title: Evaluation of Customized Prosthesis for Irregularly Formed Tracheostoma After Laryngectomy.
abstract: BACKGROUND
  After laryngectomy, the tracheostoma forms the functional center for breathing and phonation. An occasionally occurring but typical problem can arise from an oversized and/or irregularly formed tracheostoma, hampering the temporary occlusion necessary for sufficient speech production. As an alternative to a surgical correction of the tracheostoma, an individually adjusted stoma silicone prosthesis may be used.
  
  
  METHODS
  Twenty-one patients suffering from irregularly formed tracheostoma after laryngectomy followed by insertion of a speech valve were provided with a silicone tracheostomal prosthesis. They underwent subjective assessment of voice quality and breathing function according to a standardized general questionnaire and to the Voice Handicap Index (VHI). Furthermore, a clinical evaluation was performed including detection of peristomal leakage and phonation time.
  
  
  CONCLUSIONS
  Patients described a significant improvement of voice production with the tracheostomal prosthesis (averagely graded as 1.9 with and 3.2 without prosthesis, P = .0026). Breathing was also slightly improved by the prosthesis with an average grade of 1.7 compared to 2.3 with a conventional cannula (P = .063). There was a strong correlation between self-evaluation and the total score of the VHI after insertion of the prosthesis (P < .0001). Minor local skin reactions caused by the adhesive were described by 5 of the 21 patients.
  
  
  CONCLUSIONS
  A tracheostomal prosthesis represents an efficient alternative to surgical revision of irregularly formed tracheostoma after laryngectomy, enhancing voice production and breathing function.
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors: Johannes
authors: J
authors: Doescher
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Heinrich-Heine-University, Düsseldorf, Germany.
authors: Kathrin
authors: K
authors: Scheckenbach
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Heinrich-Heine-University, Düsseldorf, Germany.
authors: Wolfgang
authors: W
authors: Angerstein
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors: Johannes A
authors: JA
authors: Veit
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors: Simon
authors: S
authors: Laban
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors: Julia
authors: J
authors: Thierauf
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors: Marie-Nicole
authors: MN
authors: Theodoraki
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors: Jens
authors: J
authors: Greve
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors: Patrick J
authors: PJ
authors: Schuler
authors: Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany t.hoffmann@uniklinik-ulm.de.
authors: Thomas K
authors: TK
authors: Hoffmann
mesh_terms: D000368:Aged; D059026:Diagnostic Self Evaluation; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000534:rehabilitation*; D007831:Larynx, Artificial; D008297:Male; D008422:Materials Testing / Q000379:methods; D008875:Middle Aged; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D014139:Tracheostomy / Q000295:instrumentation / Q000379:methods / Q000534:rehabilitation; D016896:Treatment Outcome
keywords: Voice Handicap Index; laryngectomy; speech valve; tracheostomal prosthesis; voice quality