Factors for pain in office-based voice implant replacement. A multicenter prospective GETTEC study

To determine factors affecting pain on a numeric rating scale (NRS) during office-based voice prothesis exchange. And, secondarily, to review voice prothesis replacement techniques in France.

A multicenter prospective observational study was conducted by the Head and Neck Tumor Study Group (GETTEC) between November 2022 and November 2024. A survey questionnaire was filled out by the practitioner after informed consent was obtained from the patient. All laryngectomized patients presenting in consultation for voice prothesis exchange were included. Pain was assessed on a unidimensional 0-10 numeric rating scale.

Three hundred and nine questionnaires were collected. Mean pain rating was 2±2.8. Three factors were associated with significantly lower pain intensity: procedure duration <5minutes (P<0.001), a single attempt (P<0.001), and the status of the practitioner performing the replacement (P=0.002); 2 factors were associated with suggestively lower pain intensity: male gender (P=0.030), and use of a capsule (P=0.011). Pain intensity was not significantly associated with local anesthesia (P=0.4) or the extraction technique (P=0.2). Sixty seven percent of replacements were in emergency contexts, particularly for intra-prosthetic leakage (68%). Local anesthesia was used in 87% of cases. Extraction was by pushing the implant into the esophagus in 52% of cases, and by pulling it out in 48%. Most replacements (75%) required only 1 attempt, and 77% required less than 5minutes (77%). Capsules were used in 23% of cases.

We found a wide range of techniques for replacing a voice prothesis. The procedure is quick and relatively painless. For replacement that is as painless as possible, it is advisable for it to be carried out quickly, using a capsule.