[Medical after-care of laryngectomized patients with voice prosthesis]

The success of prosthetic voice rehabilitation in laryngectomies depends not only upon logopedic training but also upon qualified follow-up care by the otorhinolaryngologist. As the voice prosthesis is increasingly used, this paper discusses specific aspects of medical follow-up care. At present, three types of voice prostheses are in general use in 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 indwelling Provox-prosthesis after Hilgers and Schouwenburg, which has to be replaced by the otorhinolaryngologist. Additionally, a tracheostoma valve fixed to the skin with a liquid adhesive (Blom) or inserted after a special tracheostoma plasty (Herrmann) enables the patient to speak free-handed. During the first postoperative weeks the patient has to learn manual occlusion of the stoma, breathing and phonation techniques and, eventually, how to remove, clean and reinsert his non-indwelling prosthesis (Blom-Singer or ESKA-Herrmann). Development of granulation tissue around the prosthesis and/or shunt insufficiencies are relatively rare and are mainly seen in patients after pre- or postoperative radiation therapy. In both cases temporary removal of the prosthesis is required. In case of accidental loss of a non-indwelling prosthesis a new prosthesis has to be inserted immediately; otherwise the shunt may spontaneously close overnight. A sudden increase of phonatory air-flow resistance, which cannot be reduced by insertion of a new prosthesis, may indicate tumor recurrence.