Vocal Rehabilitation after Total Laryngectomy: Provox Tracheoesophgeal Speech Valve Experience

George L. Charpied, M.S., C.C.C.-S.L.P.
Director, The Center for Voice & Swallow Disorders

Gregory A. Grillone, M.D., F.A.C.S., Vice-Chairman

Robert W. Dolan, M.D., F.A.C.S.,
Director, Lahey Clinic, Burlington, MA

Abstract:

Surgical efforts to provide voice production after total laryngectomy has had varying degrees of success. Tracheoesophageal speech with valve prosthesis has become an important method of voice rehabilitation with refinements such as the Blom-Singer Duckbill tracheoesophageal prosthesis and the Panje button prosthesis worldwide.

We report here, data collected from three years experience in our department on complication rates, device lifetime, replacement maintenance procedures, cost, and the efficacy of the Provox prosthesis when compared with the Blom-Singer voice prosthesis.

Subjects included 11 males (mean age = 60) and three females (mean age = 54). Primary and secondary valve placement procedures were considered. The time interval for secondary procedure placement of tracheoesophageal speech valve ranged from four to 24 months (mean = 14 months). In all except one case, patients underwent total laryngectomy with unilateral or bilateral neck dissection and radiation therapy for treatment of laryngeal carcinoma.

The single most common complication for the Blom-Singer was extrusion or accidental removal (85%), followed by improper length or French size (62%), valve leakage (38%) due to clogging, improper valve orientation, or poor maintenance. For the Provox, extrusion and improper sizing fell to zero percent and valve leakage was 15%. Speech and acoustic data revealed functional voices in all but one patient.

The Provox produced better results for durability, ease of maintenance, reduced strain when speaking and voicing characteristics. In our experience prosthetic shunt tracheoesophageal speech is the preferred method of voice rehabilitation. Based on its 'near' normal intelligibility and fluency and shallow learning curve, the Provox was clearly the superior device.