Does Prophylactic Replacement of Voice Prosthesis Make Sense? A Study to Predict Prosthesis Lifetime

Area of Science:

• Otolaryngology
• Biomedical Engineering

Background:

• Voice prosthesis leakage significantly impacts laryngectomy patients' quality of life, leading to insecurity and increased healthcare costs.
• Preventing these leakages is crucial for patient well-being and managing healthcare resources.

Purpose of the Study:

• To explore the feasibility of prophylactic voice prosthesis replacement to prevent leakages.
• To determine optimal replacement strategies and their effectiveness in reducing leakage events.

Main Methods:

• A retrospective cohort study was conducted on laryngectomy patients (2000-2012).
• Device lifetimes and replacement data were analyzed to calculate needed prostheses per year for leakage prevention.
• Adaptive and fixed prophylactic replacement strategies were simulated using Monte-Carlo methods.

Main Results:

• Patients used a median of 3.4 voice prostheses annually, with high inter- and intrapatient variability in device lifetime.
• Prophylactic replacement, even with adaptive strategies, could only prevent a median of 25% of leakages.
• Simulations indicated that prophylactic replacement is not feasible due to significant variations in device lifespan.

Conclusions:

• Prophylactic voice prosthesis replacement is not a feasible strategy to prevent leakages.
• High inter- and intrapatient variability in voice prosthesis device lifetime is the primary barrier.
• Current strategies are insufficient to reliably prevent leakage events through scheduled replacement.