[Prosthetic Voice Restoration After Laryngectomy: the Management of Fistula Complications with Anti-reflux Medications]

Overview

Journal HNO

Specialty Otorhinolaryngology

Date 2010 Jun 22

PMID 20563542

Citations 9

Authors

K J Lorenz

L Grieser

T Ehrhart

H Maier

Affiliations

Soon will be listed here.

Abstract

Introduction: Approximately 30% of all patients show periprosthetic leakage or severe fistula enlargement after laryngectomy and prosthetic voice restoration. In a prospective study, we investigated the role of aggressive anti-reflux therapy in fistula complications.

Patients And Methods: A total of 48 patients were assigned to one of two groups. Group A consisted of 16 patients with recurrent periprosthetic leakage. Group B comprised 32 patients without periprosthetic leakage. The presence of reflux was objectively assessed using 24-h dual-probe pH monitoring. All patients with pathological reflux underwent proton pump inhibitor (PPI) therapy. After 6 months, patients were re-evaluated for fistula complications and objective reflux parameters.

Results: The mean absolute number of reflux events was 202.8 (+/-44) before and 74.5 (+/-22.9) after PPI therapy (p=0.025). The reflux area index decreased from 419.5 (+/-112.5) before treatment to 105.8 (+/-54.7) after treatment (p=0.0005). The mean DeMeester score was 104.4 (+/-21.3) without PPIs and 43.5 (+/-9.3) after 6 months with PPIs (p=0.028). A risk analysis for patients with both periprosthetic leakage and pathological reflux (15 patients at the beginning of the study, four patients after therapy) showed that the relative risk of periprosthetic leakage decreased to 0.3 (p=0.0054) with PPI therapy.

Conclusion: Patients with recurrent periprosthetic leakage in the region of the fistula showed a significantly higher number of supra-oesophageal reflux episodes. Rigorous anti-reflux treatment can help manage or prevent leakage problems in a large proportion of patients.

Citing Articles

Analysis of Factors Affecting the Longevity of Voice Prosthesis Following Total Laryngectomy with a Review of Literature.

Krishnamurthy A, Khwajamohiuddin S Indian J Surg Oncol. 2018; 9(1):39-45.

PMID: 29563733 PMC: 5856693. DOI: 10.1007/s13193-017-0700-z.

Post-laryngectomy voice rehabilitation with voice prosthesis: 15 years experience of the ENT Clinic of University of Catania. Retrospective data analysis and literature review.

Serra A, di Mauro P, Spataro D, Maiolino L, Cocuzza S Acta Otorhinolaryngol Ital. 2016; 35(6):412-9.

PMID: 26900247 PMC: 4755057. DOI: 10.14639/0392-100X-680.

[Solving problems after rehabilitation with voice prostheses : Two rare cases of fistula-related complications].

Lorenz K, Nolte S HNO. 2015; 64(7):508-14.

PMID: 26403994 DOI: 10.1007/s00106-015-0059-9.

[Voice rehabilitation after total laryngectomy: A chronological review of medical history].

Lorenz K HNO. 2015; 63(10):663-4, 666-80.

PMID: 26403993 DOI: 10.1007/s00106-015-0043-4.

[Importance of cellular tight junction complexes in the development of periprosthetic leakage after prosthetic voice rehabilitation].

Lorenz K, Kraft K, Graf F, Propper C, Steinestel K HNO. 2014; 63(3):171-2, 174-8, 180-1.

PMID: 25515126 DOI: 10.1007/s00106-014-2951-0.

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