A new low-resistance, self-retaining prosthesis (Provox) for voice rehabilitation after total laryngectomy

Prosthetic rehabilitation of voice after total laryngectomy has gained wide acceptance in the last 10 years. Several reliable voice prostheses have been developed and used successfully. Priorities for further development of the methods and instruments for prosthetic voice rehabilitation have led to the design of a low-resistance, self-retaining voice prosthesis (Provox) and an adapted replacement method. The results obtained in 79 patients are described. In vivo airflow resistance ranged from 1.0 to 3.8 kPa (mean = 1.9 kPa). Speech quality was good in 91% of the patients. The self-retaining properties of the prosthesis appeared to be satisfactory. The average device-life was more than 5 months. Replacement of the prosthesis with a new disposable guide wire was done quickly as an outpatient procedure. Maintenance of the prosthesis by the patient was simple. The new low-resistance, self-retaining Provox voice prosthesis and the modified replacement method appeared to further improve the results of prosthetic voice rehabilitation after total laryngectomy.     

Voice rehabilitation after total laryngectomy using the Provox voice prosthesis

Esophageal speech is the first choice for vocal rehabilitation in laryngectomized patients. However, shunt speech is a needed alternative for patients who cannot succeed at esophageal speech. Many kinds of voice prostheses, with good results, have been reported. Provox was selected for 15 laryngectomized patients who were treated in our department. Voice rehabilitation was successful in 13 patients. However, removal of the prosthesis was required in one patient because of stomal stenosis. Voice rehabilitation was not successful in one patient who exhibited esophageal stenosis. The rate of voice rehabilitation was not influenced by the extent of surgery, the dose of radiation, etc.. The maximum phonation time was more than 10 minutes in the 13 patients who succeeded at shunt speech. Prosthetic rehabilitation was requested by two patients who had been successful at esophageal speech. These results suggest that prosthetic voice rehabilitation may be indicated for a wide range of conditions.     

Vocal rehabilitation after total laryngectomy using the Provox voice prosthesis

Vocal rehabilitation in laryngectomized patients can be attained by surgical (tracheoesophageal speech) or conservative methods (oesophageal speech or artificial larynx). We prospectively studied voice restoration in 37 patients who underwent total laryngectomy in the period from February 1991 to February 1993. The patients were given the opportunity to assess both non-shunt oesophageal speech and shunt oesophageal speech using the Provox voice prosthesis. The Provox low resistance, self-retaining voice prosthesis is a biflanged device made of silicon rubber. A primary tracheoesophageal puncture was made in 28 patients, while a secondary puncture was performed in another nine patients. The results were assessed according to criteria established at the ‘Third International Congress on Voice Prosthesis’ in Groningen (1988). Functional tracheoesophageal speech after primary puncture was achieved in 95% of patients 12 months after puncture, while oesophageal voice was acquired by 55%. Only minor surgical and prosthesis-related complications were encountered during this follow-up period in 29% of the patients. The device lifetime varied from 3 months to at least 2 years (mean 5.4 months).     

Voice rehabilitation after laryngectomy with the Provox voice prosthesis in South Africa

A study was undertaken to determine whether the Provox voice prosthesis provides good voice rehabilitation following a total laryngectomy in the urban, suburban and rural populations served by a tertiary referral hospital in South Africa. Between 1995 and 1999, a cohort of 128 patients at Tygerberg Hospital was rehabilitated with the Provox voice prosthesis after laryngectomy. In 104 patients primary placement of the prosthesis was done at the time of the laryngectomy. Mean device life and adverse events were determined. Voice quality was assessed subjectively in 104 patients and objectively in 26 patients. The mean device life was 303 days and adverse events occurred in 16 patients. Subjectively, 77 of 104 patients had a good voice, and objectively 22 of 26 patients had good voice intelligibility. The Provox voice prosthesis provides good voice rehabilitation following total laryngectomy, with minimal complications, in the population served by Tygerberg Hospital.     

Voice restoration and long-term progress in voice rehabilitation using the Provox2 voice prosthesis after total laryngectomy

From January 2000 to December 2008, we conducted voice rehabilitation using the Provox2 voice prosthesis total-laryngectomy subjects. Of these, 36 attained restoration of 90.0%. Mean maximum phonation time (MPT) was 14.5s, ranging from MPT was not influenced by age, radiotherapy use, primary tumor site, or reconstructive surgery use. Voice prosthesis replacement averaged 25 weeks (5.8 months), ranging from 9 to 74 weeks. Complications occurred in 16 caces (40.0%), mainly granulation tissue formation and prosthesis-site infection, also aspiration pneumonia, prosthesis-site salivary leakage, inability to replace the prosthesis, tracheomalacia, bodies in the trachea. Management rather than medical problems included cost, frequent hospital visits, and lack of motivation to use a prosthesis. The Provox2 voice prosthesis speech provides a higher rate of speech restoration, longer phonatory better intelligibility. Management problems, however, require that we work to understand subjects' living environments and family situations better for evaluating Provox2 voice prosthesis indication more effectively.     

Voice rehabilitation with Provox2 voice prosthesis following total laryngectomy for laryngeal and hypopharyngeal carcinoma

OBJECTIVE: To analyze the effectiveness of the Provox2 voice prosthesis for voice rehabilitation following total laryngectomy. METHODS: From September 2000 to December 2004, the Provox2 voice prosthesis was used for voice rehabilitation in 32 patients following total laryngectomy. The quality of speech with the Provox2 voice prosthesis was analyzed using the HRS rating scale, the maximum phonation time (MPT), incidence of complications and the in situ lifetime. The rate of speech restoration was further analyzed in 129 patients with total laryngectomy from 1996 to 2004. RESULT: Twenty-nine of 32 patients were able to restore speech using the Provox2 voice prosthesis, a speech restoration rate of 90.6%. The maximum phonation time (MPT) was measured in 18 patients using the Provox2 voice prosthesis. The mean MPT was 15.1 s, with a range of 8-28 s. MPT was not influenced by age, concurrent radiotherapy treatment, the location of the primary tumor or use of reconstructive surgery. The average lifetime of the Provox2 in patients with laryngeal carcinoma (12 patients) and hypopharyngeal carcinoma (17 patients) was 27.2 and 16.6 weeks, respectively, which was significantly different (P=0.024, non-parametric Mann-Whitney's U-test). The rate of speech restoration by the use of esophageal speech, and insertion of an artificial larynx was 62.7% for laryngeal carcinoma (59 cases) and 38.6% for hypopharyngeal carcinoma (70 cases), which was also significantly different (P<0.01, chi-square test). CONCLUSION: Provox2 voice prosthesis speech was very useful due to the higher rate of speech restoration, longer phonatory time, and better intelligibility. It was also thought that voice prosthesis speech was useful in conjunction with esophageal speech and an artificial larynx depending on the patient's condition or wishes.     

A new prosthesis for voice rehabilitation after laryngectomy

Summary Since the first laryngectomy, several surgical and prosthetic techniques have been developed in order to restore voice. Problems encountered with these techniques include: Leakage through the tracheoesophageal fistula, spontaneous closure of the fistula, dislodgement of the prosthesis, and the use of adhesives for fixation. We now introduce a new silicone voice prosthesis that overcomes these problems. The prosthesis is easily inserted as a one-stage procedure during total laryngectomy. Successful acquisition of voice was achieved in 30 of 33 patients, irrespective of preoperative or postoperative radiotherapy. Average device life proved to be approximately 100 days. The high rate of success with minimal morbidity merits further investigation of this one-stage voice rehabilitation technique.     

Groningen prosthesis for voice rehabilitation after laryngectomy

Singer and Blom's endoscopic technique, using a single valved silicone prosthesis, constituted a dramatic advance in speech rehabilitation following total laryngectomy. Since 1980, we have developed a silicone biflanged prosthesis that overcomes some of the inconveniences of previous prostheses. Insertion via the mouth and the oesophagus, or as a primary procedure during total laryngectomy is easily done with the use of specially developed instruments. The success rate in 36 patients in which the voice button was inserted at the time of total laryngectomy was 86.2%.     

The use of the vocal prosthesis Provox 2 for speech rehabilitation after total laryngectomy

The authors have presented the application and usage the alloplastic vocal prosthesis Provox 2 to serve for rehabilitation speech after total laryngectomy. Surgical technique of implantation of vocal prosthesis was discussed. The authors estimated in 6 patients following parameters of speech; fundamental frequency, maximum phonation time of vowel "a", maximum intensity and degree of dysphonia. In all 6 cases post-operative course was uncomplicated. Above mentioned parameters of voice were measured in order to comparison quality of oesophageal speech to tracheo - oesophageal speech. The authors assessed speech at 6 patients with voice prosthesis and 6 with good oesophageal speakers as a control group. The results of our investigations showed, that quality of tracheo - esophageal speech obtained with usage vocal prosthesis Provox 2 is more like normal speech than oesophageal speech. Social efficiency and quality of tracheo - oesophageal voice is better than oesophageal voice.     

Quality of life for patients after laryngectomy and surgical voice rehabilitation. Experience with the Provox prosthesis

BACKGROUND: Our study included 52 patients who received follow-up care after laryngectomy; a Provox I prosthesis was used for voice rehabilitation. METHODS: The EORTC Quality of Life Questionnaire was used to assess the postoperative quality of life of these patients with voice prostheses. RESULTS: Of the patients, 36.1% complained of a lack of energy, and 22% experienced sadness suggesting a reactive depression. Of the 55.6% of patients who expressed satisfaction with managing their disease, more than two-thirds were afraid of a potential deterioration of their health. More than 90% of the patients received extensive support from family and friends. As many as 52.8% expressed themselves satisfied with their current life, which is perhaps attributable to the successful rehabilitation of their voice. Eating problems, i.e., varying degrees of dysphagia as a result of treatment, were experienced by 47.3% of the patients. CONCLUSIONS: After the laryngectomy, 11% continue to smoke and 46% regularly consume alcohol. For this reason, rehabilitation measures should place more emphasis on patient education and on programs designed to help patients stop smoking and drinking alcohol.     

Voice rehabilitation after total laryngectomy using the Newvox voice prosthesis

OBJECTIVES: To evaluate the anatomy, as well as the probability of restoring voice (study of the methods of vocal recovery) with the Newvox voice prosthesis. MATERIAL AND METHODS: This study relates to 225 patients having undergone a total laryngectomy and a Newvox voice prosthesis (one or more prosthesis) between April 1979 and November 2003. All the cases were followed up for 2 years. During evolution the complications were noted. All the valves removed were sent for microbiological analysis, including culture. The Statistical Analysis were carried out on the cohort of patients defined as having benefited from one or more voice prostheses after undergoing total laryngectomy. The lifespan of the implants has been described by the median duration (corresponding to the duration above which 50% of the implants lasted) the first quartile (corresponding to the duration above which 75% of the implants lasted) and the third quartile (corresponding to the duration above which 25% of the implants lasted). RESULTS: No infection by candida albicans was found. Complete removal of the Newvox voice prosthesis for local problems was necessary only in 20 cases (8.9% of the cases). The general lifespan (on 225 patients) of the 1st implant corresponded to a median of 252 days (8.4 months) with a first quartile of 452 days (1.2 year). The statistical analysis of the lifespan of the Newvox voice prosthesis made it possible to study the impact of radiotherapy on the quality of the results. The time to onset of satisfactory phonation was studied: The general median (time above which includes 50% of the patients) was three weeks. After two weeks, 25% of the patients obtain a satisfactory voice. CONCLUSION: On the whole, out of 185 documented cases, a satisfactory voice was obtained in 84% of patients, either by the voice prosthesis or by oesophageal voice. The absence of infection by candida albicans of the Newvox voice prosthesis is one of the factors which probably account for it being so well tolerated and having a significantly longer lifespan compared with other prostheses.     

Conversion from a non-indwelling to a Provox2 indwelling voice prosthesis for speech rehabilitation: comparison of voice quality and patient preference

This prospective study assessed the advantages and problems associated with converting a patient using an older generation non-indwelling voice prosthesis to a newer generation indwelling voice prosthesis, in this case the Provox2. The voice characteristics of each patient were measured using the old and then the new voice prosthesis. Technical aspects of the insertion of the indwelling prosthesis were noted. Each patient completed a questionnaire after a period of use with the indwelling prosthesis. Changing the prosthesis was simple and uncomplicated in 15 of 17 patients. Acoustic analysis showed improved parameters with the indwelling prosthesis, but no perceptual difference between the two prostheses. The questionnaire revealed that most patients preferred the indwelling prosthesis. Replacing a non-indwelling with an indwelling prosthesis is technically simple, leading to improvement in voice quality and patient satisfaction. It may be reasonable to offer this choice to patients currently using an older generation non-indwelling voice prosthesis.     

The indwelling voice prosthesis for speech rehabilitation after total laryngectomy: a safe approach

Primary prosthetic voice restoration by performing tracheoesophageal puncture (TEP) and immediate insertion of a voice prosthesis at the time of total laryngectomy (TLE) is presently the method of choice. This enables the easiest and most comfortable voice rehabilitation with the patient still under general anesthesia when the first prosthesis is inserted. Reconstruction of the pharynx with e.g. free revascularized or pedicled flaps does not preclude surgical prosthetic voice restoration. The TEP can even be done as a primary procedure after total laryngectomy and total pharyngectomy when the full circumference of the neopharynx has to be reconstructed, provided the esophagus is still present at the level of the trachea. Since indwelling devices may have a more robust construction, their device-life generally is longer than that of their non-indwelling counterparts. Indwelling devices have the unique advantage in that patient's dexterity plays a lesser role in the daily maintenance of the device. With a few refinements in the surgery of TLE several postlaryngectomy problems can be avoided or diminished such as hypertonicity of the pharyngoesophageal (PE) segment and a poor contour of the stoma. The combination of Heat and Moisture Exchanger (HME) and indwelling voice prosthesis contributes to a significant improvement of both pulmonary function and voice quality. The solution of the majority of prosthesis and TE-fistula related problems by the well trained physician, make prosthetic voice restoration a safe procedure.     

双瓣式发音钮全喉切除术后发音重建

为解决无喉者发音问题，从１９９３年３月￣１９９６年１１月，利用自行研制的双瓣式喉发音钮及安装器为全喉切除术后患者应用９７例，其中男８４例，女１３例，年龄３５岁￣７８岁，全喉切除术后１期安装２０例，Ⅱ期安装７７例，效果满意，患者均能清晰说话，语言流利，地方语言特色明显，部分患者能唱歌，随防观察：在发音钮有效使用时间（１￣２年）内，配戴满２年者６８例，发音有效率１００％，误咽率为零。该发音钮具有安装，