Managing Voice-Related Issues in Laryngectomized Patients With Voice Prosthesis: A Troubleshooting Algorithm for Rehabilitation

SUMMARY: Objectives. To analyze the voice-related issues in laryngectomized patients with voice prosthesis (VP) and to evaluate the effectiveness of voice therapy (VT) in their management. Materials and methods. The retrospective analysis included 194 patients (170 M, 24 F; mean age 64.86 ± 10. 09 years) who underwent total laryngectomy (TL) with VP placement and subsequent VT between May 2010 and May 2024. In this study, patients were categorized based on vocal symptoms and underlying causes. To investigate issue resolution solving and outcomes, post-TV outcomes were analyzed using patient-reported outcome measures (PROMs) and auditory-perceptual assessments. Specifically, the Italian Self-Evaluation of Communication Experiences After Laryngeal Cancer (I-SECEL) and University of Washington Quality of Life (UWQoL-v4) Questionnaires, and the INFVo scale. Results. 100 out of 194 patients (51.55%) presented a voice-related issue (82 M, 18 F; mean age 67 ± 9.35 years). The age over 65 years and female sex increased the incidence of voice-related complications. Hypertonic voice was the most frequent issue (40%) and was resolved in 72% of cases through ∼20 sessions of VT. This resolution rate increased to 95% when combined with botulinum toxin injections. No results were recorded in cases of hypertonic voice associated with post-radiation fibrosis. Problems related to the stoma, anatomical abnormalities, interference between esophageal and tracheoesophageal (TE) voice, and radiotherapy, as well as hypotonic and poor-quality voices, achieved a 100% resolution rate after 5–15 sessions of VT. Issues related to breathing, coordination and posture achieved a resolution rate of 92%, with lower-quality vocal outcomes. The implementation of specific VT allowed for an overall resolution of 92% of treated cases, reaching a success rate of 95% in the entire cohort of patients (N = 194). Conclusions. In the treatment of TE voice, identifying voice-related issues through patient assessment and symptoms analysis allows for targeted VT, leading to higher success rate. Key Words: Total laryngectomy–Tracheoesophageal voice–Voice prosthesis–Voice therapy–Patient-reported outcome measures (PROMs).