Tracheoesophageal puncture: prosthetic voice management

In the past two decades, prosthetic voice rehabilitation has become the method of choice for many clinicians treating laryngectomized patients. The clinical applicability of voice prostheses, the safety of the tracheoesophageal puncture procedure, and the long-term success rates have been established. The superiority of prosthetic over esophageal voice and the importance of an optimal tonicity of the pharyngoesophageal segment or neoglottis for fluent speech are well known. Most clinicians have become familiar with the inevitable but mostly well-controllable complications associated with the use of a prosthetic device at this vulnerable spot in the human body. Also the role of Candida overgrowth, limiting the device life of voice prostheses, and the positive effect of antifungal medication have been established. The importance and possibilities of pulmonary rehabilitation of laryngectomized patients using heat and moisture exchangers have been worked out as well. Despite this progress in the last 20 years, there is still room for improvements. To establish which issues currently are focused on in clinical research, recent papers (approximately last half of 1997 through November 1998) were reviewed. The publications have been divided into seven subtopics: evaluation of prosthetic devices, clinical and surgical aspects, pharyngoesophageal segment/neoglottis, Candida aspects, voice and speech evaluation, speech therapy, and quality of life. The most relevant work in each subtopic has been reviewed.