Current status and future prospects in prosthetic voice rehabilitation following laryngectomy

Total laryngectomy or laryngopharyngectomy remains the procedure of choice for advanced-stage (UICC T3 and T4) laryngeal carcinoma around the world despite advances in conservative laryngeal surgery and radiotherapy. However, it has profound effects on respiration and deglutition, in addition to the most disabling effect-the loss of verbal communication. Successful voice restoration can be attained with any of three speech options, namely esophageal speech, electrolarynx, and tracheoesophageal (TO) speech using an artificial valve. Although, no single method is considered the best for every patient, the tracheoesophageal puncture has become the preferred method in the past decade. Several types of voice prostheses have been produced since the first prosthesis was introduced in 1980 by Blom and Singer. However, eventually all prostheses are confronted by the same problem, i.e., the development of a biofilm, leading to deterioration and ultimately to dysfunction of the prostheses, necessitating replacement. This article attempts to sum up the historical background as well as the current state of surgical voice rehabilitation following laryngectomy; we review the recent major advances as well as the future prospects. Data was collected by conducting a computer-aided search of the MEDLINE and PubMed databases, supplemented by hand searches of key journals. Over 50 articles published in the last three decades on the topic have been reviewed, out of which about 20 were found to be of relevance for this article.