Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Online Research Club, Nagasaki, Japan.
J Speech Lang Hear Res. 2021 Jul 16;64(7):2668-2681. doi: 10.1044/2021_JSLHR-20-00597. Epub 2021 Jun 29.
Purpose Our aim was to assess the different voice prostheses (VPs) to identify the most efficient, safest, patient-tailored, longest lifetime, and inexpensive VPs and assess the different factors affecting their quality. Method In September 2017, 15 databases were searched to include all randomized controlled trials. A new search was done in May 2019 to include all other study design articles, which include all the new-era VPs subtypes. Network meta-analysis (NMA) was applied to all 27 outcomes, besides NMA overall and partial order setting was done by using Hasse scatter plots. values were used in NMA, where the best VPs are approaching one and the least approaches zero. Meta-analysis was done for the rest of the outcomes. Results Two hundred one articles were eligible for inclusion in our study ( = 11,918). Provox-2 was significantly the most efficient and safest device concerning the most patient preference (odds ratio [] = 33.88 [0.65, 1762.24]; = .92), the least dislodgement (risk ratio [RR] = 0.27 [0.13, 0.57]; = .79), the least airflow resistance (RR = 0.42 [0.08, 2.11]; = .84), the least granulation formation (RR = 0.73 [0.02, 26.32]; = .60), and the least VPs' inaccurate size (RR = 0.77 (0.23, 2.61); = .66). Heat and moisture exchanger addition showed a significant increase in maximum phonation time and breathing experience, with values (1 and .59), respectively. While heat and moisture exchanger addition showed a significant decline in stoma cleaning frequency, coughing frequency, forced expectoration, sputum production, sleeping problems, and loosening of adhesive, with values (.99, .72, .69, .96, 1, and 0.96), respectively, Groningen low resistance and Nijdam were considered the worst devices with both overall mean value of .44. Conclusions Provox-2 is considered the best choice as being the most preferable for patients, with the least airflow resistance, dislodgment, granulation formation, and prosthesis inaccurate size. Groningen low resistance and Nijdam were considered the worst devices according to our analysis. Supplemental Material https://doi.org/10.23641/asha.14802903.
目的 本研究旨在评估不同的嗓音假体（VP），以确定最有效、最安全、最适合患者、寿命最长和最便宜的 VP，并评估影响其质量的不同因素。 方法 2017 年 9 月，检索了 15 个数据库以纳入所有随机对照试验。2019 年 5 月进行了新的检索，以纳入所有其他研究设计的文章，其中包括所有新一代 VP 亚型。应用网络荟萃分析（NMA）对所有 27 个结局进行分析，除 NMA 外，还通过哈塞散点图进行了整体和部分排序设置。使用 值来表示 NMA，其中最佳 VP 接近 1，而最差 VP 接近 0。其余结局采用荟萃分析。 结果 共有 201 篇文章符合纳入标准（n = 11918）。在患者最偏好方面，Provox-2 是最有效和最安全的设备（比值比 [] = 33.88 [0.65，1762.24]； =.92），脱位发生率最低（风险比 [RR] = 0.27 [0.13，0.57]； =.79），气流阻力最小（RR = 0.42 [0.08，2.11]； =.84），肉芽形成最少（RR = 0.73 [0.02，26.32]； =.60），VP 尺寸不准确最少（RR = 0.77 [0.23，2.61]； =.66）。热湿交换器的添加显著增加了最大发声时间和呼吸体验， 值分别为 1 和.59。然而，热湿交换器的添加显著降低了造口清洗频率、咳嗽频率、强制咳痰、痰液生成、睡眠问题和粘合松动， 值分别为 (.99，.72，.69，.96，1 和 0.96）。Groningen 低阻力和 Nijdam 被认为是最差的设备，总体平均 值均为.44。 结论 Provox-2 被认为是最佳选择，因为它是最受患者欢迎的，气流阻力、脱位、肉芽形成和假体尺寸不准确最小。根据我们的分析，Groningen 低阻力和 Nijdam 被认为是最差的设备。 补充材料 https://doi.org/10.23641/asha.14802903.
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