title: [Causes and indwelling times of multiple voice prosthesis replacements in patients after total laryngectomy--analysis of 184 replacements in 42 patients].
abstract: BACKGROUND
  Implantation of the indwelling voice prosthesis has become the preferred method of voice rehabilitation after total laryngectomy. Frequent prosthesis dysfunction remains the major problem.
  
  
  OBJECTIVE
  Analysis of the indwelling time and indications for multiple voice prosthesis replacements.
  
  
  METHODS
  Forty two patients after total laryngectomy due to laryngeal cancer (6 women and 36 men, mean age 62.1 ± 6.7 years) were included. 184 voice prosthesis replacements were analyzed (1271 patient-months).
  
  
  RESULTS
  Mean time between replacements was 260 ± 150 days. The indwelling time decreased from 267 days to the first replacement to 100-160 days at eighth and subsequent exchanges (p < 0.01). Most frequent indications for replacement were leakage of fluids through the prosthesis, phonation problems caused by mucosal overgrowth around the prosthesis, inaccurate sizing, deformation, and spontaneous extrusion. The lifetime of voice prostheses was positively correlated with patients' age. Mycological culture of the smear taken from tracheoesophageal fistula at first replacement was positive in 34/41 cases, at the second in 29/31 cases, the third in 29/31, and at the fourth and subsequent replacements in all specimens. Most patients indicated the following factors as possible causes of a shortened lifetime of the prosthesis: use of alcohol and coffee (34% of responders), inappropriate dietary habits (sweets and tough foodstuff - 17%), cleaning of voice prosthesis discordant with the recommendations of the manufacturer (14%).
  
  
  CONCLUSIONS
  Although our results confirm common indications for voice prosthesis replacement we also showed that the time between exchanges is gradually getting shorter. This observation could have implications for the current reimbursement practices.
authors.affiliation: Klinika Chirurgii Nowotworów Głowy i Szyi, II Katedra Otolaryngologii Uniwersytetu Medycznego w Łodzi, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Zimmer-Nowicka
authors.forename: Alina
authors.initials: A
authors.lastname: Morawiec-Sztandera
mesh_terms: D019544:Equipment Failure Analysis / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000628:therapy; D007825:Laryngectomy / Q000534:rehabilitation*; D007831:Larynx, Artificial / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011044:Poland; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000191:economics / Q000534:rehabilitation; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014833:Voice Quality