[Tracheostoma valve with integrated cough lid for improvement of hands-free speech in laryngectomees - long term results].
BACKGROUND
Tracheostoma valves for laryngectomized patients were introduced to enable the laryngectomee after successful surgical voice restoration either by a voice prosthesis, a surgical shunt or microvascular laryngoplasty, to speak without using his fingers to close the tracheostoma. The basic principle of these aids is a mobile valve, which closes automatically at a certain air flow, directing the expired air of the lungs into the pharynx. In spite of the clear advantage of enabling a hands-free speech, the long term acceptance rate is still rather low, which is mainly caused by problems of an airtight fixation within or at the tracheostoma. Another important disadvantage of these tracheostoma valves is the necessity of removing the valve during coughing. The new tracheostoma valve "Window" (ADEVA Company, Lübeck, Germany) offers a clear improvement regarding this point. It is constructed with an additional coughing lid, which opens at a certain airflow and closes automatically after the coughing attack. After successful development and clinical testing of the new aid in 1999 and 2000, it was now the question, if the previously low acceptance rate of tracheostoma valves could be improved in the long term use by this new type of valve.


METHODS
Within the last 4 years 70 patients were provided with the "Window" tracheostoma valve. Patients were followed up at regular intervals in order to evaluate the function, the acceptance and the durability of the new device. Additional to the clinical examination patients had to fill in a questionnaire in order to investigate the subjective estimation by each patient himself. 15 patients did not send back their questionnaire or did not fill it in correctly, 5 patients refused clinical supervision after adjustment of the device, so finally the long term use in 50 patients could be analysed.


RESULTS
82 % of the patients reported, that the coughing lid worked safely and opened immediately during the coughing attack. Most of the patients were satisfied with their device, but had nevertheless some proposals for a further improvement: although they cover the tracheostoma either with their clothes or a protection scarf, most of the patients would prefer a device which is smaller than the current model. Some patients reported on an insufficient stability of the plastic material, which led to a defect at the sliding mechanism of the coughing lid. The greatest problem regarding the regular use of the valve was - comparable to conventional tracheostoma valves - the occurrence of an air leakage around the tracheostoma. Although there are three different models of the "Window" tracheostoma valve available, only patients being fitted with the "standard-T-type" version could wear the device 10 hours a day or longer without any problems of air leakage.


CONCLUSIONS
The "Window" tracheostoma valve with an integrated coughing lid provides further improvement in speech rehabilitation of laryngectomees. The actual rate of acceptance of 62 % for all "Window" patients (1 month daily use for at least 2 hours) is superior to other reports on the use of tracheostoma valves and probably caused by the additional comfort provided by the coughing lid. Another important factor for the long term use of tracheostoma valves is however the safe fixation of the device in or around the tracheostoma. In this point further improvement is necessary, as only the model with the fixation within the trachea (T-type) led to a satisfactory long term airtight fixation.
Schwarz
Ch
Ch
Klinik für Hals-Nasen-Ohrenheilkunde, Plastische Operationen, Katharinenhospital Stuttgart. christophe.schwarz@t-online.de
Cirugeda-Kühnert
M
M
Hagen
R
R
D003371:Cough / Q000503:physiopathology*; D005500:Follow-Up Studies; D006801:Humans; D007825:Laryngectomy / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D013071:Speech, Alaryngeal / Q000295:instrumentation*; D013524:Surgical Flaps; D013525:Surgical Instruments; D014139:Tracheostomy / Q000295:instrumentation*