SECONDARY TRACHEOESOPHAGEAL PUNCTURE - FACTORS PREDICTIVE OF VOICE QUALITY AND PROSTHESIS USE

Objective. To identify factors predicting prosthesis use and final spe ech quality in patients undergoing secondary tracheoesophageal punctur e (IEP) for voice restoration after laryngectomy. Methods. We undertoo k a retrospective study of 168 patients who underwent secondary TEP at the Cleveland Clinic between June 1980 and October 1993. Factors exam ined were: patient demographics, extent of initial surgery, method of pharyngeal preparation, history of irradiation, insufflation test resu lts, pharyngeal stricture, and concurrent medical conditions. Univaria te and multivariate statistical analyses were performed to identify pr edictive factors. Results. At last evaluation, 73.8% (124) of the pati ents were still using the prosthesis. Quality of speech was the only p redictor of prosthesis use (p <.001). Phonation on the first day was a chieved in 90% (151) of patients. Speech result improved significantly over the first 6 months (p <.001). Univariate analysis found that the need for reconstruction at laryngectomy (p=.04), the presence of phar yngeal stricture (p=.001), and continued prosthetic use (p <.001) were associated with the speech result. There was no significant advantage to the lack of approximation of the pharyngeal constrictors(p=.31). S tepwise logistic regression showed that only the absence of pharyngeal stricture was associated with a better-quality voice (p=.001). Conclu sion. Tracheoesophageal puncture is a reliable method for restoring vo ice after laryngectomy. Prosthesis use decreases with time, and good v oice quality is the only predictor of continued prosthesis use. In thi s series the absence of pharyngeal stricture was the only significant predictor of good to excellent speech. (C) 1996 John Wiley & Sons, Inc .