Discussion | 249 11 Part 2: Rehabilitation after Total Laryngectomy After a TL, vocal rehabilitation is needed. In most Western countries, the use of a voice prosthesis is (VP) the gold standard23. VPs have been available since the 1980s and have been developed by Dr. Mark Singer and Dr. Eric Blom24. Modern prostheses, typically made of silicone, are essential tools for vocal rehabilitation post-laryngectomy. However, their limited lifespan remains a significant issue for patients. These devices require periodic replacement due to factors such as leakage, bacterial colonization, or mechanical wear25,26. The need for regular replacements can be burdensome for patients, as it requires frequent, unplanned, medical visits and procedures. Additionally, these replacements can be costly (if not reimbursed) and may lead to interruptions in speech. Variability in prosthesis lifespan across studies reflects differences in patient anatomy, lifestyle, and maintenance, which further complicates their management. This makes long-term rehabilitation challenging, highlighting the need for more durable, userfriendly prostheses. Chapter 7 highlights the challenges associated with prophylactic replacement of voice prostheses (VPs) in laryngectomized patients, revealing that such an approach is not feasible due to the high variability in device lifetime. While prophylactic replacement has been successful in other medical devices like pacemakers, the unpredictable nature of VP device lifetimes makes it impractical for routine application27. Despite the potential benefits of planned replacements in reducing unexpected VP leakages and improving patient quality of life, the study’s findings suggest that such a strategy would lead to increased clinic visits without clear benefits in preventing complications and a high frequency of needed visits. The results were so clearly unhelpful that, given the current VPs, further prospective investigation seems not to be recommended. Fortunately, new VPs are developed, as we investigated the Provox High Performance (PVHP), which was intended to be a more affordable VP (than the ActiValve) with a predictable and prolonged device lifetime (Chapter 8). The PVHP is made of silicon rubber with a fluoroplastic valve flap and valve seat, a material that resists biofilm destruction similar as in ActiValve28, but without the use of a valve magnet. Fluoroplastic is a sticky material, for which the use of a lubricant is needed to prevent blockage of speech29,30. While initial acceptance of the PVHP was relatively high, dropping to 40% after device replacement due to failures, key issues such as valve stickiness affecting speech were reported. Interestingly, despite objective assessments indicating no significant improvement in voice quality with the PVHP, half of the patients subjectively rated their voice quality and speaking effort better compared to their regular VP. This discrepancy
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