gms | German Medical Science

81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

12.05. - 16.05.2010, Wiesbaden

Can voice prostheses remain in situ? An inquiry to ensure the safety of modern voice prostheses in MRI

Meeting Abstract

  • corresponding author presenting/speaker Daniel Neuberger - Klinikum Mutterhaus der Borromäerinnen Abteilung für Hals- Nasen- Ohrenheilkunde, Trier, Deutschland
  • Peter Kress - Klinikum Mutterhaus der Borromäerinnen Abteilung für Hals- Nasen- Ohrenheilkunde, Trier, Deutschland
  • Gilles Weidig - Klinikum Mutterhaus der Borromäerinnen Abteilung für Hals- Nasen- Ohrenheilkunde, Trier, Deutschland
  • Ingo Klug - Klinikum Mutterhaus der Borromäerinnen Abteilung für Diagnostische und Interventionelle Radiologie, Trier, Deutschland
  • F.- Peter Schwerdtfeger - Klinikum Mutterhaus der Borromäerinnen Abteilung für Hals- Nasen- Ohrenheilkunde, Trier, Deutschland

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Wiesbaden, 12.-16.05.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. Doc10hno011

DOI: 10.3205/10hno011, URN: urn:nbn:de:0183-10hno0112

Published: July 6, 2010

© 2010 Neuberger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Introduction: Currently, there are about 20,000 people living without a larynx in Germany. The voice restauration is an essential part of the rehabilitation of these patients without larynx. At the present day, voice prostheses constitute the gold standard of vocal rehabilitation after total laryngectomy in addition to the oesophageal voice and operative procedures (e.g. laryngoplastic). Due to these voice prostheses, 85–90% of the affected patients attain a substitute voice that is suitable for daily use [1], [2], [3], [4]. Due to the further development of these prostheses new materials (silicones to be high in silver oxide, steel tubes, titanium rings and magnets) are used more frequently [5], [6], [7], [3], [4]. Particularly oncological after-treatment of laryngeal operated patients, having voice prostheses, consistently raises the question whether special voice prostheses are MRI-proof and, for instance, can remain in the original position, or not. Therefore, the aim of the following paper is to examine all models of voice prostheses on the current German market in regard to their safety in MRI.

Material/method: Voice prostheses of the following types have been exposed in a Siemens Avanto MRI with a maximum of 1.5T, whereby the emerging forces were determined: Provox® 1, Provox® 2, Provox Vega®, Provox® ActiValve (light, strong, extra strong) Atos Medical; Blom Singer® Classic 20fr, Blom-Singer® Advantage (first generation, second generation) Blom-Singer® Dual Valve, Inhealth; Tracoe Voicemaster®, Tracoe medical; ESKA® Herrmann (flexion 60°, 75°, 90°), Adeva® Highflow, ESKA Medical; Groningen® 4 Ultra Low Resistance and Heimomed Phonax®, Heimomed Heinze. At the beginning of the study a rough calculation of the occurring forces and the places of the maximal force were asserted with the help of a dynamometer ultra light®. Subsequently it was carried out the quantitation of the voice prostheses affected by the maximal magnetic gravitational pull and translation according to a standardised procedure, referred to as thread test.

It is supposed that the force that leads to the deflection of the object is equivalent to the magnetical force that affects the object. Additionally, the rotation force has been evaluated using a five point scale [8], [9], [10], [11], [12]. With this scale the rotation force that affects the voice prosthesis can be determined with an established procedure (angular degree 0 = no alteration of the alignment of the object, angular degree 4 = immediate and powerful adaptation to the magnetic field.

Result: As expected, the prostheses containing silicon and synthetic materials didn’t show any conspicuousness in the MRI. Prostheses containing prefabricated titan parts are most widely MRI-proof, whereas voice prostheses including metal parts and magnets, Provox® ActiValve (light, strong, extra strong), its weights are all 0.66 gram, cause forces up to 0.003334 N and a torsional moment up to 0.0005 Nm. The measurement with the five point scale showed a rotation force of angular degree 0/4.

Conclusion: Pure synthetic voice prostheses are MRI-proof. Merely the three tested Provox Activalve prostheses (light, strong, extra strong) showed forces that are equivalent to 0.5g. In all probability, this can not lead to a dislocation of the prosthesis. The examination showed that the used metal parts can cause picture imageries in the MRI what needs to be examined in additionally examinations.


References

1.
Op de Coul BM, Hilgers FJ, Balm AJ, Tan IB, van den Hoogen FJ, van Tinteren H. A decade of postlaryngectomy vocal rehabilitation in 318 patients: a single Institution`s experience with consistent application of provox indwelling voice prostheses. Arch Otolaryngol Head Neck Surg. 2000;126(11):1320-8.
2.
Seinsch W. Laryngectomy - a treatment on the way out? Voice retoration, quo vadis? Laryngo-Rhino-Otologie. 2001;80(11):674-6.
3.
Delank KW, Scheuermann K. Praktische Aspekte der prothetischen Stimmrehabilitation nach Laryngektomie. Laryngo-Rhino-Otol. 2008;87:160-6.
4.
Kramp B, Dommerich S. Kanülen und Stimmprothesen. Laryngo-Rhino-Otol. 2009;88:S95-S118.
5.
www.stimmprothese.com/ Trier: ENT-Technik; 2010. Available from: http://www.stimmprothese.com/index.php External link
6.
Soolsma J, van den Brekel MW, Ackerstaff AH, Balm AJ, Tan B, Hilgers FJ. Long-term results of Provox Activalve, solving the problem of frequent candida- and "underpressure"- related vioce prothesis replacements. Laryngoscope. 2008;118:252-7.
7.
Hilgers FJ, Ackerstaff AH, Balm AJ, Van den Brekel MW, Bing Tan I, Persson JO. A new problem-solving indwelling voice prosthesis, eliminating the need for frequent Candida- and "underpressure"-related replacements: Provox ActiValve. Acta Otolaryngol. 2003;123(8):972-9.
8.
Gersten C, Meschede D. Gerthsen Physik. 21. völlig neubearb. Aufl. Berlin: Springer; 2005.
9.
Klocke A, et al. Magnetische Kräfte auf kieferorthopädische Drähte während Magnetresonanztomographie bei 1,5 Tesla. Fortschritte der Kieferorthopädie. 2005;66:279-87.
10.
Sommer T, et al. Hochfeld-Magnetresonanztomographie: Magnetische Anziehungs- und Rotationskräfte auf metallische Implantate bei 3,0 T. Fortschr Röntgenstr. 2004;176:731-8.
11.
Nogueira M, Shellock FG. Otologic bioimplants: ex vivo assessment of ferromagnetism and artifacts at 1.5 T. AJR Am J Roentgenol. 1994;163(6):1472-3.
12.
Shellock FG, Shellock VJ. Metallic stents: evaluation of MR imaging safety. AJR Am J Roentgenol. 1999;173(3):543-7.