Prophylactic Replacement of Voice Prosthesis | 175 7 Introduction In most Western countries, the most successful technique for voice restoration after Total Laryngectomy (TL) is tracheoesophageal (TE) prosthetic speech1. The most commonly used voice prostheses (VPs) are indwelling VPs, which can be categorized as regular and problem-solving VPs. Regular VPs are the most commonly used for laryngectomized patients. In case of frequent short device lifetimes the so called problem-solving VPs are indicated. Regular VPs are expected to have a median lifetime ranging from 2 to 6 months2,3. Soolsma et al. showed that problem-solving VPs have a 16-fold longer device lifetime than regular VPs (median device lifetime 337 days)4. The main reason for VP replacements is transprosthetic leakage (55-80%), followed by periprosthetic leakage (5-30%) 5–8. The frequent replacements significantly impact the patient quality of life, causing insecurity and unplanned hospital visits and costs. 9. The standard policy for replacements is Wait-to-Leakage (WtL), but possibly the replacements can be planned to prevent leakage (prophylactic replacement). The principle of prophylactic replacement has been used in pacemaker users for years. This has given pacemaker users the security of a continuously working device 10,11. The device lifetime of pacemakers depends on the battery. The device lifetime of VPs depends on many more aspects such as the ability of a patient to clean the VP properly, type of VP, biofilm formation, shrinking TEP, hypertrophy, infection, etc. But also distance to the hospital, voice problems, diet, having a partner, country of origin have been found to be related to device lifetime3,12–18. The aim of the present study was to explore the possibility of prophylactic voice prosthesis replacement (PVPR) by predicting VP lifetime and calculating the needed number of VPs when applying PVPR using these predictions.
RkJQdWJsaXNoZXIy MTk4NDMw