Objective To identify factors predicting prosthesis use and final speech quality in patients undergoing secondary tracheoesophageal puncture (TEP) for voice restoration after laryngectomy. Methods We undertook a retrospective study of 168 patients who underwent secondary TEP at the Cleveland Clinic between June 1980 and October 1993. Factors examined were: patient demographics, extent of initial surgery, method of pharyngeal preparation, history of irradiation, insufflation test results, pharyngeal stricture, and concurrent medical conditions. Univariate and multivariate statistical analyses were performed to identify predictive factors. Results At last evaluation, 73.8% (124) of the patients were still using the prosthesis. Quality of speech was the only predictor of prosthesis use (p < .001). Phonation on the first day was achieved in 90% (151) of patients. Speech result improved significantly over the first 6 months (p < .001). Univariate analysis found that the need for reconstruction at laryngectomy (p = .04), the presence of pharyngeal stricture (p = .001), and continued prosthetic use (p < .001) were associated with the speech result. There was no significant advantage to the lack of approximation of the pharyngeal constrictors (p = .31). Stepwise logistic regression showed that only the absence of pharyngeal stricture was associated with a better‐quality voice (p = .001). Conclusion Tracheoesophageal puncture is a reliable method for restoring voice after laryngectomy. Prosthesis use decreases with time, and good voice quality is the only predictor of continued prosthesis use. In this series the absence of pharyngeal stricture was the only significant predictor of good to excellent speech. HEAD & NECK 1996;18:393–398 © 1996 John Wiley & Sons, Inc.

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One hundred forty-six secondary tracheoesophageal puncture (TEP) procedures were performed on 132 patients at the Cleveland Clinic Foundation in the past 10 years. The complications of these procedures are reviewed, along with assessment of potential risk factors such as irradiation, esophageal/hypopharyngeal stricture, alcoholism, diabetes, or chronic obstructive pulmonary disease. Among the subgroups studied, only stricture dilation was associated with an increased incidence of postsurgical complications. The majority of these, however, were immediate, and were probably related to the esophagoscopy or dilation itself. The incidence of TEP-related complications in all groups of patients may be higher than previously suspected.

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