Abstract
A 3-year prospective study on primary tracheoesophageal puncture was carried out at Nanavati Hospital and Tata Memorial Hospital, Bombay, to assess its feasibility in a developing country and its success in vocal rehabilitation. We report our experience with primary tracheoesophageal puncture in 64 patients (57 males and 7 females) following surgical treatment for carcinoma of the pyriform fossa (45 cases) and endolarynx (19 cases). All patients underwent total laryngectomies with or without partial pharyngectomy and primary pharyngeal mucosal closure. Fifty-one patients underwent primary surgery followed by postoperative radiotherapy. At 3 months successful tracheoesophageal speech was achieved in 84% patients, although this percentage decreased to 67% at 9 months. There were no major complications. Successful vocal rehabilitation was related more to “patient factors” such as delays in seeking medical attention when prosthetic valves dislodged, improper use and care of the valves and inability to learn speech with the prosthesis. Overall, primary tracheoesophageal puncture was found to be feasible and should be used more extensively for vocal rehabilitation following laryngectomy in developing countries.
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Andrews JC, Mickel RA, Hanson DG, Monahan GP, Ward PH (1987) Major complications following tracheoesophageal puncture for voice rehabilitation. Laryngoscope 97:562–567
Baugh RF, Baker SR, Lewin JS (1988) Surgical treatment of pharyngeosophagealspasm. Laryngoscope 98:1124–1126
Baugh RF, Lewin JS, Baker SR (1987) Preoperative assessment of tracheoesophageal speech. Laryngoscope 97:461–466
Baugh RF, Lewin JS, Baker SR (1990) Vocal rehabilitation of tracheoesophageal speech failures. Head Neck 12:69–73
Blom ED, Singer MI, Hamaker RC (1986) A prospective study of tracheocsophageal speech. Arch Otolaryngol Head Neck Surg 112:440–447
Clevens RA, Esclamado RM, Hartshorn DO, Lewin JS (1993) Voice rehabilitation after total laryngectomy and tracheoesophageal puncture using nonmuscle closure. Ann Otol Rhinol Laryngol 102:792–796
Desai PB, Rao RS, Rao DN, Shroff PD (1994) Hospital Cancer Registry. Annual Report 1991. Bombay, Tata Memorial Hospital, p 24
Hamaker RC, Singer MI, Blom ED, et al (1985) Primary voice restoration at laryngectomy. Arch Otolaryngol 111:182–186
Juarbe C, Shermen L, Eberle R, Klatsky I, Fox M (1986) Primary tracheoesophageal puncture for voice restoration. Am J Surg 152:464–466
Lau WF, Wei WI, Ho CM, Lam KH (1988) Immediate tracheoesophageal puncture for voice restoration in laryngopharyngeal resection. Am J Surg 156:269–272
Lewin JS, Baugh RF, Baker SR (1987) An objective method for prediction of tracheoesophageal speech production. J Speech Hear Disord 52:212–217
Mahieu HF, Annyas AA, Schutte HK, et al (1987) Pharyngoesophageal myotomy for vocal rehabilitation of laryngectomees. Laryngoscope 97:451–457
Maves MD, Lingemann RE (1982) Primary vocal rehabilitation using the Blom-Singer and Panje Voice prostheses. Ann Otol Rhinol Laryngol 91:458–460
McConnel FMS (1988) Analysis of pressure generation and bolus transit during pharyngeal swallowing. Laryngoscope 98:71–78
Morrison MD, Ogrady M (1986) Primary tracheoesophageal puncture voice restoration with laryngectomy. J Otolaryngol 15:69–73
Pinsola RH, Cain BH (1988) Acceptability ratings of tracheoesophageal speech. Laryngoscope 98:394–397
Robbins J, Fisher H, Blom E, Singer M (1984) Selected acoustic features of tracheoesophageal, esophageal, and laryngeal speech. Arch Otolaryngol 110:670–672
Sarkar S, Mehta S, Tiwari J, Mehta A (1990) Complications following surgery for cancer of the larynx and pyriform fossa. J Surg Oncol 43:245–249
Schaefer SD, Johns DF (1984) Attaining functional esophageal speech. Arch Otolaryngol 108:647–649
Shultz JR, Harrison J (1992) Defining predicting tracheoesophageal puncture success. Arch Otolaryngol Head Neck Surg 118:811–816
Singer MI, Blom ED (1980) An endoscopic technique for restoration of voice after laryngectomy. Ann Otol Rhinol Laryngol 89:529–533
Singer MI, Blom ED, Hamaker RC (1986) Pharyngeal plexus neurectomy for alaryngeal speech rehabilitation. Laryngoscope 96:50–54
Silver FM, Gluckman JL, Donegan JO (1985) Operative complications of tracheoesophageal puncture. Laryngoscope 95:1360–1362
Stiernberg CM, Bailey BJ, Calhoun KH, Perez DG (1987) Primary tracheoesophageal fistula procedure for voice restoration: the University of Texas Medical Branch experience. Laryngoscope 97:820–824
Trudeau MD, Hirsch SM, Schuller DE (1986) Vocal restorative surgery: why wait? Laryngoscope 96:975–977
Welch RW, Luckmann K, Ricks PM, et al (1971) Manometry of the normal upper esophageal sphincter and its alterations in laryngectomy. J Clin Invest 63:1036–1041
Williams SE, Watson JB (1987) Speaking proficiency variation according to method of alaryngeal voicing. Laryngoscope 97:737–739
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Mehta, A.R., Sarkar, S., Mehta, S.A. et al. The Indian experience with immediate tracheoesophageal puncture for voice restoration. Eur Arch Otorhinolaryngol 252, 209–214 (1995). https://doi.org/10.1007/BF00179913
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DOI: https://doi.org/10.1007/BF00179913