Przyczyny i czas pomiędzy kolejnymi wymianami protez głosowych u chorych po laryngektomii – analiza 184 wymian u 42 chorych

Abstract

IntroductionImplantation of the indwelling voice prosthesis has become the preferred method of voice rehabilitation after total laryngectomy. Frequent prosthesis dysfunction remains the major problem. AimAnalysis of the indwelling time and indications for multiple voice prosthesis replacements. MethodsForty two patients after total laryngectomy due to laryngeal cancer (6 women and 36 men, mean age 62.1±6.7 years) were included. 184 voice prosthesis replacements were analyzed (1271 patient-months). ResultsMean time between replacements was 260±150 days. The indwelling time decreased from 267 days to the first replacement to 100–160 days at eighth and subsequent exchanges (p<0.01). Most frequent indications for replacement were leakage of fluids through the prosthesis, phonation problems caused by mucosal overgrowth around the prosthesis, inaccurate sizing, deformation, and spontaneous extrusion. The lifetime of voice prostheses was positively correlated with patients’ age. Mycological culture of the smear taken from tracheoesophageal fistula at first replacement was positive in 34/41 cases, at the second in 29/31 cases, the third in 29/31, and at the fourth and subsequent replacements in all specimens. Most patients indicated the following factors as possible causes of a shortened lifetime of the prosthesis: use of alcohol and coffee (34% of responders), inappropriate dietary habits (sweets and tough foodstuff – 17%), cleaning of voice prosthesis discordant with the recommendations of the manufacturer (14%). ConclusionsAlthough our results confirm common indications for voice prosthesis replacement we also showed that the time between exchanges is gradually getting shorter. This observation could have implications for the current reimbursement practices.