Efficacy of primary tracheoesophageal puncture in laryngectomy rehabilitation.

Primary voice restoration has been the preferred treatment for laryngectomy patients at the Sir Mortimer B. Davis Jewish General Hospital since 1986. This study reviews 71 consecutive patients over a 5-year period. Number, types of complications, and whether post-surgery radiation increases complications were studied. The Robillard Shultz-Harrison Tracheoesophageal Puncture Rating Scale, measuring use, voice quality, and independence at 1, 3, 6, and 12 months, was employed to rate functional outcome. A Patient Satisfaction Questionnaire was used to assess patient satisfaction. The patients were subdivided into two groups. Group A, 24 patients with no radiation post-surgery, was compared to Group B consisting of 22 patients, all of whom received postsurgical radiation treatment. There was no significant difference between groups in the number and types of complications. The most frequent problems for both groups were immediate and delayed extrusion, tracheoesophageal fistula migration, and pharyngocutaneous fistula. Group A achieved better functional communication scores statistically significant only at the 3-month interval (p = .02). Cumulative scores from the Patient Satisfaction Questionnaire revealed that 60% of the patients were moderately to very satisfied with tracheoesophageal speech. Modification in rehabilitation protocol to reduce complications and a significantly shortened list of contraindications for primary TEP are presented.