Early speech results with the Provox prosthesis after laryngectomy.
OBJECTIVE
To assess our initial success using the Provox (Atos Medical AB, Horby, Sweden, and Entermad BV, Woerden, the Netherlands) tracheoesophageal speaking valve as the primary prosthesis to rehabilitate patients after total laryngectomy and to compare our success and complication rates with those previously reported.


METHODS
A retrospective analysis of all the patients who had a Provox prosthesis placed from November 1994 to November 1995.


METHODS
Medical charts were reviewed for success or failure of the prosthesis as determined by the quality of speech and the utility of the device. In addition, complications, whether the patient had a pharyngeal myotomy and/or radiation, and the reasons and timing for replacement were assessed. Twenty-one patients had a Provox prosthesis placed either primarily at the time of their total laryngectomy (n = 8), delayed (n = 5), or as a replacement for another type of prosthesis (n = 8). Follow-up ranged from 2 to 17 months.


RESULTS
The initial success rate was 84%, and the long-term success rate was 74%. Of note, 3 patients had substantially improved speech and none were worse when changed from another type of prosthesis. The mean interval to prosthesis change was 166 days. Reasons for failure included infection, radiation fibrosis, manual incoordination, cerebrovascular accident, and combination of total laryngectomy and total glossectomy. The most common complication (in 2 patients) was retraction of the prosthesis into the esophagus that was successfully managed by replacement with a longer device.


CONCLUSIONS
Our early results confirm the effectiveness, longevity, and safety of the Provox prosthesis for speech rehabilitation following total laryngectomy.
Aust
M R
MR
Department of Otorhinolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minn, USA.
McCaffrey
T V
TV
D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000209:etiology; D004947:Esophagus; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000209:etiology; D005927:Glossectomy / Q000009:adverse effects; D006801:Humans; D007825:Laryngectomy / Q000534:rehabilitation*; D007831:Larynx, Artificial / Q000009:adverse effects; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D010614:Pharynx / Q000528:radiation effects / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011832:Radiation Injuries / Q000209:etiology; D012189:Retrospective Studies; D012449:Safety; D013065:Speech Intelligibility; D013071:Speech, Alaryngeal; D013530:Surgical Wound Infection / Q000209:etiology; D017211:Treatment Failure; D016896:Treatment Outcome