Abstract
SummaryTo 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.
Highlights
Since its introduction, the tracheo-esophageal puncture technique (TEP) and vocal prosthesis (VP) placement became the standard for vocal rehabilitation in patients submitted to total laryngectomy (TL) . 1 -11 Esophageal voice rehabilitation has a success rate of 24% to 26% 6, 12 and prosthesis with TEP has an increased success rate of 58% to 94% for immediate results of primary TEP and 61% to 64% for secondary TEP 6,8,10,11,1317
The purpose of the present study was to assess the experience of indwelling voice prosthesis Blom-Singer in patients submitted to TL in a tertiary hospital, at the Discipline of Otorhinolaryngology, Head and Neck Surgery, Universidade Estadual de Campinas (Unicamp)
The rehabilitation of total laryngectomized patients with tracheoesophageal voice with VP, after primary or secondary TEP, proved to be a more reproducible method and with fewer complications to patients . 1,3,5-11 Vocal rehabilitation with esophageal voice has success rate of 24 to 26% 6, 12, but with VP this rate is increased to 58% to 94% for immediate results with primary TEP and 61% to 64% for secondary TEP . 6,8,10,11,13-17 Long-term results in the literature with one-year follow up ranged from 65% to 85% in primary and 69% to 83% in secondary TEP . 6,10,13-15,17-22 This is one of the few studies that focused on long-term use of VP after primary and secondary TEP, especially with assessment of results after two years of follow up
Summary
The tracheo-esophageal puncture technique (TEP) and vocal prosthesis (VP) placement became the standard for vocal rehabilitation in patients submitted to total laryngectomy (TL) . 1 -11 Esophageal voice rehabilitation has a success rate of 24% to 26% 6, 12 and prosthesis with TEP has an increased success rate of 58% to 94% for immediate results of primary TEP and 61% to 64% for secondary TEP 6,8,10,11,1317. The tracheo-esophageal puncture technique (TEP) and vocal prosthesis (VP) placement became the standard for vocal rehabilitation in patients submitted to total laryngectomy (TL) . 6,10,13-15,17-22 The main innovation in design and shape of prosthesis placement took place in the USA and Europe, with gradual and global improvement thanks to long-term use by patients 4.The most recent innovation was the introduction of indwelling VP to suppress the inconvenience and the problems associated with frequent exchanges of VP. The purpose of the present study was to assess the experience of indwelling voice prosthesis Blom-Singer in patients submitted to TL in a tertiary hospital, at the Discipline of Otorhinolaryngology, Head and Neck Surgery, Universidade Estadual de Campinas (Unicamp). We studied the influence of time of TEP performance (primary or secondary), use of postoperative radiotherapy (RTX postop), age of patients and follow-up over success rate of VP
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