Summary | 263 12 a preventive replacement schedule is challenging. Mathematical simulations indicated that preventing 70% of leaks through prophylactic replacement is not feasible, suggesting this strategy is not viable due to the high variability in VP lifespans. Chapter 8 tests the new Provox Vega High Performance (PVHP) voice prosthesis, designed for longer and more predictable lifespans. We assessed patient acceptance, adverse events, voice quality, and device lifespan. Patients who previously used a Provox Vega or ActiValve Light were evaluated over two weeks. Of the fifteen participants, 87% accepted the PVHP after two weeks, but this dropped to 40% after leakage. The median lifespan of the prostheses was 64 days. Voice quality did not differ between the PVHP and standard prostheses. The most reported adverse event was valve stickiness (46%). Acceptance of a new VP strongly depends on its lifespan, which remains a challenge. In Chapter 9, the feasibility of maximal cardiopulmonary exercise testing (CPET) in patients after laryngectomy with an HME in situ was assessed, using a specially designed connector. We also examined the effect of different HME resistances on exercise capacity in this group. Ten participants underwent two CPETs with their daily HME (with different resistance levels) and one specifically developed for activity (very low resistance), with the order randomized and blinded. All participants completed both tests without adverse events. Only four participants reached a Respiratory Exchange Ratio (RER) >1.1 in at least one test. Maximum exercise levels did not differ with HMEs of varying resistance. Although CPET with an HME is feasible, the protocol does not seem suitable to reach the group’s maximal exercise capacity, and lowering HME resistance does not increase exercise capacity in this cohort. Chapter 10 shares the inspiring story of a laryngectomy patient who, despite the major surgery, relearned to sing and play guitar. After his total laryngectomy, the patient began voice rehabilitation and quickly mastered tracheoesophageal speech and handsfree speaking. His passion for singing led to the creation of a YouTube channel where he shares videos of himself singing Dutch songs and French chansons. This story demonstrates that singing after a total laryngectomy can improve respiratory function and voice quality, enhancing patients’ quality of life and self-confidence. It highlights the value of music and singing as rehabilitation tools and sources of joy. In Chapter 11, all the aforementioned chapters are discussed and contextualized. The dissertation aims to improve head and neck cancer care by exploring shared decisionmaking (SDM) and various aspects of rehabilitation after TL.
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