MEDICAL FOLLOW-UP CARE OF LARYNGECTOMIZED PATIENTS WITH VOICE-PROSTHESES

The success of prosthetic voice rehabilitation in laryngectomees depen ds not only upon logopedic training but also upon qualified follow-up care by the otorhinolaryngologist. As the voice prosthesis is increasi ngly used, this paper discusses specific aspects of medical follow-up care. At present, three types of voice prostheses are in general use i n Germany: (1) the non-indwelling, low-pressure voice-prosthesis after Singer and Blom, which can be removed and reinserted by the patient, (2) the non-indwelling ESKA-Herrmann prosthesis as an angled duckbill prosthesis, which can also be maintained by the patient and (3) the in dwelling Provox-prosthesis after Hilgers and Schouwenburg, which has t o be replaced by the otorhinolaryngologist. Additionally, a tracheosto ma valve fixed to the skin with a liquid adhesive (Blom) or inserted a fter a special tracheostoma plasty (Herrmann) enables the patient to s peak freehanded. During the first postoperative weeks the patient has to learn manual occlusion of the stoma, breathing and phonation techni ques and, eventually, how to remove, clean and reinsert his non-indwel ling prosthesis (Blom-Singer or ESKA-Herrmann). Development of granula tion tissue around the prosthesis and/or shunt insufficiencies are rel atively rare and are mainly seen in patients after pre- or postoperati ve radiation therapy. In both cases temporary removal of the prosthesi s is required. In case of accidental loss of a non-indwelling prosthes is a new prosthesis has to be inserted immediately; otherwise the shun t may spontaneously close overnight. A sudden increase of phonatory ai r-flow resistance, which cannot be reduced by insertion of a new prost hesis, may indicate tumor recurrence. `