Device Life of the Tracheoesophageal Voice Prosthesis Revisited

Abstract

Importance-Voice prosthesis (VP) device life is a limiting factor of tracheoesophageal (TE) voice restoration that drives patient satisfaction, health care costs, and overall burden. Historic data suggest that TE VPs have an average device life of generally 3 to 6 months, but these data are typically derived from small samples using only 1 or 2 devices.Objective-To reexamine current device life in a large, contemporary cancer hospital in the United States that uses a wide assortment of VPs. Main Outcomes and Measures-Tracheoesophageal voice-related outcomes were: (1) device life duration to VP removal, and (2) treatment-related and prosthetic-related factors influencing device failure. Primary independent variables included treatment history (extent of surgery and radiation history), VP type (indwelling vs nonindwelling, size, specialty features), and reason for removal (leakage, complication, other). Duration was examined using Kaplan-Meier analysis. Disease, treatment, and patient-specific factors were analyzed as predictors of duration.Results-Overall, 3648 VPs were placed in the 390 patients (median [range] age, 62 [34-92] years). Indwelling prostheses accounted for more than half (56%) of the devices placed (55%, 20-Fr diameter; 33%, 8-mm length). More than two-thirds (69%) of prostheses were removed because of leakage, while the rest were removed for other reasons. Median device life was 61 days for all prostheses. Indwelling and nonindwelling VPs had median device lives of 70 and 38 days, respectively. There was no significant difference between specialty prostheses compared with standard devices (median duration, 61 vs 70 days, respectively). The Provox ActiValve (Atos HHS Public AccessAuthor manuscript JAMA Otolaryngol Head Neck Surg. Author manuscript; available in PMC 2018 January 01. Conclusions and Relevance-Our data suggest that VP duration demonstrates a lower durability than historically reported. This may reflect the intensification of treatment regimens that complicate TEP management in an era of organ preservation; however, further investigation is needed.

Postlaryngectomy prosthetic voice rehabilitation outcomes in a consecutive cohort of 232 patients over a 13‐year period

“…15 The increasing number of TLs after prior (chemo)radiotherapy since 1990 (68% in the present study and 45% in our historical cohort 4 ), which has a profound effect on the TEPtract, seems a likely explanation for the shorter device lifetime found in our study population. However, just like in the study of Lewin et al 11 there was no significant effect of the extent of surgery or RT on device lifetime in the multivariable analysis. On the other hand, we did find an association with the indication for TL, with the primary TL patients having a longer device lifetime than salvage TL patients.…”

“…8 This has, however, also led to an increase in salvage TLs after failed (C)RT, which have been associated with more TE wall (TEP tract)-related problems and possibly a lower device lifetime of VPs. [9][10][11] In 2000, Op de Coul et al 4 published the long-term results of voice rehabilitation with the first Provox VPs in the Netherlands Cancer Institute. Since then, several new generations of VPs have been developed, aimed at improving patient comfort, by, for example, improving airflow characteristics and replacement tools (Provox Vega), and at reducing biofilm overgrowth or inadvertent opening of the valve during swallowing or breathing (Provox ActiValve).…”

Prosthetic Voice Rehabilitation Following Laryngectomy

“…In this issue of JAMA Otolaryngology-Head and Neck Surgery, Lewin et al 4 provide invaluable information on device life of TEPs in a cohort of 390 laryngectomized patients from a high-volume center over a 10-year period. Not only is this the largest series of its kind, but it is also a study that covers the crucial period after organ preservation protocols became popular and salvage TL more prevalent.…”

“…One can stop and quibble with Lewin et al 4 regarding technical points of TE prosthesis, such as primary or secondary TEP placement, the efficacy of 20F or 16F prostheses, and the effectiveness of in-operating room or in-office procedures. 7 Focusing on the technical fine points would seriously obscure the more important and salient issues of their study.…”

“…Recommendations for TEP placement should not be an afterthought. As Lewin et al 4 point out, proper patient counseling should incorporate information as to device longevity and the possible need to return for care to a treating institution which may be geographically distant.…”