Tracheoesophageal Voice Prosthesis Research Articles

Colonization of voice prostheses by albicans and non-albicans Candida species.

The purposes of the study were to assess the colonization of tracheoesophageal voice prostheses by albicans and non-albicans Candida species and to determine their susceptibility for three antimycotics that are frequently used for prophylaxis or treatment of oral candidiasis (i.e., miconazole, fluconazole, and nystatin). In total, 101 patients, corresponding to 170 voice prostheses, were monitored over a period of 28 months. An enzymatic two-step method was used for differentiation and presumptive identification of Candida species colonizing the voice prostheses. The identity of the isolates was confirmed by the germ-tube test, morphological appearance on cornmeal agar with 0.5% Tween 80, sugar assimilation tests, and appearance on CHROMagar Candida (CHROMagar Co., Paris), Albicans ID (BioMérieux Vitek, Hazelwood, MO), and Fluoroplate Candida (Merck, Darmstadt, Germany). Susceptibility testing for miconazole, fluconazole, and nystatin was performed according to the microdilution method of the National Committee for Clinical Laboratory Standards. The predominant species isolated were Candida albicans (41.4%), Candida glabrata (33.1%), Candida krusei (15.9%), and Candida tropicalis (5.3%). A broad range of minimal inhibitory concentrations of the isolates was observed for miconazole and fluconazole. In contrast, minimal inhibitory concentration values for nystatin were narrowly distributed around 4 microg/mL for all isolates, suggesting uniform sensitivity. Our data on the prevalence and susceptibility of yeast isolates will contribute to a rational choice of an antimycotic for prophylaxis of the early deterioration and leakage of tracheoesophageal voice prostheses.

How I do it: closure of tracheoesophageal puncture site.

Tracheoesophageal voice prosthesis is highly effective in providing speech after total laryngectomy. Although it is a safe method, tracheoesophageal fistulas occasionally need to be closed, usually at the request of the patient, because of leakage through an enlarging fistula. We present our technique for closure of tracheoesophageal fistula. An incision is made at the mucocutaneous junction of the stoma from the 9 to the 3-o'clock position. Tracheoesophageal space is dissected down to and beyond the fistula. The tracheoesophageal tract is divided. The esophageal mucosa is closed with inverted sutures. After multiple layer closure of the esophageal fistula, the tracheal mucosa is closed with everted sutures. This technique has been used in nine patients. Eight were successful. The remaining patient had radiation therapy failure. This method of closure is simple and effective for those patients who require permanent closure of the tracheoesophageal fistula.

Biofilm formation and design features of indwelling silicone rubber tracheoesophageal voice prostheses—an electron microscopical study

Biofilm formation and design features of indwelling silicone rubber tracheoesophageal voice prostheses—an electron microscopical study

Alternatives for reconstruction after laryngopharyngectomy: The jejunum interposition autograft

There are several options for reconstructing circumferential defects of the hypopharynx and cervical esophagus after total laryngopharyngectomy. Both myocutaneous pedicled flaps (pectoralis, trapezius) and fasciocutaneous free flaps (radial forearm, lateral arm, lateral thigh) can be useful for partial defects; however, because of bulk or lack of length, they may not be appropriate for total circumferential defects. The jejunum free flap has proven to be an effective alternative in these circumstances. Jejunum free flaps allow for a complete single-staged reconstruction, early restoration of normal deglutition, and accommodation of a tracheoesophageal voice prosthesis. Complications such as graft failure and fistula formation are potentially serious problems; however, the overall success rates of jejunum free tissue transfer make it a favorable reconstructive alternative.

Ectopic Hair Growth After Flap Reconstruction of the Head and Neck

A 53-year-old Peruvian man underwent total laryngopharyngectomy with tubed radial forearm free flap reconstruction for chondronecrosis of the larynx and pharynx that developed as a complication of radiation therapy. A tracheoesophageal fistula was created for speech rehabilitation. Two years later, he returned with complaints related to frequent trapping of small food particles in his hypopharyngeal segment, causing frequent food regurgitation, halitosis, and mild but bothersome intermittent dysphagia. He also complained of the frequent dysfunction of his tracheoesophageal voice prosthesis, which was caused by clogging of the valve mechanism by hair. Topical nystatin therapy provided no relief. Endoscopic examination of the reconstructed hypopharyngeal segment revealed prominent hair growth without evidence of stricture for

The long-term indwelling tracheoesophageal prosthesis for alaryngeal voice rehabilitation.

To analyze the initial experience at Oregon Health Sciences University, Portland, with the use of long-term indwelling tracheoesophageal voice prostheses. Retrospective case series. Tertiary referral academic medical center. Thirty patients undergoing speech rehabilitation after laryngectomy during a period of 18 months. Insertion of a long-term indwelling tracheoesophageal voice prosthesis. Duration of use, complications. The mean duration of placement for a single prosthesis was 4.9 months (148 days), with a range of 14 to 330 days. Sixteen of the 30 patients encountered problems with leakage because of fungal colonization, the majority of which (15 of 16 cases) were solved with either oral or topical application of nystatin. Size matching in terms of prosthesis length and tract length was critical, and problems of this nature were encountered in 11 of 30 patients. The incorporation of a second system of prostheses that offered an increased number of size options solved these problems in all of these patients. Ultimately, 27 of 30 patients were able to successfully wear these prostheses. The indwelling tracheoesophageal voice prosthesis offers patients all the advantages of tracheoesophageal speech rehabilitation after laryngectomy without the inconvenience of frequent prosthesis changes. With careful attention to the details of fitting and care, it can be worn by the majority of patients successfully.

Voice restoration after laryngectomy: experience with the Blom-Singer extended-wear indwelling tracheoesophageal voice prosthesis.

The Blom-Singer tracheoesophageal voice prosthesis has undergone continuous design modifications during the last 18 years to make it more effective, anatomically compatible, and easier to use. This evolution continues with the recent introduction of an indwelling-style voice prosthesis intended for use by individuals who are unable or disinclined to use a self-removable-style voice prosthesis. The a priori self-lifespan goal of the indwelling prosthesis was 180 days. The present investigation describes the experience of 81 consecutive participants who used a total of 206 indwelling voice prosthesis. Selection criteria included total laryngectomy and either primary (n = 35) or secondary (n = 46) tracheoesophageal puncture. All participants had external-beam radiotherapy either pre- or postlaryngectomy. Specifically, lifespan of the prosthesis, the effects and clinical management of fungal colonization, and participant satisfaction with this style prosthesis were studied. A prosthesis use rate of 90% was observed. Group 1 prostheses (without fungal colonization and without Nystatin therapy) exhibited a lifespan significantly longer than did group 2 prostheses (with fungal colonization and prior to Nystatin therapy) (sample mean [mean] = 185.6 days versus 80.6 days; p < .05). Group 3 prostheses (following Nystatin therapy) also exhibited a lifespan significantly longer than that of group 2 prostheses (mean = 156.1 days versus 80.6 days; p < .05). Lifespans of group 1 and group 3 prostheses were not significantly different (p < .05). The extended-wear, indwelling voice prosthesis achieved its a priori lifespan goal of 180 days (6 months) with almost uniform patient preference and without risk of increased complications. When fungal colonization was present. Nystatin therapy significantly prolonged prosthesis lifespan.

Voice restoration after laryngectomy: Experience with the Blom–Singer extended‐wear indwelling tracheoesophageal voice prosthesis

Voice restoration after laryngectomy: Experience with the Blom–Singer extended‐wear indwelling tracheoesophageal voice prosthesis

Deterioration of the Provox™ Silicone Tracheoesophageal Voice Prosthesis: Microbial Aspects and Structural Changes

van Weissenbruch R, Albers FWJ, Bouckaert S, Nelis HJ, Criel G, Remon JP, Suiter AM. Deterioration of the Provox™ silicone tracheoesophageal voice prosthesis: microbial aspects and structural changes. Acta Otolaryngol (Stockh) 1997; 117: 452-458.Device life of tracheoesophageal voice prostheses is limited due to deterioration of the polymers. A group of 55 postlaryngectomy patients fitted with a Provox™ voice prosthesis have been studied prospectively during 6 months. Thirty-seven prostheses were replaced due to a dysfunctional valve mechanism. Although colonization with Candida species was highly associated with destruction of the silicone material, other upper respiratory tract commensals, e.g. Staphylococcus aureus, were also demonstrated. Electron microscopy of the contaminated devices showed colonization and disruption of the silicone material by penetrating yeast hyphae. During the study a remarkable increase of intratracheal phonatory pressures was assessed with progressive colonization of the prostheses.

Total Intravenous Anesthesia and Endotracheal Oxygen Insufflation for Repair of Tracheoesophageal Fistula in an Adult

A tracheoesophageal voice prosthesis facilitates speech rehabilitation after laryngectomy (1,2). We describe the anesthetic management of a patient who required repair of a large tracheoesophageal fistula around the voice prosthesis. The requirements for access to the upper trachea excluded the use of a tracheotomy tube. Our technique of total intravenous anesthesia, spontaneous ventilation, and endotracheal O 2 insufflation provided excellent operating conditions while ensuring adequate anesthesia depth, oxygenation, and patient safety.

Tracheoesophageal voice prosthesis

First Page

TE Voice Restoration Following Total Laryngectomy

Educational objectives: To perform primary and secondary tracheoesophageal voice restoration procedures and measure, fit, and trouble-shoot tracheoesophageal voice prostheses.

Changing the indwelling Provox tracheoesophageal voice prosthesis as an Out-patient procedure

The use of the indwelling tracheo-oesophageal prosthesis is gaining popularity for vocal rehabilitation after laryngectomy. These devices can often provide trouble-free phonation for many months before they become incompetent or require increased effort to open them. When this occurs changing the defective valve for a new one is required. We describe simplification of the technique described by the manufactures which is eminently suitable for use as an out-patient procedure under local anaesthesia.

Facilitating training in tracheoesophageal prosthesis placement.

Success in the utilization of a tracheoesophageal voice prosthesis may be limited due to the failure to learn how to insert the prosthesis independently. Reasons that may account for this inadequacy include inadequate preoperative screening tools to assess adequacy of the insertion process and lack of the availability of a model that allows safe practice in the skills necessary for insertion and retention. To avoid these possible complications, a model has been developed that will assist the medical care team in preoperative evaluation and postoperative care.

Fungal colonization of tracheoesophageal voice prosthesis.

Laryngectomized patients fitted with tracheoesophageal (TE) puncture voice prosthesis may experience frequent failures in adequate production of neophonation. In some cases, these phonatory problems result from obstruction of the voice prosthesis with various deposits. The nature of these deposits was studied with mycologic techniques and by light and scanning electron microscopy. Candida albicans and other fungal species were identified.

Vocal Rehabilitation After Laryngectomy

The evolution of treatment of laryngeal cancer has passed a number of milestones. The maintenance of useful communication is of paramount importance in all cases and, with the newer modalities of tracheoesophageal phonation and voice prostheses, the quality of life after laryngectomy is clearly improved. Future advances may restore continuity of the upper respiratory tract with resumption of normal nasal function, humidification of the lower respiratory tract, and elimination of the permanent tracheostoma.