title: Secondary tracheoesophageal puncture: factors predictive of voice quality and prosthesis use.
abstract: OBJECTIVE
  To identify factors predicting prosthesis use and final speech quality in patients undergoing secondary tracheoesophageal puncture (TEP) for voice restoration alter laryngectomy.
  
  
  METHODS
  We undertook a retrospective study of 168 patients who underwent secondary TEP at the Cleveland Clinic between June 1980 and October 1993. Factors examined were: patient demographics, extent of initial surgery, method of pharyngeal preparation, history of irradiation, insufflation test results, pharyngeal stricture, and concurrent medical conditions. Univariate and multivariate statistical analyses were performed to identify predictive factors.
  
  
  RESULTS
  At last evaluation, 73.8% (124) of the patients were still using the prosthesis. Quality of speech was the only predictor of prosthesis use (p < .001). Phonation on the first day was achieved in 90% (151) of patients. Speech result improved significantly over the first 6 months (p < .001). Univariate analysis found that the need for reconstruction at laryngectomy (p = .04), the presence of pharyngeal stricture (p = .001), and continued prosthetic use (p < .001) were associated with the speech result. There was no significant advantage to the lack of approximation of the pharyngeal constrictors (p = .31). Stepwise logistic regression showed that only the absence of pharyngeal stricture was associated with a better-quality voice (p = .001).
  
  
  CONCLUSIONS
  Tracheoesophageal puncture is a reliable method for restoring voice after laryngectomy. Prosthesis use decreases with time, and good voice quality is the only predictor of continued prosthesis use. In this series the absence of pharyngeal stricture was the only significant predictor of good to excellent speech.
authors.affiliation: Department of Otolaryngology & Communicative Disorders, Cleveland Clinic Foundation, OH 44195, USA.
authors.forename: P
authors.initials: P
authors.lastname: Lavertu
authors.forename: M E
authors.initials: ME
authors.lastname: Guay
authors.forename: S S
authors.initials: SS
authors.lastname: Meeker
authors.forename: J R
authors.initials: JR
authors.lastname: Kmiecik
authors.forename: M
authors.initials: M
authors.lastname: Secic
authors.forename: J R
authors.initials: JR
authors.lastname: Wanamaker
authors.forename: I
authors.initials: I
authors.lastname: Eliachar
authors.forename: B G
authors.initials: BG
authors.lastname: Wood
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000379:methods; D007831:Larynx, Artificial / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D014832:Voice Disorders / Q000534:rehabilitation* / Q000601:surgery; D014833:Voice Quality