title: Tracheoesophageal speech in a developing world community.
abstract: OBJECTIVE
  To determine the tracheoesophageal speech results in a Third World medical practice; to examine the impact of socioeconomic status, literacy, and proximity to specialist services on tracheoesophageal speech; to assess whether these factors should affect patient selection for fistula speech; and to determine guidelines for voice prosthesis selection.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Groote Schuur Hospital, Cape Town, South Africa, which serves a Third World community.
  
  
  METHODS
  Ninety-seven consecutive patients who underwent total laryngectomy between January 1, 1996, and October 1, 1998. Patients who undergo total laryngectomy routinely have a primary tracheoesophageal fistula created for speech.
  
  
  METHODS
  Speech outcomes after total laryngectomy; tracheoesophageal speech in relation to social class, literacy, and proximity to specialist services; and experience with removable and indwelling valves.
  
  
  RESULTS
  Fifty-nine (81%) of 73 patients acquired useful speech. Speech outcome was not affected by employment status or proximity to specialist services. Although speech was affected by literacy and housing, several illiterate shack dwellers acquired good speech. Average device life of removable prostheses was 16 weeks (>4 months in 35% [64/183]). Indwelling prostheses had an average life of 28 weeks.
  
  
  CONCLUSIONS
  Tracheoesophageal speech results in a Third World community equate with those in the Developed World. All patients who undergo laryngectomy and have adequate manual dexterity and cognitive function should be given a trial of fistula speech. Removable voice prostheses can successfully be used as indwelling prostheses.
authors.affiliation: Department of Otolaryngology, University of Cape Town School of Medicine, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa. fagan@iafrica.com
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Fagan
authors.forename: Roslyn
authors.initials: R
authors.lastname: Lentin
authors.forename: Manuel F
authors.initials: MF
authors.lastname: Oyarzabal
authors.forename: Sedick
authors.initials: S
authors.lastname: Isaacs
authors.forename: Sean L
authors.initials: SL
authors.lastname: Sellars
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D007825:Laryngectomy; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012923:Social Class; D013019:South Africa; D013072:Speech, Esophageal; D016896:Treatment Outcome