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Success and Predictability of Provox Prosthesis Voice Rehabilitation
Michel A. Hotz, MD;
Ariane Baumann, MD;
Isabelle Schaller, MA;
Peter Zbären, MD
Arch Otolaryngol Head Neck Surg. 2002;128:687-691.
Objectives To determine the success rate and relating clinical factors of voice
prosthesis rehabilitation and to analyze the discrimination ability of the
multidimensional Harrison–Robillard-Shultz Tracheoesophageal Puncture
Rating Scale (HRS Rating Scale).
Design Prospective clinical study.
Setting University Department of Otorhinolaryngology, Head and Neck Surgery,
University Hospital Inselspital, Bern, Switzerland.
Subjects And Methods From 1992 through 1998, 87 patients with advanced squamous cell carcinoma
of the larynx and/or hypopharynx underwent primary tracheoesophageal puncture
after total laryngectomy. Clinician otolaryngologists and speech/language
pathologists independently used the HRS Rating Scale for success assessment
of voice prosthesis rehabilitation.
Results Age, sex, tumor localization, tumor stage, and radiation therapy had
no influence on the success of voice prosthesis rehabilitation. Overall, voice
rehabilitation success rates between 40% and 62% were achieved. Speech/language
pathologists and clinician otolaryngologists evaluated the same patient group
without significant statistical differences. The HRS Rating Scale analysis
showed an equal distribution of the subscale parameter care in functional and nonfunctional speakers and a strong correlation
between the subscale parameters quality and use.
Conclusions Because of its safety and simplicity, tracheoesophageal puncture has
become a state of the art method for voice rehabilitation after total laryngectomy.
The short-term superiority of voice prosthesis in voice rehabilitation over
esophageal speech rehabilitation must be seen in light of comparable long-term
success rates of the 2 methods.
From the Department of Otorhinolaryngology, Head and Neck Surgery,
University Hospital Inselspital, Bern, Switzerland.
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