Selective patient experience with the Blom-Singer Dual Valve voice prosthesis.

OBJECTIVES/HYPOTHESIS: This study compares the overall durability, phonation effort, and speech quality achieved by the Blom-Singer Dual Valve prosthesis to the same characteristics achieved by the single-valve prosthesis used in a select population of total laryngectomy patients who have demonstrated single-valve prosthesis failure within 3 months of placement. STUDY DESIGN: Prospective phase IV study. METHODS: Fourteen patients who had previously experienced early valve failure using a single-valve prosthesis had a Dual Valve placed by a speech language pathologist. A total of seventeen Dual Valves were inserted during routine clinical visits for valve replacement. Time intervals from insertion to replacement of the Dual Valve, as well as the average lifespan of patients' three previous single valves were collected. Subjective, categorical responses to speech quality and phonation effort for the Dual Valve compared to the single valve were collected on a questionnaire upon failure of the device. RESULTS: The mean duration of the single valve was 60 days, with a median of 51 days, whereas the mean duration of the Dual Valve was 164 days, with a median duration of 84 days. Both sets of data were statistically significant, with a P value of .0131. Valve life was increased in 86% of patients, with 43% experiencing greater than 150 days improvement in valve duration when using the Dual Valve. Phonation effort was increased in 14% of patients, and speech quality was not significantly affected in any patients. CONCLUSIONS: In this select population, the Dual Valve offers improved durability over the single valve without sacrificing speech quality, making it a preferred prosthesis option for patients experiencing single-valve failure in less than 3 months. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:422-426, 2018.

Primary tracheoesophageal puncture in salvage laryngectomy patients.

OBJECTIVES/HYPOTHESIS: The purpose of this study was to determine the rate of complications in the immediate postoperative period following primary tracheoesophageal puncture (TEP) after salvage laryngectomy. STUDY DESIGN: Retrospective. METHODS: A retrospective review was done of 26 patients who underwent primary TEP with salvage total laryngectomy. To minimize variables, the patients included were operated on by a single surgeon and rehabilitated by a single speech-language pathologist. The outcomes evaluated were the frequency of leakage around the TEP, dehiscence of the stoma, dislodging of the prosthesis, pharyngocutaneous fistula, time to initiation of oral intake, and length of hospital stay. RESULTS: The mean age of the patients was 60.8 years (range, 41-78 years). Previous treatment consisted of radiotherapy in 14 patients and chemotherapy and radiation in 12. Tumor site was glottic in 12 patients, supraglottic in seven, subglottic in two, vallecula in three, and overlapping in two. The pharynx was repaired primarily in all patients and then reinforced with a pectoralis muscle flap in 13. Leakage around the TEP was observed in 4% of the cases. There were no instances of dislodging of the TEP, and six patients (23%) developed pharyngocutaneous fistula; 12% had a wound dehiscence but none were around the stoma. The average time to begin oral feeding was 5.7 days (standard deviation, 1.93), and the average hospital stay was 8.4 days (standard deviation, 1.93). CONCLUSIONS: Primary TEP in the setting of a salvage laryngectomy is associated with a low rate of complications. A pharyngocutaneous fistula occurred in 23% of the cases. LEVEL OF EVIDENCE: 4.

Verbal communication for the ventilator-dependent patient requiring an inflated tracheotomy tube cuff: A prospective, multicenter study on the Blom tracheotomy tube with speech inner cannula.

BACKGROUND: The purpose of this study was to present our findings on the impact of the Blom tracheotomy tube with speech inner cannula on voice production abilities and speech intelligibility scores of ventilator-dependent patients requiring a fully inflated tracheotomy tube cuff. METHODS: Prospective single group case-series design permitted consecutive accrual of 23 adult inpatients from acute care and rehabilitation settings. Maximum ambient room noise, voice intensity, phonation duration of vowel /a/, and speech intelligibility scores were determined over 3 sessions. RESULTS: All participants achieved audible voicing with the Blom tracheotomy tube. Voice intensity was significantly greater than ambient room noise by >10 dB SPL (p = .003). Speech intelligibility scores improved significantly from 80% to 85% (p = .03). Phonation duration averaged from 3.30 to 3.45 seconds. There were no significant changes in oxygen saturation (p > .05), and no significant complications occurred. CONCLUSION: The Blom tracheotomy tube with speech inner cannula permitted individuals requiring mechanical ventilation with a fully inflated tracheotomy tube cuff to produce excellent speech intelligibility for verbal communication. © 2012 Wiley Periodicals, Inc. Head Neck, 2013.