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Novel modification of voice prosthesis

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

The undesired dilatation of the tracheooesophageal shunt after surgical implantation of voice prosthesis is a typical complication of this procedure. Temporary removal of the prosthesis and reinsertion after a short period of time is a first-line therapeutical option aiming shrinkage of the shunt. Failure of this measure generally is an indication of revision surgery. We present first experiences treating leakage problems with novel modified voice prosthesis without surgical intervention in specified cases. 11 patients (1 female, 10 male) aging between 51 and 71 years were presented with shunt leakage between 11/2008 and 11/2012 in the ENT-Department of the University Hospital of Homburg/Saar after a custom built voice prosthesis had been used initially successfully. A “Provox 2”® voice prosthesis was modified with two discs made of silicone each on the tracheal and oesophageal side and additionally reinforcing the diameter of the prosthesis by a silicone tube. The modified prosthesis was inserted in a retrograde way under general anesthesia, analogical to the approach used with the “Provox 1”®-prosthesis. The period of observation ranged between 12 and 48 months. As a measure of control swallowing of methylene blue was used. In all cases leakage suspended. Durability of the modified prosthesis ranged between 2 and 6 months. Neither the patients’ complained about, nor did the physicians notice subjectively an impairment of the voice quality. Modifications of “Provox 2”®-prosthesis should be regarded in individual cases and constitute a reasonable alternative to revision surgery. A surgical approach is more intricate and costly, more taxing for the patient and susceptible to failure. We regard the necessity of general anesthesia for the insertion of the modified prosthesis as a disadvantage.

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References

  1. Vartanian JG, Carrara-de-Angelis E, Kowalski LP (2013) Practice of laryngectomy rehabilitation interventions: a perspective from South America. Curr Opin Otolaryngol Head Neck Surg 21:212–217

    Article  PubMed  Google Scholar 

  2. Eadie TL, Doyle PC (2004) Auditory-perceptual scaling and quality of life in tracheoesophageal speakers. Laryngoscope 114:753–759

    Article  PubMed  Google Scholar 

  3. Liu H, Ng ML (2007) Electrolarynx in voice rehabilitation. Auris Nasus Larynx 34:327–332

    Article  PubMed  Google Scholar 

  4. Saikachi Y, Stevens KN, Hillman RE (2009) Development and perceptual evaluation of amplitude-based F0 control in electrolarynx speech. J Speech Lang Hear Res 52:1360–1369

    Article  PubMed Central  PubMed  Google Scholar 

  5. Asai R (1972) Laryngoplasty after total laryngectomy. Arch Otolaryngol 95:114–119

    Article  CAS  PubMed  Google Scholar 

  6. Staffieri M, Procaccini A, Steiner W, Staffieri A (1978) Surgical rehabilitation of speech after total laryngectomy: the Staffieri techniques (author’s transl). Laryngol Rhinol Otol (Stuttg) 57:477–488 (article in German)

  7. Bremke M, Werner JA, Lichtenberger G, Folz BJ (2007) Chronische Aspiration infolge einer tracheo-ösophagealen Fistel nach Staffieri: Erfolgreiche Therapie mittels einer Provox®-Stimmprothese. Laryngorhinootologie 86:798–801

    Article  CAS  PubMed  Google Scholar 

  8. Ehrenberger K, Wicke W, Piza H, Roka R, Grasl M, Swoboda H (1985) Jejunal grafts for reconstructing a phonatory neoglottis in laryngectomized patients. Arch Otorhinolaryngol 242:217–223

    Article  CAS  PubMed  Google Scholar 

  9. Hagen R (1990) Laryngoplasty with a radialis pedicle flap from forearm: a surgical procedure for voice rehabilitation after total laryngectomy. Am J Otolaryngol 11:85–89

    Article  CAS  PubMed  Google Scholar 

  10. Hilgers FJ, Schouwenburg PF (1990) A new low-resistance, self-retaining prosthesis (Provox) for voice rehabilitation after total laryngectomy. Laryngoscope 100:1202–1207

    Article  CAS  PubMed  Google Scholar 

  11. Singer MI, Blom ED (1980) An endoscopic technique for restoration of voice after laryngectomy. Ann Otol Rhinol Laryngol 89:529–533

    Article  CAS  PubMed  Google Scholar 

  12. Panje WR (1981) Prosthetic vocal rehabilitation following laryngectomy—the voice button. Ann Otol Rhinol Laryngol 90:116–120

    Article  CAS  PubMed  Google Scholar 

  13. Nijdam HF, Annyas AA, Schutte HK, Leever H (1982) A new prosthesis for voice rehabilitation after laryngectomy. Arch Oto-Rhino-Laryngol 237:27–33

    Article  Google Scholar 

  14. van den Hoogen FJA, Oudes MJ, Hombergen G et al (1996) The Groningen, Nijdam and Provox voice prostheses: a prospective clinical comparison based on 845 replacements. Acta Otolaryngol 116:119–124

    Article  Google Scholar 

  15. Bessede JP, Bories F, Enaux M et al (1995) Closure of esotracheal fistula after phonation implants. Technique and results of tracheal ascension. Ann Otolaryngol Chir Cervicofac 112:353–355 (article in French)

  16. Birk S, Michaeli P, Kapsreiter M, Alexiou C (2009) Dislokation von Stimmprothesen. HNO. 57:1126–1130

    Article  CAS  PubMed  Google Scholar 

  17. The World Medical Association (2013) www.wma.net. http://www.wma.net/en/30publications/10policies/b3/

  18. Genden EM, Ferlito A, Silver CE, Jacobson AS, Werner JA, Suárez C, Leemans CR, Bradley PJ, Rinaldo A (2007) Evolution of the management of laryngeal cancer. Oral Oncol 43:431–439

    Article  PubMed  Google Scholar 

  19. Mozolewski E. Surgical rehabilitation of voice and speech following laryngectomy. Otolaryngol Pol 26:653–661 (article in Polish)

  20. Issing WJ, Fuchshuber S, Wehner M (2001) Incidence of tracheo-oesophageal fistulas after primary voice rehabilitation with the Provox or the Eska-Herrmann voice prosthesis. Eur Arch Otorhinolaryngol 258:240–242

    Article  CAS  PubMed  Google Scholar 

  21. Herrmann IF (1987) Die sekundäre chirurgische Stimmrehabilitation. HNO 35:351–354

    CAS  PubMed  Google Scholar 

  22. Ackerstaff AH, Hilgers FJ, Meeuwis CA, van der Velden LA, van den Hoogen FJ, Marres HA, Vreeburg GC, Manni JJ (1999) Multi-institutional assessment of the Provox 2 voice prosthesis. Arch Otolaryngol Head Neck Surg 125:167–173

    Article  CAS  PubMed  Google Scholar 

  23. Fusconi M, Taddei AR, Gallo A, Conte M, De Virgilio A, Greco A, Lo Vasco VR, Macrì GF, Roma R, Volpini F, Benincasa AT, De Vincentiis M (2014) Degradation of silicone rubber causes Provox 2 voice prosthesis malfunctioning. J Voice 28:250–254

    Article  PubMed  Google Scholar 

  24. Malik T, Bruce I, Cherry J (2007) Surgical complications of tracheo-oesophageal puncture and speech valves. Curr Opin Otolaryngol Head Neck Surg 15:117–122

    Article  PubMed  Google Scholar 

  25. Kress P, Schäfer P, Schwerdtfeger FP (2006) Die Custom-fit-Stimmprothese. Zur Therapie der periprothetischen Leckage bei Stimmprothesenträgern. Laryngorhinootologie 85:496–500

    Article  CAS  PubMed  Google Scholar 

  26. Hilgers FJ, Soolsma J, Ackerstaff AH, van den Brekel MW (2008) A thin tracheal silicone washer to solve periprosthetic leakage in laryngectomies: direct results and long-term clinical effects. Laryngoscope 118:640–645

    Article  PubMed  Google Scholar 

  27. Lewin JS, Hutcheson KA, Barringer DA, Croegaert LE, Lisec A, Chambers MS (2012) Customization of the voice prosthesis to prevent leakage from the enlarged tracheoesophageal puncture: results of a prospective trial. Laryngoscope. 122:1767–1777

    Article  PubMed Central  PubMed  Google Scholar 

  28. Pattani KM, Morgan M, Nathan CO (2009) Reflux as a cause of tracheoesophageal puncture failure. Laryngoscope. 119:121–125

    Article  PubMed  Google Scholar 

  29. Boscolo-Rizzo P, Marchiori C, Gava A, Da Mosto MC (2008) The impact of radiotherapy and GERD on in situ lifetime of indwelling voice prostheses. Eur Arch Otorhinolaryngol 265:791–796 (Epub 2007 Nov 16)

    Article  PubMed  Google Scholar 

  30. Lorenz KJ, Ehrhart T, Grieser L, Maier H (2009) Koinzidenz von Stimmfistelerweiterungen und supraösophagealem Reflux nach stimmprothetischer Versorgung bei Laryngektomie. HNO 57:1253–1261

    Article  CAS  PubMed  Google Scholar 

  31. Lorenz KJ, Grieser L, Ehrhart T, Maier H (2010) Role of reflux in tracheoesophageal fistula problems after laryngectomy. Ann Otol Rhinol Laryngol 119:719–728

    PubMed  Google Scholar 

  32. Lorenz KJ, Grieser L, Ehrhart T, Maier H (2011) The management of periprosthetic leakage in the presence of supra-oesophageal reflux after prosthetic voice rehabilitation. Eur Arch Otorhinolaryngol 268:695–702

    Article  PubMed  Google Scholar 

  33. Starmer HM, Agrawal N, Koch W, Richmon J, Webster K, Gourin CG (2011) Does prosthesis diameter matter? The relationship between voice prosthesis diameter and complications. Otolaryngol Head Neck Surg 144:740–746

    Article  PubMed  Google Scholar 

  34. Hutcheson KA, Lewin JS, Sturgis EM, Risser J (2012) Multivariable analysis of risk factors for enlargement of the tracheoesophageal puncture after total laryngectomy. Head Neck 34(4):557–567

    Article  PubMed Central  PubMed  Google Scholar 

  35. Hutcheson KA, Lewin JS, Sturgis EM, Kapadia A, Risser J (2011) Enlarged tracheoesophageal puncture after total laryngectomy: a systematic review and meta-analysis. Head Neck 33:20–30

    Article  PubMed Central  PubMed  Google Scholar 

  36. Odland R, Adams G (1988) Pneumothorax as a complication of tracheoesophageal voice prosthesis use. Ann Otol Rhinol Laryngol 97:537–541

    Article  CAS  PubMed  Google Scholar 

  37. Koch M, Zenk J, Birk S, Alexiou C, Iro H (2010) Surgical closure of persistent tracheoesophageal fistulas by esophageal suturing and cranial transposition of the trachea. Otolaryngol Head Neck Surg 143:843–844

    Article  PubMed  Google Scholar 

  38. Schwandt LQ, Tjong-Ayong HJ, van Weissenbruch R, der Mei HC, Albers FW (2006) Differences in aerodynamic characteristics of new and dysfunctional Provox 2 voice prostheses in vivo. Eur Arch Otorhinolaryngol 263:518–523

    Article  PubMed  Google Scholar 

  39. Luff DA, Izzat S, Farrington WT (1999) Viscoaugmentation as a treatment for leakage around the Provox 2 voice rehabilitation system. J Laryngol Otol 113:847–848

    Article  CAS  PubMed  Google Scholar 

  40. Perie S, Ming X, Dewolf E, St. Guily JL (2002) Autologous fat injection to treat leakage around tracheoesophageal puncture. Am J Otolaryngol 23:345–350

    Article  PubMed  Google Scholar 

  41. Rokade AV, Mathews J, Reddy KT (2003) Tissue augmentation using Bioplastique as a treatment of leakage around a Provox 2 voice prosthesis. J Laryngol Otol 117:80–82

    Article  CAS  PubMed  Google Scholar 

  42. Hoffmann TK, Sommer P, Bier H (2006) Die Kollageninjektion zur Augmentation des insuffizienten Stimmprothesenlagers. Laryngorhinootologie 85:556–558

    Article  CAS  PubMed  Google Scholar 

  43. Jacobs K, Delaere PR, Vander Poorten VL (2008) Submucosal purse-string suture as a treatment of leakage around the indwelling voice prosthesis. Head Neck 30:485–491

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Otorhinolaryngology, University Medical Center Homburg/Saar, Kirrberger Straße, 66421, Homburg/Saar, Germany

    Basel Al Kadah, George Papaspyrou & Bernhard Schick

  2. Institut of Anaplastology Schneider, Zweibrücken, Germany

    Mathias Schneider

Authors
  1. Basel Al Kadah
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  2. George Papaspyrou
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  3. Mathias Schneider
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  4. Bernhard Schick
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Correspondence to Basel Al Kadah.

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Al Kadah, B., Papaspyrou, G., Schneider, M. et al. Novel modification of voice prosthesis. Eur Arch Otorhinolaryngol 273, 697–702 (2016). https://doi.org/10.1007/s00405-015-3795-2

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  • DOI: https://doi.org/10.1007/s00405-015-3795-2

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