Improved Outcomes in Primary Prosthesis Placement during Tracheoesophageal Puncture

Abstract

Objective: Tracheoesophageal prosthesis facilitates esophageal speech in postlaryngectomy patients. The vocal prosthesis can be placed either during tracheoesophageal puncture (TEP) or, more commonly, in a delayed fashion. Our objectives were to: 1) analyze the voice outcomes and 2) compare the pain and emergency care, following primary versus delayed prosthesis placement.

Method: A 2011 cohort study. A tracheoesophageal puncture occurred in conjunction with, or within 3 months of, total laryngectomy. Nine patients underwent primary and 11 patients underwent delayed prosthesis placement. The primary outcome was voice production at the first postoperative appointment. Secondary outcomes included pain and perioperative emergency room visits.

Results: All patients (100%) with prostheses placed at the time of the TEP had voice production at the first postoperative clinic visit, in comparison to only 45% (5/11) of patients with prostheses placed in delayed fashion. Significant pain with vocalization occurred in zero primary placement prosthesis patients, but in 55% (6/11) of delayed placement prosthesis patients. Only one primary placement prosthesis patient (11%) sought emergency medical care related to their stoma or voice prosthesis versus 7 (64%) delayed placement prosthesis patients.

Conclusion: Primary prosthesis placement during TEP has significantly improved voice and quality of life outcomes with earlier voice production, reduced postoperative pain and the virtual elimination of perioperative emergency room visits. This significant modification of the standard technique represents a highly successful and cost-effective approach to vocal rehabilitation in post-laryngectomy patients.