title: Does prosthesis diameter matter? The relationship between voice prosthesis diameter and complications.
abstract: OBJECTIVE
  To assess the impact of tracheoesophageal voice prosthesis diameter and treatment status on prosthesis-related complications.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  Single academic medical institution.
  
  
  METHODS
  Patients who underwent total laryngectomy (TL) between 1996 and 2008 were divided into 2 subgroups according to prosthesis diameter: 16F (n = 19) and 20/22F (n = 71). Each patient only used 1 diameter of prosthesis. Time to leakage through the prosthesis, number of episodes of leakage around the prosthesis, number of prosthesis dislodgements, and length changes after the first 6 months were chosen as outcomes of interest.
  
  
  RESULTS
  Analysis included 90 patients. Analysis of selected complications by prosthesis diameter revealed no significant differences for time to leakage through the prosthesis, number of leaks around the prosthesis, or dislodgement. Larger diameter prosthesis use was associated with a greater number of length changes (P = .008). Multivariable regression analysis did not find any significant association between prosthesis-specific complications and prosthesis diameter when controlling for other variables. Prior radiation was associated with an increased number of size changes (β = 2.0, P = .004) and a decrease in time to leakage through the prosthesis (β = -4.4, P = .048), after controlling for other variables.
  
  
  CONCLUSIONS
  Prosthesis diameter is not associated with an increased prevalence of certain voice prosthesis complications in laryngectomy patients, regardless of initial treatment modality, whereas prior radiation or chemoradiation is associated with complications. These data suggest that factors affecting tissue health, rather than prosthesis size, may be more responsible for prosthesis complications.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. hstarme1@jhmi.edu
authors.forename: Heather M
authors.initials: HM
authors.lastname: Starmer
authors.forename: Nishant
authors.initials: N
authors.lastname: Agrawal
authors.forename: Wayne
authors.initials: W
authors.lastname: Koch
authors.forename: Jeremy
authors.initials: J
authors.lastname: Richmon
authors.forename: Kimberly
authors.initials: K
authors.lastname: Webster
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007825:Laryngectomy; D007831:Larynx, Artificial / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011474:Prosthesis Design