Long-term results of VoiceMaster voice prosthesis use in laryngectomized patients

OBJECTIVE: To report on the long-term results, focusing on prosthesis lifetime, achieved with the VoiceMaster prosthesis in an outpatient population. MATERIAL AND METHODS: The VoiceMaster prosthesis was used over a 40-month period. Average prosthesis lifetimes were calculated both individually and for the group as a whole. Factors determining prosthesis insertion were noted. Also, the possible effect of interim prosthesis cleaning and reinsertion of the same device, a specific VoiceMaster characteristic, was assessed. RESULTS: An average prosthesis lifetime of 6.5 months was attained for the whole patient group and several devices were still in situ at the end of the 40-month period. Local factors (tracheostoma size, fistula position and characteristics) influence insertion. Interim cleaning with immediate reinsertion of the device can greatly enhance prosthesis lifetime on an individual basis. CONCLUSIONS: The attained average prosthesis lifetime demonstrates that the VoiceMaster merits a place within the array of available prostheses used in post-laryngectomy outpatient voice rehabilitation.     

Microbial colonization of silicone voice prostheses used in laryngectomized patients

The aim of this study was to identify the microbial colonization of dysfunctioning voice prostheses in laryngectomized patients and determine the influence of patient radiation therapy on prosthesis life span. In a 40-month period, 257 outpatient voice prosthesis replacements were carried out in a laryngectomized group of 31 patients. The voice prostheses were all removed from the tracheo-oesophageal fistula after dysfunctioning of the prosthesis. Of the replaced prostheses 183 were cultured. The microbial cultures showed a predominant colonization with Candida albicans and commensal oral microflora. Radiation therapy induced xerostomia shortened the lifetime of the first inserted prosthesis in particular.     

The VoiceMaster voice prosthesis for the laryngectomized patient

Since the introduction and performance of total laryngectomy, voice restoration has become an important issue. Voice prostheses are widely used for this purpose. Based on experience with previous and current prostheses, the important characteristics for any voice prosthesis can be defined. These characteristics are: indwelling fixation, low resistance to airflow, less bothersome and easier insertion into the tracheoesophageal (TE) fistula. Also, predictable long device life span (resistance to Candida deterioration) and easy removal of the prosthesis to allow inspection or cleaning and consequent re-insertion are desirable. The VoiceMaster voice prosthesis was developed with these characteristics in mind. The VoiceMaster prosthesis is described in this paper. The first results from the preliminary study in which the currently available VoiceMaster was tested are very encouraging.     

下咽癌全喉切除术后内脏器官代食管发声

目的 总结因晚期下咽癌、行全喉、全下咽及全食管切除，胃或结肠代食管术后患者，在发声训练康复中的经验。方法 报告晚期下咽癌患者２０例（胃代食管１３例，结肠代食管６例，空肠代食管１例）。术后利用内脏器官代食管进行发声康复训练。结果 １９例获得了消化道发音语言。结论 胃或结肠代食管术的患者能够利用消化道进行语言重建；与食管发声相比较，它有着进气容易，并能较快学会发基本音，成功率较高等优点，但音质较食管发     

Microbial colonization of silicone voice prostheses used in laryngectomized patients.

The aim of this study was to identify the microbial colonization of dysfunctioning voice prostheses in laryngectomized patients and determine the influence of patient radiation therapy on prosthesis life span. In a 40-month period, 257 outpatient voice prosthesis replacements were carried out in a laryngectomized group of 31 patients. The voice prostheses were all removed from the tracheo-oesophageal fistula after dysfunctioning of the prosthesis. Of the replaced prostheses 183 were cultured. The microbial cultures showed a predominant colonization with Candida albicans and commensal oral microflora. Radiation therapy induced xerostomia shortened the lifetime of the first inserted prosthesis in particular.     

The influence of radiotherapy on the lifetime of silicone rubber voice prostheses in laryngectomized patients

OBJECTIVES: To establish a relationship between voice prosthetic lifetime in laryngectomized patients and the irradiation dose applied to the neck node levels (field of the neck) in which the major salivary glands are partially included. Furthermore, a possible relationship between voice prosthetic lifetime and the irradiation dose applied to the primary tumor site was studied. STUDY DESIGN: A retrospective analysis was performed on 101 patients after laryngectomy. METHODS: The records of 101 patients who underwent total laryngectomy between January 1993 and November 1999 at the Department of Otorhinolaryngology, University Hospital Groningen, The Netherlands, were analyzed. The following parameters were obtained: age, sex, radiotherapy, radiation fields, irradiation dose per field, tumor site, TNM classification, and valve insertion. RESULTS: Irradiation to extensive neck fields, including the submandibular glands, did not influence the voice prosthetic lifetime after laryngectomy. However, primary tumor doses exceeding 60 Gray significantly shortened the mean voice prosthetic lifetime per patient. CONCLUSIONS: This study identified an association between radiation on the primary tumor site with a dose equal to or more than 60 Gray and limited lifetimes of voice prostheses.     

The influence of early speech rehabilitation with voice prostheses on the psychological state of laryngectomized patients

This survey assessed how early speech rehabilitation influences the emotional state and psychological adjustment of 43 male laryngectomy patients, at three different chronological stages. The first assessment occurred 2–3 days before the operation. The patients filled out a stress questionnaire (SVF) which assessed coping strategies. Exactly 2 weeks after the operation the patients were given a list of adjectives (EWL) which measured their actual emotional state. One day before leaving the hospital the patients were given the Post-laryngectomy Telephone Test (PLTT) which ascertained the quality of speech intelligibility. In addition, patients filled out a questionnaire on postoperative stress and anticipated stigmatisation with regard to their changed voice. Results demonstrated that patients who had early speech rehabilitation felt significantly more active and, in general, felt considerably better than patients who had not received speech rehabilitation training. Patients assessed voice loss as extremely distressing. The postoperative stress and the anticipated stigmatisation on the basis of the changed voice was significantly higher in those patients with good speech intelligibility than in patients with poor speech articulation at hospital discharge. The coping strategies “Giving up and resignation” and “Need for social support” correlated positively with postoperative stress and anticipated stigmatisation. Results show that early speech rehabilitation with voice prostheses had a positive effect on the emotional state of laryngectomy patients. However, the early speech rehabilitation leads to distress in the initial phase in laryngectomy patients. Moreover, patients who habitually tend towards resignation, or need lots of social support should receive psychological support during the early phase of speech rehabilitation training. Received: 27 April 2001 / Accepted: 5 July 2001     

Microbial colonization of Blom-Singer indwelling voice prostheses in laryngectomized patients: a perspective from India

We analyzed a series of adults with an implanted voice prosthesis that had malfunctioned and required removal as a result of the attachment and growth of microorganisms. Our goal was to determine the characteristics of these colonizing microbes. We swabbed the esophageal side of each prosthesis to obtain microbial flora for analysis with standard culture media. In all, we studied 22 prostheses in 18 patients (3 patients had received multiple prostheses). We found mixed contamination (both yeast and bacteria) in 19 of the 22 cultures (86.4%); the other 3 cultures yielded bacteria only, and there was no instance of yeast only. The most common yeast isolated was Candida albicans (68.2% of cultures), and the most common bacterium was Pseudomonas aeruginosa (63.6%). The average lifetime of the prostheses was 201 days (～6 mo, 3 wk). This study, which was the first of its kind in India, revealed that the microbial picture here was different from that found in previously reported studies of European populations. We presume the differences are attributable to different lifestyles and dietary habits.     

The comprehensively oriented complex rehabilitation of laryngectomized patients

We report 14 patients who took part in a specially designed comprehensive rehabilitation programme for the laryngectomee. Our results clearly indicate that it is only possible to carry out such a project successfully if there is intensive communication between all participants in the programme, including the patient and his/her partner.     

下咽癌全喉切除术后内脏器官代食管发声

目的总结因晚期下咽癌，行全喉、全下咽及全食管切除，胃或结肠代食管术后患者，在发声训练康复中的经验。方法报告晚期下咽癌患者２０例（胃代食管１３例，结肠代食管６例，空肠代食管１例）。术后利用内脏器官代食管进行发声康复训练。结果１９例获得了消化道发音语言。结论胃或结肠代食管术的患者能够利用消化道进行语言重建；与食管发声相比较，它有着进气容易、并能较快学会发基本音、成功率较高等优点；但音质较食管发声者差，声时较短。     

A questionnaire to assess olfactory rehabilitation for laryngectomized patients (Provox voice prosthesis users) in Japan

Objective

We used a questionnaire to investigate olfactory function and the present state of olfactory rehabilitation for laryngectomized patients in Japan.

The concept of comprehensively oriented rehabilitation of laryngectomized patients

A comprehensive rehabilitation program for laryngectomized patients is presented, consisting of close cooperation between the ENT clinic, phoniatric department and post-operative reconvalescent institution. Four main points are emphasized: (1) rehabilitation with both the oesophageal voice and the vibrator voice; (2) involvement of the patient's partner in the whole rehabilitation program, including participation in the 4-week stay in a post-operative reconvalescent institution; (3) information for the employer about the special needs of a laryngectomee; (4) contact with the regional branch of the laryngectomees' association.     

Cochlear implantation of solid organ transplant patients receiving immunosuppressive therapy

ObjectiveTo evaluate the incidence of infectious complications and healing problems in cochlear implant (CI) patients receiving immunosuppressive therapy following solid organ transplant.Study designIRB-approved retrospective chart review of implanted patients.SettingTertiary care children's hospital.MethodsSeven patients of the more than 1000 implanted during the time period between 1991 and 2014 underwent cochlear implantation while on immunosuppressive therapy after having received a solid organ transplant. Their charts were reviewed for demographic and medical information pre- and post-implantation. The 4 males and 3 females ranged in age at CI from 2.4 to 18.8 years, with a mean of 9.0 years. Postimplant follow-up averaged 3.9 years (range: 0.1–13.1). Main outcome measures were occurrence of wound healing, infectious complications, whether open-set word recognition was achieved, and communication mode(s).ResultsNo wound infections or delayed healing, mastoiditis, or bacterial meningitis occurred after cochlear implantation. All seven patients had received at least one pneumococcal vaccination prior to implantation. Five of 6 (83%) developed open-set speech perception, of whom 4 (67%) use only oral communication.ConclusionIn our series of patients receiving immunosuppressive therapy following solid organ transplantation, none developed wound healing or infectious complications after cochlear implantation. History of solid organ transplantation alone should not be a contraindication to cochlear implant candidacy which would deprive the child of the potential benefits of hearing, including language development.     

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，