Longitudinal TEP Size Stability

Abstract

Objective: Tracheoesophageal speech rehabilitation is considered the gold standard after laryngectomy. Changes in size of the prosthesis are common in the early period after initial fitting. Size may be affected by factors over time necessitating continued assessment. This study will determine size stability in laryngectomized patients over a 5-year period.

Method: Individuals s/p total laryngectomy and TEP with a minimum 5-year follow-up will be accrued. Data will be derived from chart review including demographic, surgical, medical, and prosthesis factors by stability of size over time after the first three-month initial fitting phase.

Results: Thirty-seven patients, 32 males and 5 females, met the criteria and were included in the study. Mean age was 63.7 years (range, 41-78 years). Medical factors leading to total laryngectomy changed over the follow-up period with more recent patients only undergoing laryngectomy for either extremely advanced disease or recurrence versus persistent disease after chemo-radiation therapy. A total of 80% of patients required a change in the length and/or diameter of their prosthesis over the 5-year follow-up period regardless of other medical and surgical factors.

Conclusion: Clinicians need to continually reassess prosthesis fit for the life of the patient to prevent inadvertant closure of the posterior fistula tract from a prosthesis that is too short or pistoning resulting in aspiration from a prosthesis that is too long. This contrasts previous reports of stability after initial fitting.