This book reviews, for the very first time, the causes of, and treatment options for, complications after surgical voice rehabilitation using voice prostheses.The authors, all with many years' experience in this field and with considerable involvement in developing treatment strategies, offer a comprehensive, practice-oriented review of the current state of knowledge on this issue and thereby provide a valuable guide for the management of complications - one that should be available in every ENT clinic.

1.Introduction13
1.1.Epidemiology13
1.2.Treatment approaches in laryngeal cancer13
1.3.History of laryngectomy13
1.4.Consequences of laryngectomy for the patient13
1.4.1.Loss of voice14
1.4.2.Loss of conditioning of inspired air14
1.4.3.Loss of the sense of smell14
1.5.Possibilities for voice rehabilitation14
1.5.1.Oesophageal voice14
1.5.2.Electronic speaking aids15
1.5.3.Surgical techniques for voice rehabilitation15
1.6.Value of voice rehabilitation with voice prostheses16
1.6.1.Prosthesis technique17
1.6.2.Indwelling/non-indwelling prostheses18
2.Physiology of voice production after laryngectomy22
2.1.Conservative methods for voice rehabilitation22
2.2.Voice-producing segment23
2.3.Possibilities for the differential diagnosis27
3.Change of voice prosthesis30
3.1.Operation technique30
3.1.1.Primary puncture and placement of a voice prosthesis30
3.1.2.Secondary placement of a voice prosthesis31
3.2.Changing the voice prosthesis33
3.2.1.Retrograde voice prosthesis replacement33
3.2.2.Antegrade voice prosthesis replacement34
3.2.3.Non-indwelling prostheses36
3.2.4.Practical procedure37
4.Complications after insertion of a voice prosthesis40
4.1.Major complications40
4.2.Minor complications40
4.3.Leaks41
4.3.1.Transprosthetic leakage41
4.3.1.1.Prosthesis-related problems42
4.3.1.2.Puncture-associated problems43
4.3.1.3.Phenomenon of negative thoracic pressure44
4.3.2.Periprosthetic leakage and tracheo-oesophageal puncture enlargement44
4.3.2.1.Incidence of periprosthetic leakage46
4.3.2.2.Pathology of the tracheo-oesophageal puncture46
4.3.2.3.Aetiology of periprosthetic leakage46
4.3.2.4.Leakage and prosthesis diameter47
4.3.2.5.Primary and secondary voice prosthesis placement48
4.3.2.6.Leakage and pharyngo-oesophageal stenosis/strictures48
4.3.2.7.Leakage and irradiation48
5.Importance of gastro-oesophageal reflux as a risk factor for enlargement
of the tracheo-oesophageal puncture57
5.1.Molecular biology causes of reflux-induced enlargement of the tracheo-oesophageal
puncture60
5.2.Other risk factors61
6.Treatment of periprosthetic leakage64
6.1.Supportive measures64
6.1.1.Prophylaxis of aspiration64
6.1.2.Ensuring food intake64
6.1.3.Drug treatment65
6.1.4.Management of enlargement of the tracheo-oesophageal puncture and periprosthetic leakage
using pharmacological antireflux therapy65
6.2.Conservative measures66
6.2.1.Downsizing66
6.2.2.Silicon washers67
6.2.3.Shrinking of the puncture70
6.2.4.Puncture augmentation (injection treatment)71
6.2.5.Botulinum toxin injections73
6.3.Surgical measures74
6.3.1.Surgical closure techniques74
6.3.2.Stents and epitheses79
7.Special prostheses85
7.1.Biofilm colonisation85
7.2.Material fatigue86
7.3.Periprosthetic leakage86
8.Epitheses to cover defects and epitheses for tracheostomas90
8.1.Background90
8.2.Clinical features and reduction in quality of life90
8.3.Treatment approach using individually fitted fistula epitheses90
8.4.Anatomical types of pharyngotracheal/oesophagotracheal fistulae91
8.5.Functional results, complications and long-term outcomes93
9.Diagnosis and therapy of phonation problems in voice prosthesis users95
9.1.Tracheo-oesophageal speech95
9.2.Role of the voice prosthesis95
9.3.Prevention of phonation problems95
9.3.1.Tracheostoma95
9.3.2.Tonicity of the neoglottis96
9.3.3.Voice and speech rehabilitation96
9.3.4.Patient education96
9.3.5.Timing of TE puncture97
9.4.Voice rehabilitation97
9.4.1.Patient selection97
9.4.2.Preoperative counselling97
9.4.3.Patient education97
9.4.4.Postoperative voice and speech training97
9.4.5.Further optimisation99
9.4.6.Problem solving103
10.Speech therapy110
10.1.Communication - the overriding goal110
10.2.The route towards voice function110
10.2.1.Information, counselling110
10.2.2.Pseudo-whispering as the first possibility for verbal communication111
10.2.3.Work on basic functions111
10.2.4.Starting to produce a voice112
10.3.Treatment focus at different time points of the rehabilitation process114
10.3.1.Loudness/blowing pressure114
10.3.2.Sound duration and phrase length114
10.3.3.Pitch and modulation115
10.4.Treatment options in phonation deficit - problems and solutions115
10.4.1.Unfavourable tone in the region of the PE segment115
10.4.2.Oedema116
10.4.3.Poor sealing of the tracheostoma116
10.4.4.Dried secretions, mucus plug, Candida colonisation116
10.4.5.Classic oesophageal speech116
11.Provision of aids, tubes, creation of a tracheostoma119
11.1.Pulmonary rehabilitation119
11.2.How the use of an HME impacts on voice quality120
11.3.New HMEs121
11.4.Fixation of aids at the tracheostoma121
11.5.Tracheostomy surgery122
11.6.Treatment of haemorrhagic tracheitis125
12.Quality of life and voice prostheses128
13.Pre-treatment counselling of cancer patients134
Index138