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Chirurgische Therapie von Stimmshunt-Komplikationen unter besonderer Berücksichtigung eines supraösophagealen Refluxes

Fallbericht und Literaturübersicht

Surgical treatment of enlarged trachoesophageal puncture with and without supraesophageal reflux

Case report and review of literature

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Zusammenfassung

Etwa ein Viertel der Patienten mit Stimmprothesen zeigt 1–4 Jahre nach der Stimmprothesenanlage eine periprothetische Leckage mit Aspirationssymptomatik. Je nach Ausmaß der Fistelerweiterungen kommen konservative oder chirurgische Maßnahmen in Betracht. Trotz aller Bemühungen verlaufen diese Interventionen bei einigen Patienten jedoch frustran. Die Ursache für dieses Therapieversagen ist ebenso wie die Genese der Fistelerweiterung nicht vollständig geklärt. Es mehren sich jedoch die Hinweise, dass ein begleitender supraösophagealer Reflux an diesen Fistelkomplikationen beteiligt sein kann. Wir berichten über 2 Patienten mit mehrfachem erfolglosem Fistelverschluss bei synchroner schwerer Refluxerkrankung, die nach konsequenter Antirefluxtherapie erfolgreich verschlossen werden konnten.

Abstract

Approximately a quarter of all patients who undergo prosthetic voice restoration develop periprosthetic leakage with aspiration symptoms within 1 to 4 years following surgery. Depending on the severity of fistula enlargement, treatment ranges from conservative approaches to surgical procedures. In some cases, however, these measures prove unsuccessful. The causes of treatment failure and fistula enlargement are not fully understood. There is growing evidence, however, that the presence of coexisting supraesophageal reflux can contribute to fistula complications. We report the case of two patients with voice prostheses and simultaneous severe reflux disease who underwent multiple failed attempts at fistula closure. After effective reflux therapy, the fistulas could eventually be closed successfully.

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  1. Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf-Hals-Chirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland

    K.J. Lorenz OFA & H. Maier

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  2. H. Maier
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Correspondence to K.J. Lorenz OFA.

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Lorenz, K., Maier, H. Chirurgische Therapie von Stimmshunt-Komplikationen unter besonderer Berücksichtigung eines supraösophagealen Refluxes. HNO 57, 1317–1324 (2009). https://doi.org/10.1007/s00106-009-1990-4

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