title: Post-laryngectomy voice rehabilitation: comparison of primary and secondary tracheoesophageal puncture.
abstract: BACKGROUND
  Voice restoration following total laryngectomy is an important part of patients' rehabilitation and long-term quality of life.
  
  
  OBJECTIVE
  To evaluate the long-term outcome of indwelling voice prostheses inserted during (primary procedure) or after (secondary procedure) total laryngectomy.
  
  
  METHODS
  The study group included 90 patients who underwent total laryngectomy and tracheoesophageal puncture (TEP) with placement of voice prosthesis at a tertiary medical center during the period 1990-2008. Background, clinical and outcome data were collected by medical file review. Findings were compared between patients in whom TEP was performed as a primary or a secondary procedure.
  
  
  RESULTS
  TEP was performed as a primary procedure in 64 patients and a secondary procedure in 26. Corresponding rates of satisfactory voice rehabilitation were 84.4% and 88.5% respectively. There was no association of voice quality with either receipt of adjuvant radiation/chemoradiation or patient age. The average lifetime of the voice prosthesis was 4.2 months for primary TEP and 9.06 months for secondary TEP (P= 0.025).
  
  
  CONCLUSIONS
  Primary TEP provides almost immediate and satisfactory voice rehabilitation. However, it is associated with a significantly shorter average prosthesis lifetime than secondary TEP. Chemoradiotherapy and patient age do not affect voice quality with either procedure.
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors: Dan
authors: D
authors: Guttman
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors: Aviram
authors: A
authors: Mizrachi
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors: Tuvia
authors: T
authors: Hadar
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors: Gideon
authors: G
authors: Bachar
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors: Yaniv
authors: Y
authors: Hamzani
authors: Institute for Speech, Swallowing and Voice Rehabilitation, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors: Sari
authors: S
authors: Marx
authors: Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors: Jacob
authors: J
authors: Shvero
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery*; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods*; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D011677:Punctures; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014832:Voice Disorders / Q000534:rehabilitation*; D014833:Voice Quality; D055815:Young Adult