gms | German Medical Science

Introduction: Voice prostheses have proven to be save and effective to restore voice after total Laryngectomy. The extended worldwide use voice prostheses has uncovered biofilm formation, underpressure related valve openings, material fatigue of the valve and periprosthetic leakage as specific problems of voice prostheses. Attempts have been made to manage these problems by technical developments that lead to „problem solving voice prostheses“ or „special voice prostheses“. We have checked 4 special prostheses regarding their clinical use, indication and efficiency.

Material and methods: Short characteristic of the 4 tested special voice prostheses:

• The Provox^® ActiValve prosthesis was designed to resist underpressure related valve openings and biofilm formation. It has a biofilm resistant flap valve made out of fluoroplastics and a magnetic enhanced closing mechanism that is available in 3 strengths.
• The flap valve of the Blom-Singer^® Increased Resistance prosthesis has a moderately enforced hinge to resist underpressure during inspiration anyhow allowing easy speech.
• The biofilm resistance of the Blom-Singer^® Advantage prosthesis is based on a flap valve and valve seat made of silicon containing 7% silver oxide to inhibit biofilm formation. There are two generations of Advantage Prosthesis, we tested the first generation.
• Leakage around a voice prosthesis is the target for the Blom-Singer^® Large Esophageal Flange prosthesis. Its large flange is intended to provide a seal from inside the esophagus in case of periprosthetic leakage.

The efficiency of the Provox^® ActiValve, the Blom-Singer^® Increased Resistance and the Blom-Singer^® Advantage first generation prosthesis was analyzed by lifetime comparison with a standard voice prosthesis (Provox^® 2, Blom-Singer^® Classic). To determine the efficiency of the Blom-Singer^® Large Esophageal Flange prosthesis the rate of complete sealing of the shunt was determined.

Results: Provox^® ActiValve prostheses were used in 19 cases of extremely short lifetimes with visible underpressure related valve openings. In 17 cases the strong magnets and in 2 cases the light magnets were used. The mean lifetime of the ActiValve was 317 days (median 260d) compared to 27 days (median 12d) with a standard voice prosthesis in this population.

In 57 cases with underpressure related valve opening a Blom-Singer^® Increased resistance prosthesis was inserted. The mean lifetime of the increased resistance prosthesis was 51 days (median 38d) compared to 14 days (median 10d) with the standard voice prosthesis previously used by theses patients.

A Blom-Singer^® Advantage prosthesis was used in 33 cases. The mean lifetime of the Advantage prosthesis was 110 days (median 87d) compared to 36 days (median 36d) with a standard voice prosthesis.

312 Blom-Singer^® Large Esophageal Flange prostheses have been used to seal periprosthetic leakage. This was successful in 307 cases (98%). In 136 cases (43%) an additional enlarged tracheal flange had to be used. Figures 1–3 [Fig. 1] [Fig. 2] [Fig. 3]

Discussion: All 4 special voice prostheses have proven to be safe in their clinical use and effective for the purpose they were developed.

Effective management of short prosthesis lifetime and periprosthetic leakage requires detailed knowledge of these special voice prostheses. The differentiated use of special voice prostheses can reduce the need for frequent voice prosthesis replacements, save a lot of money and reduce discomfort for the patient.