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Objective/Hypothesis: Tracheoesophageal diversion (TED) can prevent damage to the respiratory system in patients with swallowing disorders and/or repetitive aspiration pneumonia; however, TED may cause the loss of phonation. Our previous study demonstrated that TED with tracheoesophageal puncture (TEP) prevents aspiration while retaining phonation. In this study, we aimed to further evaluate the feeding status and phonation of patients who underwent TED with TEP to verify the reproducibility of this procedure. Study Design: Case series study. Methods: We retrospectively reviewed the medical records of 11 patients who underwent TED with TEP for intractable aspiration from February 2017 to August 2019 at Fukuoka Sanno Hospital. We evaluated the preoperative penetration aspiration score (PPAS), daily activities, preoperative and postoperative food intake level scale (FILS) score, nutrition route, maximum phonation time(MPT), and postoperative communication method. Results: The study population included 10 men and 1 woman (mean age, 66 years; range, 44–81) with a PPAS of 6.8 ± 1.0. The FILS score changed from 2.1 ± 0.5 preoperatively to 7.5 ± 2.0 postoperatively (paired t‐test, P <.05), while the MPT changed from 7.9 ± 4.1 to 10.3 ± 4.2 s (paired t‐test, P =.9). Preoperatively, a gastric fistula (eight patients [73%]) was the main nutrition route, followed by a gastric tube (two patients [18%]). Postoperatively, the main nutritional route for eight patients (73%) was oral, while the remaining three patients (27%) used the oral route occasionally. All patients maintained laryngeal phonation function, and eight (73%) used only laryngeal phonation for communication. Conclusions: Patients with intractable aspiration who wish to retain phonatory function should be advised to undergo TED with TEP. Level of Evidence: 4 Laryngoscope, 131:E1965–E1970, 2021 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Tracheoesophageal puncture (TEP) can be performed at the time of laryngectomy (primary) or postoperatively (secondary). Prior studies demonstrate safe and earlier voice acquisition and rehabilitation with primary TEP. The objectives of this study were to assess national trends in primary TEP and identify factors associated with its use.Study Design: Retrospective review.Methods: Retrospective analysis of the Nationwide Inpatient Sample (NIS) from 2010 to 2014 was performed. The NIS was queried for patients who underwent total laryngectomy (TL) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] 30.3-30.4) and primary TEP (ICD-9-CM 31.95). Patient demographics, comorbidities, and factors known to influence the decision to perform TEP were characterized. Factors associated with primary TEP were identified by multivariable regression.Results: A total of 15,410 patients underwent TL during the study period. Of this cohort, 1,124 patients (7.3%) underwent primary TEP. Among patients who underwent primary TEP, 80.9% had laryngeal cancer, 16.4% had pedicled or free-flap reconstruction at the time of TL, 4.2% underwent partial pharyngectomy, and 48.0% underwent cricopharyngeal myotomy (CPM). The majority of primary TEPs were performed at urban teaching hospitals (90.6%). In multivariable regression, patients who underwent CPM were at significantly increased odds of primary TEP (odds ratio: 3.79, P < .0001). Flap reconstruction, partial pharyngectomy, age, gender, history of laryngeal cancer, hospital region, and teaching status were not associated.Conclusions: Primary TEP is associated with earlier voice restoration after TL but is infrequently performed. The majority of primary TEPs are performed in teaching hospitals, and primary TEP is associated with concurrent cricopharyngeal myotomy. Future studies should investigate practice patterns associated with primary TEP.Level Of Evidence: 4. Laryngoscope, 128:2320-2325, 2018. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To describe the speech rehabilitation outcomes of patients undergoing total laryngectomy (TL) in the 21st century. Study Design Retrospective chart review. Setting Tertiary academic center Subjects and Methods Retrospective review of 167 patients who underwent TL from June 2000 to February 2012. Demographics, disease variables, and surgical factors were reviewed. Primary alaryngeal speech modality, speech outcome, and tracheoesophageal puncture (TEP) complication rates were assessed. Results Overall TEP speech success rate (primary or secondary) was 72%. Overall TEP speech success rate was 76% for those with primary TEP and was 68% for those with secondary TEP. TEP speech success rates at first, second, and beyond second year were 75%, 72%, and 70%, respectively. Success rates for primary TL, salvage TL, primary TL with pharyngeal reconstruction, or salvage TL with pharyngeal reconstruction groups were 71%, 72%, 73%, and 71%, respectively. TEP-related complications occurred in 43% of patients, with no difference in complication rates between primary versus salvage TL or primary versus secondary TEP. For those with complications, TEP success rate was 65%. Conclusion This study showed TEP speech-outcome success rates lower than what has been historically reported. There was no significant difference in TEP speech outcome between primary versus salvage TL or primary versus secondary TEP. Patients with TEP-related complications had TEP speech-outcome success rates comparable to those without any complication. TEP may continue to be a superior option as a mode of speech in patients with TL, including those undergoing salvage TL. Level of Evidence 4. Laryngoscope, 124:2508-2512, 2014 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To evaluate the indications, complications, and device life of the Provox NiD in a large cohort at a tertiary US cancer center. Study Design Longitudinal retrospective cohort study. Methods We reviewed the records of patients who used the NiD prosthesis (2005-2011) for general indicators, device life, and complications. Results One hundred eighty-six patients who used the NiD were included (median follow-up: 21.4 months). The NiD was placed at initial fit in 41 (22%) patients, whereas 145 (78%) tried an NiD after using another type of prosthesis. Most patients used the NiD similarly to an indwelling device. Median NiD device life was significantly longer than that of other nonindwelling prostheses (45 vs. 29 days, P = .0061), and did not significantly differ from that of standard indwelling devices (45 vs. 50 days, P = .4263). Thirty-eight percent (71 of 189) of NiD users had a history of early leakage (<8 weeks) using a different prosthesis before trying the NiD. Among patients with a pre-existing history of early leakage, almost 90% of NiD prostheses outperformed the device life of other products. Conclusions The NiD prosthesis offers satisfactory device life on a par with indwelling prostheses in our cohort of NiD users. Coupled with favorable published airflow characteristics and satisfactory tracheoesophageal voice, these data suggest that the NiD offers a durable, low-cost prosthetic alternative in contemporary practice. A unique indication for NiD may be improved device life in some patients with a history of early leakage. Level of Evidence 4. Laryngoscope, 124:1585-1591, 2014 [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Customization of the tracheoesophageal (TE) voice prosthesis (VP) is often preferred over surgical closure to prevent aspiration around the VP in laryngectomized patients with an enlarged tracheoesophageal puncture (TEP), but it has not been thoroughly evaluated. Study Design: Single-institution prospective trial. Methods: A prospective trial was conducted to evaluate the effectiveness of a customized VP with the addition of an enlarged tracheal and/or esophageal collar in patients with leakage around an enlarged TEP. Absence of leakage around the VP after placement defined immediate effectiveness. Long-term success was defined by the prevention of adverse events related to leakage during the study period. Events that defined failure included: permanent gastrostomy dependence, aspiration pneumonia, and/or surgical TEP closure. Results: Twenty-one patients with enlarged TEP were enrolled (2003-2006). Insertion of a customized VP was unsuccessful in one patient; 145 customizations were performed in the remaining 20 patients (median, 3.5 customizations) during the trial period. Of the customizations, 77% (112/145) prevented leakage immediately after VP insertion. The most common adverse event was dislodgement of the prosthesis (11%) or the collar alone (7%) in 18% (26/145) of customized VP placements. Six patients who died of disease were not evaluable for long-term outcomes. Long-term success was achieved in 80% (12/15) of evaluable patients who avoided permanent gastrostomy, aspiration pneumonia, and surgical TEP closure. Conclusions: Prosthetic customization offers an effective method to prevent leakage around the VP in many patients with an enlarged TEP, thereby preserving TE voice while avoiding surgical closure in this high-risk population. [ABSTRACT FROM AUTHOR]

Objectives: Secondary tracheoesophageal (TE) puncture standardly involves placement of a catheter at time of TE fistula creation. We explore the feasibility of placement of the prosthesis at the time of TE puncture (TEP) obviating the need for a subsequent procedure to place the prosthesis. We describe the technique and evaluate the success and potential advantages. Study Design: Retrospective chart review of consecutive patients who underwent TE prosthesis placement at the time of secondary TEP from 3/2009 to 1/2011. Methods: Fourteen patients underwent the primary TE prosthesis placement at the time of secondary puncture and were evaluated. Assessed outcomes included patient demographics, success of prosthesis placement, need for repeat procedure, early or late prosthesis dislodgement, complications, and specific voice outcomes. Results: Patient cohort included nine males, five females, with average age of 64 years. All TE prosthesis placements were successful. The 12-mm 20 F Blom-Singer Indwelling prosthesis was used in all cases. No complications occurred during prosthesis placement. Two perioperative complications occurred: one case of transient pulmonary edema from general anesthesia, one case of posterior tracheal wall swelling. The second was addressed with placement of a larger prosthesis. All patients successfully achieved good voice at an average of 4 days after the procedure (range: 1-9 days). Conclusions: This initial series of 14 consecutive patients demonstrates successful TE prosthesis placement at the time of secondary TE puncture. Functional voice was achieved in all patients with no significant immediate complications. No dislodgements occurred and no repeat procedures were required. Voice acquisition was achieved at an earlier time (4 days on average) than with traditional techniques and without the necessity of a subsequent procedure. Primary prosthesis placement at the time of secondary TE puncture is a successful option for surgical voice restoration with distinct advantages and minimal complications. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Enlargement of the tracheoesophageal puncture (TEP) results in aspiration around the voice prosthesis (VP) and may lead to pneumonia. The primary objective was to summarize control of leakage around the VP after conservative management of enlarged TEP. Study Design: Retrospective cohort study. Methods: This 5-year cohort included 194 patients who underwent total laryngectomy (with or without pharyngectomy) and TEP at the University of Texas MD Anderson Cancer Center. Control of leakage around the VP was analyzed at last follow-up after enlarged TEP. Adverse events were compared in patients with and without enlarged TEP. Results: The incidence of enlarged TEP was 18.6% (36 of 194, 95% confidence interval [CI]: 13.0%-24.1%). Conservative methods commonly attempted in lieu of complete TEP closure included placement of an enlarged-flange VP (34 of 36, 94%), temporary VP removal (14 of 36, 39%), and TEP-site injection (8 of 36, 22%). At last follow-up, conservative methods controlled leakage around the VP in 81% (29 of 36) of patients. Only two patients required complete TEP closure due to persistent leakage after enlarged TEP. Unresolved leakage was more common in patients with recurrent cancer after laryngectomy (P = .081) and irregular TEP contour (P = .003). Relative to controls without TEP enlargement, patients with enlarged TEP had a three-fold higher risk of pneumonia (relative risk: 3.4, 95% CI: 1.9-6.2) and aspiration of the prosthesis (relative risk: 3.3, 95% CI: 0.8-14.1). Conclusions: Although the rate of enlarged TEP is relatively low, the complication significantly elevates risk of pneumonia. Prosthetic leakage related to TEP enlargement can often be managed conservatively to avoid complete closure of the TEP. [ABSTRACT FROM AUTHOR]

Objectives To present a new technique for secondary tracheoesophageal puncture (TEP) in laryngectomized patients. The technique is performed on an outpatient basis under local anesthesia. Study Design Laryngectomized patients waiting for secondary TEP procedures were given the choice between the new technique under local anesthesia on an outpatient basis and the traditional technique under general anesthesia requiring hospitalization. Methods Using basic implements available in an outpatient clinic, the traditional TEP technique was modified with the oral introduction of an intubation tube with an illuminated, inflatable cuff at the puncture site. The illuminated, inflated cuff serves as a beacon during the procedure and the tube protects the posterior tracheal wall. Results Nine patients underwent the procedure under local anesthesia. In 8 of them the procedure went smoothly, but in 1 of them the inflatable cuff could not be satisfactorily placed as a result of the local anatomy and the procedure was canceled. All patients were pleased with the technique and said the procedure was painless. Conclusions With some modifications, the traditional TEP technique has been rendered suitable for selected outpatient use under local anesthesia, and the necessary hospitalization for secondary TEP can thus be avoided. [ABSTRACT FROM AUTHOR]

Laryngoscope, 124:469-471, 2014 [ABSTRACT FROM AUTHOR]

The article presents information on tracheoesophageal puncture (TEP) which can be performed at the time of laryngectomy or after an interval of time. Topics discussed include use of the Ciaglia Blue Rhino percutaneous tracheotomy set to perform TEP under general anesthesia, use of Hopkins rod telescope to improve visualization, and problem of leakage at the puncture site.