title: The management of periprosthetic leakage in the presence of supra-oesophageal reflux after prosthetic voice rehabilitation.
abstract: The objective of the study was to investigate the influence of anti-reflux medications on the management of periprosthetic leakage in laryngectomised patients with prosthetic voice rehabilitation. Sixty patients underwent laryngectomy and prosthetic voice rehabilitation. In a prospective non-randomised study, we examined the patients clinically and assessed the presence of reflux disease using 24-h dual-probe pH monitoring before and 6 months after oral anti-reflux treatment with proton pump inhibitors (PPIs). The severity of reflux, the effectiveness of anti-reflux therapy, and the clinical success of treatment were evaluated. Reflux parameters before and after anti-reflux therapy as well as the severity and incidence of periprosthetic leakage before and after PPI therapy were the main outcome measures. The absolute number of reflux events was 162.2 (±144.3) before treatment and 63.1 (±87.9) after treatment with PPIs (p = 0.031). The reflex area index score decreased from 327.1 (±419.3) without PPIs to 123.8 (±249.7) with PPIs (p = 0.0228). The mean DeMeester score was 108.3 (±85.4) before treatment and 47.4 (±61.7) after 6 months of treatment (p = 0.0557). The relative risk of periprosthetic leakage decreased to 0.5 after anti-reflux treatment. In 19 patients, leakage problems were successfully managed by rigorous treatment with PPIs. No further surgical procedures were required in these cases. Rigorous anti-reflux treatment leads to an improvement in parameters that can be assessed objectively by 24-h dual-probe pH monitoring. In the majority of patients, the symptoms associated with periprosthetic leakage can be improved or cured.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany. kai.lorenz@extern.uni-ulm.de
authors.forename: Kai J
authors.initials: KJ
authors.lastname: Lorenz
authors.forename: L
authors.initials: L
authors.lastname: Grieser
authors.forename: T
authors.initials: T
authors.lastname: Ehrhart
authors.forename: H
authors.initials: H
authors.lastname: Maier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007825:Laryngectomy; D007831:Larynx, Artificial / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000473:pathology / Q000628:therapy
chemical_list: D054328:Proton Pump Inhibitors