title: Changing trends of speech outcomes after total laryngectomy in the 21st century: a single-center study.
abstract: OBJECTIVE
  To describe the speech rehabilitation outcomes of patients undergoing total laryngectomy (TL) in the 21st century.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Tertiary academic center
  
  
  METHODS
  Retrospective review of 167 patients who underwent TL from June 2000 to February 2012. Demographics, disease variables, and surgical factors were reviewed. Primary alaryngeal speech modality, speech outcome, and tracheoesophageal puncture (TEP) complication rates were assessed.
  
  
  RESULTS
  Overall TEP speech success rate (primary or secondary) was 72%. Overall TEP speech success rate was 76% for those with primary TEP and was 68% for those with secondary TEP. TEP speech success rates at first, second, and beyond second year were 75%, 72%, and 70%, respectively. Success rates for primary TL, salvage TL, primary TL with pharyngeal reconstruction, or salvage TL with pharyngeal reconstruction groups were 71%, 72%, 73%, and 71%, respectively. TEP-related complications occurred in 43% of patients, with no difference in complication rates between primary versus salvage TL or primary versus secondary TEP. For those with complications, TEP success rate was 65%.
  
  
  CONCLUSIONS
  This study showed TEP speech-outcome success rates lower than what has been historically reported. There was no significant difference in TEP speech outcome between primary versus salvage TL or primary versus secondary TEP. Patients with TEP-related complications had TEP speech-outcome success rates comparable to those without any complication. TEP may continue to be a superior option as a mode of speech in patients with TL, including those undergoing salvage TL.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.
authors.forename: Seo
authors.initials: S
authors.lastname: Moon
authors.forename: Francesca
authors.initials: F
authors.lastname: Raffa
authors.forename: Rosemary
authors.initials: R
authors.lastname: Ojo
authors.forename: Mario A
authors.initials: MA
authors.lastname: Landera
authors.forename: Donald T
authors.initials: DT
authors.lastname: Weed
authors.forename: Zouka
authors.initials: Z
authors.lastname: Sargi
authors.forename: Donna
authors.initials: D
authors.lastname: Lundy
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004947:Esophagus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods*; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011677:Punctures / Q000379:methods*; D012189:Retrospective Studies; D013065:Speech Intelligibility; D013068:Speech Production Measurement; D013070:Speech Therapy; D013071:Speech, Alaryngeal; D013524:Surgical Flaps / Q000098:blood supply*; D062606:Tertiary Care Centers; D014132:Trachea / Q000601:surgery; D016896:Treatment Outcome
keywords: Total laryngectomy; electrolarynx; esophageal speech; speech rehabilitation; tracheoesophageal puncture