiation therapy, especially when post-laryngectomy radiation is likely. In patients with previous radiation therapy, generally good success rates decrease, however, without absolute contraindication of tracheoesophageal puncture. These results may affect salvage surgery concepts.
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Affiliation(s)
- P Kummer
- Abteilung für Phoniatrie und Pädaudiologie, Universitätsklinikum Erlangen.
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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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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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Bunting GW. Voice following laryngeal cancer surgery: troubleshooting common problems after tracheoesophageal voice restoration. Otolaryngol Clin North Am 2004; 37:597-612. [PMID: 15163604 DOI: 10.1016/j.otc.2004.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The introduction of tracheoesophageal voice restoration by Blom and Singer has provided laryngectomy patients with a successful alternative to the use of artificial larynx and esophageal speech. Although this method of communication provides for the rapid acquisition of intelligible, functional speech, there are common problems that may occur in these patients. Close follow-up of patients postoperatively along with thorough patient education is beneficial to improving long-term success with tracheoesophageal speech. The purpose of this article is to discuss common problems encountered in the treatment of patients who have undergone tracheoesophageal puncture and to provide systematic assessment and treatment guidelines that are essential to maintaining functional tracheoesophageal speech.
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Affiliation(s)
- Glenn W Bunting
- The Voice and Speech Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
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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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Samlan RA, Webster KT. Swallowing and speech therapy after definitive treatment for laryngeal cancer. Otolaryngol Clin North Am 2002; 35:1115-33. [PMID: 12587251 DOI: 10.1016/s0030-6665(02)00033-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
As the trend in laryngeal cancer treatment shifts towards organ-conservation surgeries and organ-preservation protocols, patients will more often retain anatomy vital to communication and swallowing. Despite a conservative approach, results of treatment may have debilitating effects. Rehabilitation efforts are directed towards a return to functional, if not normal, status. Although there are predictable trends in voice and swallowing disorders of patients with laryngeal cancer, posttreatment dysphonia and dysphagia are diverse in presentation. Considering the significant diversity of this population, speech pathologists should work closely with otolaryngologists to determine the most appropriate treatment for each patient. As this article demonstrates, voice and swallowing therapy are necessary components of the rehabilitation process following treatment for head and neck cancers. As always, treatment is tailored to the specific individual and based on information obtained during a thorough evaluation by a speech pathologist. Fortunately, with the help of voice and swallowing therapy, many patients return to functional communication and oral feeding.
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Affiliation(s)
- Robin A Samlan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Outpatient Center, Room 6011, 601 North Caroline Street, Baltimore, MD 21287, USA.
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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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Karlen RG, Maisel RH. Does primary tracheoesophageal puncture reduce complications after laryngectomy and improve patient communication? Am J Otolaryngol 2001; 22:324-8. [PMID: 11562883 DOI: 10.1053/ajot.2001.26491] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The charts of 96 patients who had a laryngectomy at the University of Minnesota and affiliated hospitals were reviewed to assess the benefit of primary tracheoesophageal puncture (TEP). Patients were stratified into those with primary TEP and those without. There was no statistical difference in rates of esophageal stenosis, stomal stenosis, or wound breakdown without fistula. No fistulas developed in 33 patients who received primary TEP. 52% Of those with primary TEP, used their prosthesis for speech long-term. Only 5 of 63 patients whose surgery did not include primary TEP, received a secondary TEP, and only 2 retained the prosthesis for speech. There was no increased morbidity or incidence of complications after laryngectomy when performing a primary TEP. Patients will maintain the initial form of speech rehabilitation, even if it is less comprehensible. The early postoperative period is convenienced by using the puncture site as the entrance for nutrition during wound healing.
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Cannon CR. Using an endotracheal tube in difficult secondary tracheoesophageal puncture: a novel technique. Otolaryngol Head Neck Surg 2001; 125:117-9. [PMID: 11458232 DOI: 10.1067/mhn.2001.116445] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- C R Cannon
- Division of Surgery, Department of Family Medicine, and Division of Diagnostic Sciences, School of Dentistry, University Medical Center, Jckson, MS 39208, USA.
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Desyatnikova S, Caro JJ, Andersen PE, Cohen JI, Wax MK. Tracheoesophageal puncture in the office setting with local anesthesia. Ann Otol Rhinol Laryngol 2001; 110:613-6. [PMID: 11465818 DOI: 10.1177/000348940111000704] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tracheoesophageal puncture (TEP) with voice prosthesis placement is currently the method of choice for vocal rehabilitation of patients who have undergone total laryngectomy. Occasionally, secondary TEP needs to be performed. We have used a TEP technique that is performed in the clinic setting with local anesthesia and no sedation. The purpose of this study was to review our technique and experience and to evaluate results, complications, and patients' acceptance of the procedure. We performed a retrospective chart review of the records of 14 patients who had undergone total laryngectomy and secondary TEP placement in the clinic setting. The procedure was well tolerated. The voice results were fair to good in 11 of 12 patients. There was 1 complication, a false passage between the trachea and the esophagus. Voicing was immediate in 12 of the 14 cases. We conclude that TEP can be performed in the office setting with local anesthesia. The voice results are excellent, and the procedure is well tolerated by the patient. Proper patient selection and regular follow-up by a speech-language pathologist are important.
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Affiliation(s)
- S Desyatnikova
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland 97201, USA
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Affiliation(s)
- P Carding
- Northern Head and Neck Cancer Centre, Freeman Hospital, NE7 7DN, Newcastle upon Tyne, UK.
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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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Parise O, Cutait R, Corrêa PA, Miguel RE, de Angelis EC, Jorge SC. Primary placement of a voice prosthesis on transposed colon after total pharyngolaryngoesophagectomy. Head Neck 1999; 21:363-5. [PMID: 10376757 DOI: 10.1002/(sici)1097-0347(199907)21:4<363::aid-hed11>3.0.co;2-u] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Primary placement of a voice prosthesis may aid rehabilitation after total laryngectomy. METHODS We present a rare clinical situation of a T4 NO MO squamous cell carcinoma of the hypopharynx and esophagus in a patient who had previously undergone a transmesocolic Billroth II gastrectomy. RESULTS The patient benefited from a total pharyngolaryngoesophagectomy, with reconstruction using a transverse-descending colon transposition, and primary placement of a low-pressure voice prosthesis. CONCLUSION Primary placement of a voice prosthesis may be successful even in a patient who requires extensive pharyngoesophageal reconstruction using transposed colon. To our knowledge, there has been no previous report of primary placement of a voice prosthesis on a colon autograft.
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Affiliation(s)
- O Parise
- Oncology Center, Sírio-Libanês Hospital, São Paulo, SP, Brazil
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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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Cantu E, Ryan WJ, Tansey S, Johnson CS. Tracheoesophageal speech: predictors of success and social validity ratings. Am J Otolaryngol 1998; 19:12-7. [PMID: 9470945 DOI: 10.1016/s0196-0709(98)90059-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to examine long-term success rates and predictors of success for patients who had undergone either primary or secondary tracheoesophageal puncture. An additional aim was to compare judgments of communication effectiveness made by a speech-language pathologist with those made by the patient or significant other. PATIENTS AND METHODS Thirty-six laryngectomees were initially rated on a 5-point functional communication scale. These ratings resulted in the formation of two distinct groups that were identified as "successful" and "unsuccessful." The groups were compared on the basis of age at time of surgery and 10 categorical variables that have been implicated in the success or failure of tracheoesophageal puncture surgery. RESULTS Results indicated that nearly two thirds of the patients had successful communication at an average of approximately 4 years posttracheoesophageal puncture. For the 13 patients judged as "unsuccessful," reduced vision, limited arm/hand movement, and history of radiotherapy were found in significantly greater numbers. When communication profile ratings made by a speech-language pathologist were compared with those made by the patient or significant other (P/SO), approximately one-third varied by at least "1" scale value, with the vast majority resulting in comparatively higher ratings by the speech-language pathologist. CONCLUSION The findings of this study are in general agreement with previously published success rates for tracheoesophageal puncture and attest to the long-term nature of these success rates in a majority of patients. Additional investigation is necessary to identify factors that may contribute to discrepancies between clinician expectations and those of the patient or significant other.
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Affiliation(s)
- E Cantu
- Department of Audiology Speech Pathology, Wilford Hall Medical Center, Lackland Air Force Base, TX, USA
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