Voice rehabilitation with Provox2 voice prosthesis following total laryngectomy for laryngeal and hypopharyngeal carcinoma.
OBJECTIVE
To analyze the effectiveness of the Provox2 voice prosthesis for voice rehabilitation following total laryngectomy.


METHODS
From September 2000 to December 2004, the Provox2 voice prosthesis was used for voice rehabilitation in 32 patients following total laryngectomy. The quality of speech with the Provox2 voice prosthesis was analyzed using the HRS rating scale, the maximum phonation time (MPT), incidence of complications and the in situ lifetime. The rate of speech restoration was further analyzed in 129 patients with total laryngectomy from 1996 to 2004.


RESULTS
Twenty-nine of 32 patients were able to restore speech using the Provox2 voice prosthesis, a speech restoration rate of 90.6%. The maximum phonation time (MPT) was measured in 18 patients using the Provox2 voice prosthesis. The mean MPT was 15.1 s, with a range of 8-28 s. MPT was not influenced by age, concurrent radiotherapy treatment, the location of the primary tumor or use of reconstructive surgery. The average lifetime of the Provox2 in patients with laryngeal carcinoma (12 patients) and hypopharyngeal carcinoma (17 patients) was 27.2 and 16.6 weeks, respectively, which was significantly different (P=0.024, non-parametric Mann-Whitney's U-test). The rate of speech restoration by the use of esophageal speech, and insertion of an artificial larynx was 62.7% for laryngeal carcinoma (59 cases) and 38.6% for hypopharyngeal carcinoma (70 cases), which was also significantly different (P<0.01, chi-square test).


CONCLUSIONS
Provox2 voice prosthesis speech was very useful due to the higher rate of speech restoration, longer phonatory time, and better intelligibility. It was also thought that voice prosthesis speech was useful in conjunction with esophageal speech and an artificial larynx depending on the patient's condition or wishes.
Terada
Tomonori
T
Department of Otolaryngology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo 663-8501, Japan. t-terada@hyo-med.ac.jp
Saeki
Nobuo
N
Toh
Kunichika
K
Uwa
Nobuhiro
N
Sagawa
Kosuke
K
Takayasu
Sadamu
S
Sakagami
Masafumi
M
D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D007583:Jejunum / Q000637:transplantation; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation; D013065:Speech Intelligibility; D013068:Speech Production Measurement; D013071:Speech, Alaryngeal; D013072:Speech, Esophageal; D013524:Surgical Flaps; D013997:Time Factors; D014832:Voice Disorders / Q000534:rehabilitation*; D014834:Voice Training