title: A decade of postlaryngectomy vocal rehabilitation in 318 patients: a single Institution's experience with consistent application of provox indwelling voice prostheses.
abstract: OBJECTIVE
  To assess long-term results with consistent use of indwelling voice prostheses (Provox; Atos Medical AB, Hörby, Sweden) for vocal rehabilitation after total laryngectomy.
  
  
  METHODS
  Retrospective clinical analysis.
  
  
  METHODS
  Comprehensive national cancer center.
  
  
  METHODS
  Three hundred eighteen patients (261 men and 57 women; mean age, 62 years) from November 1988, through May 1999.
  
  
  METHODS
  Standard wide-field total laryngectomy (287 patients) or total laryngectomy with circumferential pharyngeal resection (31 patients), and 2700 prosthesis replacements. Prostheses remained in situ during 364,339 days (1000 patient-years).
  
  
  METHODS
  Device lifetime, indications for replacement (device or fistula related), adverse events, and voice quality.
  
  
  RESULTS
  Median patient-device follow-up was 67 months. Mean actuarial device lifetime for all indications for replacement was 163 days (median, 89 days). Main indications for replacement were device-related, ie, leakage through the prosthesis (73%) and obstruction (4%), or fistula-related, ie, leakage around the prosthesis (13%), and hypertrophy and/or infection of the fistula (7%). Adverse events occurred in 11% of all replacements in one third of the patients, mostly solvable by a shrinkage period, or adequate sizing and/or antibiotic treatment. Definitive closure of the tracheoesophageal fistula tract occurred in 5% of the patients. Significant clinical factors for increased device lifetime were no radiotherapy (P =.03), and age older than 70 years (P<.02). Success rate with respect to voice quality (ie, fair to excellent rating) was 88%, which was significantly influenced by the extent of surgery (P<.001).
  
  
  CONCLUSIONS
  The consistent use of indwelling voice prostheses shows a high success rate of prosthetic vocal rehabilitation, in terms of the percentage of long-term users (95%), and of a fair-to-excellent voice quality (88% of patients).
authors.affiliation: Department of Otolaryngology, the Netherlands Cancer Institute, Plesmanlaan 1221, 1066 CS Amsterdam, The Netherlands. fhilg@nki.nl
authors.forename: B M
authors.initials: BM
authors.lastname: Op de Coul
authors.forename: F J
authors.initials: FJ
authors.lastname: Hilgers
authors.forename: A J
authors.initials: AJ
authors.lastname: Balm
authors.forename: I B
authors.initials: IB
authors.lastname: Tan
authors.forename: F J
authors.initials: FJ
authors.lastname: van den Hoogen
authors.forename: H
authors.initials: H
authors.lastname: van Tinteren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014833:Voice Quality