T.E.P. VOCAL REHABILITATION FOLLOWING TOTAL LARYNGECTOMY – PARTICULARITIES AND PRELIMINARY RESULTS FROM TWO ROMANIAN E.N.T. TERTIARY CARE CENTERS
Tracheo-esophageal puncture (T.E.P.) with vocal prosthesis placement currently is considered the “gold-standard” of vocal rehabilitation following total laryngectomy. This method is however not without shortcomings, and several studies have reported high complication rates among patients.
During a three-year period, we have followed a number of 26 patients who underwent vocal rehabilitation with T.E.P. and prosthesis placement. 10 patients were implanted during total laryngectomy, while the rest (16) were secondary placements. Mean follow-up time was 2 years and 8 months. In total, 197 prostheses were used during follow-up time, with an average device-life of 149 days, but with significant differences between different types of prostheses.
Subsequent patients’ visits were classified as scheduled or emergency – in relation to device functioning. 17 patients out of the 26 (65%) had at least one emergency (unscheduled) visit to address an issue with the vocal prosthesis. Most unscheduled (emergency) visits were related to device malfunction and leakage through the vocal prosthesis. 5 patients had severe complications that warranted removal of the prosthesis – which meant that over the time period observed, the success rate of this method of vocal rehabilitation was 80 %.
Despite some local financial issues that restrict use of new generation vocal prostheses as well as HME’s and hands-free speaking valves, vocal rehabilitation after total laryngectomy by T.E.P. with vocal prosthesis placement is a safe and effective method, with comparable results to that of existing published literature.
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