It is important on a periodic basis to evaluate and re-evaluate the standard of care in your area and to compare it to the care provided in other parts of the world. This can result in modifications and improvement in the patient's outcome.
Over the last year, additional weight has been added to the medical literature regarding the value of moisture exchangers, chronic low-risk medications, the relationship between vocal rehabilitation and esophageal reflux disease, as well as the chronic concern regarding tracheo-esophageal puncture site enlargement. Multidisciplinary input remains critical for optimum success as measured not only by the vocal outcomes, but also by the quality-of-life metrics.
Optimum outcomes for vocal rehabilitation following laryngectomy suggest the need for careful multidisciplinary perioperative planning and therapy. There have been improvements in tracheo-esophageal prosthesis design, moisturization, and ease of speech generation. Additional research is needed to explore the relationship between speech and chest wall kinematics, puncture site and location, prosthesis leakage, and the potential relationships to gastro-esophageal reflux disease. Future effort should be directed toward measurable improvements in the quality of life.
Department of Otolaryngology – Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
Correspondence to Michael L. Hinni, MD, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA. Tel: +1 480 342 2928; fax: +1 480 342 2626; e-mail: email@example.com