title: The Effect of Initial Tracheoesophageal Voice Prosthesis Size on Postoperative Complications and Voice Outcomes.
abstract: OBJECTIVE
  The optimal initial size of tracheoesophageal voice prosthesis (TEVP) for tracheoesophageal voice restoration (TEVR) remains unclear. As purported advantages exist favoring the placement of both 16F and 20F prostheses, this study compares complications and voicing outcomes after placement of 16 and 20 French (F) prostheses.
  
  
  METHODS
  All cases of TEVR at an academic medical center were retrospectively reviewed (2007-2013). Complications including dislodgement, leakage, infection, and granulation tissue were compared. Outcomes including frequency of prosthesis change, acquisition of speech, and time to fluent speech were compared.
  
  
  RESULTS
  Of 47 patients, 25 received 20F prostheses, and 22 received 16F. Postoperative complications were similar between groups, including leakage around the prosthesis (P = .373) and aspiration pneumonia (P = .670). There were no significant differences in timing of voicing or ability to achieve fluency. Although the 20F group appeared to undergo fewer prostheses changes per year (3.0 vs 5.3) and had a longer duration of use before first prosthesis change (76 vs 43 days), neither difference was found to be statistically significant.
  
  
  CONCLUSIONS
  Voice restoration was successfully achieved using either 16F or 20F prostheses. Prosthesis diameter did not significantly affect complications or voicing. Both prostheses may be placed with safety and efficacy, allowing the practitioner to choose based on the potential individual benefits of either device.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Matthew_Naunheim@meei.harvard.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Naunheim
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Remenschneider
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Scangas
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Glenn W
authors.initials: GW
authors.lastname: Bunting
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Deschler
mesh_terms: D000368:Aged; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006097:Granulation Tissue; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery; D007825:Laryngectomy / Q000534:rehabilitation*; D007831:Larynx, Artificial; D008297:Male; D011015:Pneumonia, Aspiration / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D017755:Prosthesis Fitting; D019919:Prosthesis Implantation; D016459:Prosthesis-Related Infections / Q000453:epidemiology*; D011677:Punctures; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome; D014831:Voice; D014833:Voice Quality
keywords: TEP; TEVR; total laryngectomy; tracheoesophageal puncture; voice prosthesis; voice restoration