Abstract
Objectives
Voice rehabilitation after laryngectomy is by tracheo esophageal puncture (TEP) and prosthesis insertion. Secondary TEP is very difficult due to neck fibrosis. Puncture under local anaesthesia with endoscopy guidance is a feasible option.
Methods
Retrospective review of all laryngectomy patients from March 2009 till March 2019 was done and the methods of voice rehabilitation were assessed. The patients undergoing the procedure were classified according to the timing of insertion and type as primary insertion under general anaesthesia (Group P), secondary insertion under local anaesthesia (Group L), secondary insertion under general anaesthesia (Group G). The speech outcome and the procedure outcome were compared.
Results
There were 148 patients who underwent laryngectomy, of which groups P, G, L were 12, 12 and 11. The rate of successful insertion was 100% in primary, 91.6% in secondary in general anaesthesia and 91% in secondary under local anaesthesia. All secondary TEP were done after surgery and radiotherapy. Complications related to the insertion techniques were minimal. Speech outcome were similar on intelligibility rating scale and longevity was not affected by the method.
Conclusion
TEP in local anaesthesia is feasible and has comparable outcome with TEP in general anaesthesia. Financial burden was very much less in group L compared to the other two groups.
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Reference
Xi S (2010) Effectiveness of voice rehabilitation on vocalisation in postlaryngectomy patients. Int J Evid-Based Healthc 8(4):256–258. https://doi.org/10.1111/j.1744-1609.2010.00177.x
Lorenz K (2017) Rehabilitation after total laryngectomy—a tribute to the pioneers of voice restoration in the last two centuries. Front Med 4:81. https://doi.org/10.3389/fmed.2017.00081
Bień S, Rinaldo A, Silver C, Fagan J, Pratt L, Tarnowska C et al (2008) History of voice rehabilitation following laryngectomy. Laryngoscope 118(3):453–458. https://doi.org/10.1097/MLG.0b013e31815db4a2
der Molen L, Kornman A, Latenstein M, den Brekel M, Hilgers F (2013) Practice of laryngectomy rehabilitation interventions. Curr Opin Otolaryngol Head Neck Surg 21(3):230–238. https://doi.org/10.1097/MOO.0b013e3283610060
Owen S, Paleri V (2013) Laryngectomy rehabilitation in the United Kingdom. Curr Opin Otolaryngol Head Neck Surg 21(3):186–191. https://doi.org/10.1097/moo.0b013e328360d836
Singer M, Blom E (1980) An endoscopic technique for restoration of voice after laryngectomy. Ann Otol Rhinol Laryngol 89(6):529–533. https://doi.org/10.1177/000348948008900608
Deshpande M (2010) Prosthetic voice rehabilitation after total laryngectomy. Indian J Surg Oncol 1(2):146–150. https://doi.org/10.1007/s13193-010-0028-4
Moon S, Raffa F, Ojo R, Landera M, Weed D, Sargi Z et al (2014) Changing trends of speech outcomes after total laryngectomy in the 21st century: a single-center study. Laryngoscope 124(11):2508–2512. https://doi.org/10.1002/lary.24717
Cheng E, Ho M, Ganz C, Shaha A, Boyle J, Singh B et al (2006) Outcomes of primary and secondary tracheoesophageal puncture: a 16-years retrospective analysis. Ear Nose Throat J 85(4):262–267. https://doi.org/10.1177/014556130608500417
Iwai H, Yukawa H, Yamamoto T, Miyamoto S, Adachi M, Horiguchi A et al (2002) Secondary shunt procedure for alaryngeal patients in an outpatient clinic. Acta Oto-Laryngol 122(6):661–664. https://doi.org/10.1080/000164802320396367
Hong G, John A, Theobald D, Soo K (1995) Flexible endoscopic tracheo-oesophageal puncture under local anaesthetic. J Laryngol Otol 109(11):1077–1079. https://doi.org/10.1017/s0022215100132062
Bath A, Toynton S, Innes A (1994) Technique of tracheo-oesophageal puncture under local anaesthesia. J Laryngol Otol 108(11):980–982. https://doi.org/10.1017/S002221510012866X
Varghese B, Mathew A, Sebastian S, Iype E, Sebastian P, Rajan B (2013) Objective and perceptual analysis of outcome of voice rehabilitation after laryngectomy in an Indian tertiary referral cancer centre. Indian J Otolaryngol Head Neck Surg 65(S1):150–154. https://doi.org/10.1007/s12070-013-0647-5
Robinson R, Simms V, Ward E, Barnhart M, Chandler S, Smee R (2017) Total laryngectomy with primary tracheoesophageal puncture: intraoperative versus delayed voice prosthesis placement. Head Neck 39(6):1138–1144. https://doi.org/10.1002/hed.24727
Sethi R, Kozin E, Lam A, Emerick K, Deschler D (2014) Primary tracheoesophageal puncture with supraclavicular artery Island flap after total laryngectomy or laryngopharyngectomy. Otolaryngol Head Neck Surg 151(3):421–423. https://doi.org/10.1177/0194599814539443
Chakravarty P, McMurran A, Banigo A, Shakeel M, Ah-See K (2017) Primary versus secondary tracheoesophageal puncture: systematic review and meta-analysis. J Laryngol Otol 132(1):14–21. https://doi.org/10.1017/S0022215117002390
Doctor V, Enepekides D, Farwell D, Belafsky P (2007) Transnasal oesophagoscopy-guided in-office secondary tracheoesophageal puncture. J Laryngol Otol 122(3):303–306. https://doi.org/10.1017/S0022215107000084
Britt C, Lippert D, Kammer R, Ford C, Dailey S, McCulloch T, Hartig G (2014) Secondary tracheoesophageal puncture in office using seldinger technique. Otolaryngol Head Neck Surg 150(5):808–812. https://doi.org/10.1177/0194599814521570
LeBert B, McWhorter A, Kunduk M, Walvekar R, Lewin J, Hutcheson K et al (2009) Secondary tracheoesophageal puncture with in-office transnasal esophagoscopy. Arch Otolaryngol Head Neck Surg 135(12):1190. https://doi.org/10.1001/archoto.2009.166
van Sluis K, der Molen, van Son R, Hilgers F, Bhairosing P, den Brekel M (2017) Objective and subjective voice outcomes after total laryngectomy: a systematic review. European Arch Oto-Rhino-Laryngol 275(1):11–26. https://doi.org/10.1007/s00405-017-4790-6
Krishnamurthy A, Khwaja MS (2017) Analysis of factors affecting the longevity of voice prosthesis following total laryngectomy with a review of literature. Indian J Surg Oncol 9(1):39–45. https://doi.org/10.1007/s13193-017-0700-z
Hancock K, Ward E, Lawson N, As-Brooks C (2012) A prospective, randomized comparative study of patient perceptions and preferences of two types of indwelling voice prostheses. International J Lang Commun Disord 47(3):300–309. https://doi.org/10.1111/j.1460-6984.2011.00109.x
Acknowledgement
We acknowledge the contribution made by Mr. Aneeth, speech and language pathologist for the speech analysis of patients using speech intelligibility scale.
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Thavarool, S.B., Vijay, S., S, M. et al. Tracheo Esophageal Prosthesis Insertion Under Endoscopic Guidance and Local Anaesthesia- Feasibility and Outcome. Indian J Otolaryngol Head Neck Surg 74, 39–44 (2022). https://doi.org/10.1007/s12070-020-02149-5
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DOI: https://doi.org/10.1007/s12070-020-02149-5