254 | Chapter 11 Considering the complexity of the challenges associated with VPs and HMEs, it’s imperative to explore innovative approaches for enhancing their performance and longevity. One avenue worth exploring is the development of advanced tracking mechanisms to monitor the lifespan of VPs. Simplifying the issue, we could envisage a solution where a specialized layer on the surface of the voice prosthesis undergoes a color change as bacterial and fungal growth accumulates. This visual cue could prompt patients to schedule a replacement appointment once the designated color threshold is reached. However, implementing such a solution poses considerable hurdles. Questions abound regarding the nature and sensitivity of this color-changing layer, its compatibility with diverse throat flora compositions, and the associated costs. While the concept is appealing in theory, practical implementation presents significant challenges. Patients must navigate the intricacies of detecting subtle color changes amidst mucus and crusts, thereby complicating the reliability of this method. Moreover, ensuring universal applicability across varying patient demographics further compounds the feasibility of this approach. Thus, while innovative, this concept may not offer a viable solution in its current form. But allow us to just think out loud. Does a VP need to be located in a patient’s throat? Wouldn’t it be possible to redesign the whole concept, and develop something that does not have to be located in such a vulnerable place? Perhaps a completely new approach to laryngectomy. Yes, the tumor needs to be removed and the airway needs to exit somewhere, but can’t we rethink the location and even the objective of the voice prosthesis itself? Or, can we create a new larynx for a patient? Consider the possibilities with 3D printing. I know it sounds far-fetched at this moment (and it is), but the internet was only just invented in 1969, and look where we are now! Or growing new limbs? There are, of course, many ethical considerations surrounding this, and I’m not sure if I’m for or against it, but the idea is quite interesting, right? Sea stars and some lizards can regrow limbs—could we try this for humans? As we redesign the whole concept of TL, hopefully HMEs won’t be necessary for patients either. But until then, maybe some easier solutions would help. There is already a reusable metal 3D-printed HME36. If we can design HMEs that fit patients’ airway resistance and make them adjustable for use during exercise, this would greatly benefit patients’ quality of life and, of course, adherence, and leading to fewer pulmonary complaints. As for CPET, at this moment, I think this is a bridge too far for many patients. We could definitely benefit from research that delves into the exercise responses of laryngectomized patients. This would make it possible to develop tailored exercise programs, especially since we have shown that exercise testing with gas exchange analysis is feasible using our 3D-printed adapter.
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