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A Decade of Postlaryngectomy Vocal Rehabilitation in 318 Patients
A Single Institution's Experience With Consistent Application of Provox Indwelling Voice Prostheses
B. M. R. Op de Coul, MD;
F. J. M. Hilgers, MD, PhD;
A. J. M. Balm, MD, PhD;
I. B. Tan, MD, PhD;
F. J. A. van den Hoogen, MD, PhD;
H. van Tinteren, MSc
Arch Otolaryngol Head Neck Surg. 2000;126:1320-1328.
Objective To assess long-term results with consistent use of indwelling voice prostheses (Provox; Atos Medical AB, Hörby, Sweden) for vocal rehabilitation after total laryngectomy.
Design Retrospective clinical analysis.
Setting Comprehensive national cancer center.
Patients Three hundred eighteen patients (261 men and 57 women; mean age, 62 years) from November 1988, through May 1999.
Intervention Standard wide-field total laryngectomy (287 patients) or total laryngectomy with circumferential pharyngeal resection (31 patients), and 2700 prosthesis replacements. Prostheses remained in situ during 364,339 days (1000 patient-years).
Main Outcome Measures Device lifetime, indications for replacement (device or fistula related), adverse events, and voice quality.
Results Median patient-device follow-up was 67 months. Mean actuarial device lifetime for all indications for replacement was 163 days (median, 89 days). Main indications for replacement were device-related, ie, leakage through the prosthesis (73%) and obstruction (4%), or fistula-related, ie, leakage around the prosthesis (13%), and hypertrophy and/or infection of the fistula (7%). Adverse events occurred in 11% of all replacements in one third of the patients, mostly solvable by a shrinkage period, or adequate sizing and/or antibiotic treatment. Definitive closure of the tracheoesophageal fistula tract occurred in 5% of the patients. Significant clinical factors for increased device lifetime were no radiotherapy (P = .03), and age older than 70 years (P<.02). Success rate with respect to voice quality (ie, fair to excellent rating) was 88%, which was significantly influenced by the extent of surgery (P<.001).
Conclusion The consistent use of indwelling voice prostheses shows a high success rate of prosthetic vocal rehabilitation, in terms of the percentage of long-term users (95%), and of a fair-to-excellent voice quality (88% of patients).
From the Departments of Otolaryngology–Head and Neck Oncology (Drs Op de Coul, Hilgers, Balm, and Tan) and Biometrics (Mr van Tinteren), the Netherlands Cancer Institute, Amsterdam, and the Department of Otolaryngology–Head and Neck Surgery (Drs Op de Coul and van den Hoogen), University Hospital St Radboud, Nijmegen, the Netherlands.
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