Tracheoesophageal speech: Predictors of success and social validity ratings

Influence of timing, radiation, and reconstruction on complications and speech outcomes with tracheoesophageal puncture

“…As reported in several other studies, there was no significant difference in success rate (as measured by TEP use or fluency) between patients who received radiation and those who did not . Although it was not statistically significant, all patients who did not receive radiation were fluent and using their TEPs, similar to favorable patient outcomes reported by Silverman and Black and Cantu et al in this patient population.…”

“…In 1980, Singer and Blom first described the current method of TEP with insertion of a 1‐way valve prosthesis as a secondary procedure after the patient recovered from their surgery. Numerous studies have since shown that performing TEP as a primary procedure at the time of total laryngectomy is safe and affords faster acquisition of speech compared to secondary TEP . Other advantages of primary TEP include avoiding a second procedure and the potential to use the TEP site for enteral feeding access perioperatively.…”

“…Reports of tracheoesophageal speech success and the occurrence of complications are not always clear. Many retrospective studies demonstrate similar complication rates between primary and secondary TEP, whereas others show increased major complication rates among patients receiving secondary TEP . However, the comparison of primary to secondary TEP is often confounded by patient selection, as many clinicians choose to delay the TEP procedure in patients with extended pharyngeal reconstruction and/or a history of radiotherapy.…”

Contemporary Review: Impact of primary neopharyngoplasty on acoustic characteristics of alaryngeal tracheoesophageal voice

“…The quality of voice cannot be controlled; it is usually harsh, often loses its sexual characterization, and should not be compared with preoperative voice quality. In a study by Cantu et al,29 one third of patients judged the success of their T‐E speech at a lower level than the primary investigator did. This finding indicates that the clinician and patient may be using different standards of success; the patient and significant other may be using an idealized voice standard that cannot be produced using T‐E puncture.…”

Preoperative evaluation for tracheoesophageal voice restoration

“…Other medical factors that preclude rapid development of esophageal and TE speech may occur unpredictably as the result of surgical ablation (eg, stricture) or not become apparent until the postoperative period (eg, hypertonicity), complicating the ability to predict the eventual success of esophageal or TE speech. This uncertainty is confirmed by several studies that have found various predictors of immediate or eventual TE speech success to be only modestly reliable [12][13][14]. Thus, the clinician faces the challenge of offering sound medical advice based on a thorough preoperative assessment, coupled with encouragement and reassurance, in the absence of any certainties regarding cure of disease or eventual recovery of speech.…”