EARLY SPEECH RESULTS WITH THE PROVOX PROSTHESIS AFTER LARYNGECTOMY

Objectives: To assess our initial success using the Provox (Atos Medic al AB, Herby, Sweden, and Entermad BV, Woerden, the Netherlands) trach eoesophageal speaking valve as the primary prosthesis to rehabilitate patients after total laryngectomy and to compare our success and compl ication rates with those previously reported. Design: A retrospective analysis of all the patients who had a Provox prosthesis placed from N ovember 1994 to November 1995. Patients and Methods: Medical charts we re reviewed for success or failure of the prosthesis as determined by the quality of speech and the utility of the device. In addition, comp lications, whether the patient had a pharyngeal myotomy and/or radiati on, and the reasons and timing for replacement were assessed. Twenty-o ne patients had a Provox prosthesis placed either primarily at the tim e of their total laryngectomy (n=8), delayed (n=5), or as a replacemen t for another type of prosthesis (n=8). Follow-up ranged from 2 to 17 months. Results: The initial success rate was 84%, and the longterm su ccess rate was 74%. Of note, 3 patients had substantially improved spe ech and none were worse when changed from another type of prosthesis. The mean interval to prosthesis change was 166 days. Reasons for failu re included infection, radiation fibrosis, manual incoordination, cere brovascular accident, and combination of total laryngectomy and total glossectomy. The most common complication (in 2 patients) was retracti on of the prosthesis into the esophagus that was successfully managed by replacement with a longer device. Conclusion: Our early results con firm the effectiveness, longevity, and safety of the Provox prosthesis for speech rehabilitation following total laryngectomy.