Abstract

Voice prostheses have been examined for their effect on voice production but there is little datum on their effect on swallow function. This study investigated the difference between six commonly available voice prostheses in terms of swallowing. Laryngectomy patients had up to six voice prostheses placed in a random order over two visits. Swallowing was evaluated for each prosthesis using FEES (Fibreoptic Endoscopic Evaluation of Swallowing). After each prosthesis trial, patients self-evaluated their experience of swallowing. Three independent experts indicated which prosthesis they considered best for swallowing for each patient and judged residue on the voice prosthesis and in the upper esophagus. Raters were blinded to participant details, voice prosthesis type and scores of other raters. On patient self-evaluation, scores were equally distributed across all prostheses for swallowing. Experts most frequently chose the Blom Singer Low pressure and Blom Singer Classic Indwelling voice prostheses as best for swallowing but consensus was poor for most patients. Experts found that the Blom Singer Classic Indwelling and the Provox Vega had least residue on the voice prosthesis on thin liquid (p ≤ 0.001) and soft (p = 0.001), respectively. Experts also found that the Blom Singer Low Pressure had least residue in the upper esophagus on soft consistency (p ≤ 0.001). While self-evaluation by patients did not identify a consistently preferred prosthesis for swallow, many patients expressed personal preferences, suggesting benefits to involving patients in the choice of prosthesis. Some voice prostheses may be associated with lower levels of residue on the prosthesis and upper esophagus with certain consistencies.

Highlights

  • The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.Laryngectomy surgery involves removal of the larynx in its entirety usually as a treatment for advanced laryngeal cancer

  • Experts found that the Blom Singer Classic Indwelling and the Provox Vega had least residue on the voice prosthesis on thin liquid (p B 0.001) and soft (p = 0.001), respectively

  • Surgical voice restoration (SVR) with a voice prosthesis is considered the gold standard for voice rehabilitation after laryngectomy [1, 2]

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Summary

Introduction

As a result of this surgery, patients lose the ability to communicate in a conventional manner. Since the Blom Singer Duckbill voice prosthesis was introduced [3, 4], there have been numerous improvements to the design and functionality of voice prostheses. These include the introduction of an indwelling prosthesis [5, 6], development of a candida-resistant voice prosthesis [7, 8], enhanced aerodynamic characteristics [9] and changes to insertion methods [10]. For the patient and clinician, there is currently a wide range of voice prostheses available from which to choose

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