Current status and future prospects in prosthetic voice rehabilitation following laryngectomy

Abstract

Total laryngectomy or laryngopharyngectomy remains the procedure of choice for advanced-stage (UICC T3 and T4) laryngeal carcinoma around the world despite advances in conservative laryngeal surgery and radiotherapy. However, it has profound effects on respiration and deglutition, in addition to the most disabling effect-the loss of verbal communication. Successful voice restoration can be attained with any of three speech options, namely esophageal speech, electrolarynx, and tracheoesophageal (TO) speech using an artificial valve. Although, no single method is considered the best for every patient, the tracheoesophageal puncture has become the preferred method in the past decade. Several types of voice prostheses have been produced since the first prosthesis was introduced in 1980 by Blom and Singer. However, eventually all prostheses are confronted by the same problem, i.e., the development of a biofilm, leading to deterioration and ultimately to dysfunction of the prostheses, necessitating replacement. This article attempts to sum up the historical background as well as the current state of surgical voice rehabilitation following laryngectomy; we review the recent major advances as well as the future prospects. Data was collected by conducting a computer-aided search of the MEDLINE and PubMed databases, supplemented by hand searches of key journals. Over 50 articles published in the last three decades on the topic have been reviewed, out of which about 20 were found to be of relevance for this article.

Post laryngectomy speech rehabilitation outcome in elderly patients

“…Nonetheless, even in this group of patients, the choice of the rehabilitation method that gives the best vocal result should point towards the voice prosthesis. In addition, considering that possible limits of use are only theoretical if the geriatric patients are found properly suitable as regards psychophysical conditions and motivation, which are the basis needed for obtaining rehabilitation success in tracheoesophageal recovery [13].…”

Effects of Neck Dissection and Radiotherapy on Short-Term Speech Success in Voice Prosthesis Restoration Patients

“…Voice restoration using a tracheoesophageal puncture (TEP) has become the current treatment of choice for postlaryngectomy speech rehabilitation. 1,3,4 A puncture between the posterior wall of the tracheostoma and the upper esophagus just below the cricopharyngeus is surgically created, and a voice prosthesis (VP) is inserted into the puncture. The VP is a one-way silicone valve that preserves the patency of the puncture and allows air to be shunted from trachea into the esophagus during expiration when the tracheostoma is externally occluded by the patient.…”

Functionalization of polydimethylsiloxane membranes to be used in the production of voice prostheses

“…However, indwelling prosthesis are meant to remain implanted for a long period of time [7], and one of the main problems associated with this type of prosthesis is biofilm formation, which eventually leads to dysfunction and the need for device replacement [8]. The high hydrophobicity of PDMSs has been pointed to as the main cause of adsorption of significant amounts of proteins from the surrounding biological environment, followed by microbial adhesion and biofilm formation [9].…”