Postlaryngectomy voice restoration--a 2-year review

We present a 2-year (1991/92) review of tracheo-oesophageal speech following total laryngectomy with tracheo-oesophageal fistula formation and subsequent use of a voicing prosthesis. Thirty-five primary fistulas and four secondary fistulas were created. Initially, 86% of patients obtained daily use of intelligible, fluent voice with few extraneous stomal sounds. Over a 2-3-month period following surgery, approximately one-third of these lost their fistula speech. The reasons for this were mainly related to psychological and socio-economic factors. Patient selection, surgical technique and postoperative management are described. Although a successful outcome requires a consolidated team approach, primary health care workers also need to know about postlaryngectomy prosthetic (fistula) speech and its management.