Ganesan, Sandhya (S);Finestone, Sofia A (SA);Smaoui, Sana (S);Shaver, Timothy Brandon (TB);Schottler, Jennifer (J);Thakkar, Punam (P);Joshi, Arjun (A);

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Am J Otolaryngol.2025 May 20;46(5):104681.doi:10.1016/j.amjoto.2025.104681

Abstract

INTRODUCTION: Tracheoesophageal puncture (TEP) with voice prothesis placement is a common method for voice restoration following total laryngectomy (TL). This study aims to determine patient factors associated with the need for more frequent TEP changes and maintenance in addition to TEP-associated complications.

METHODS: Patients who underwent TEP procedure were identified in the TriNetX Research Network. Cohorts were stratified by comorbidities, including diabetes, GERD, esophageal stricture, hypo/hyperthyroidism, tobacco and alcohol use, radiation history, and primary versus secondary TEP. Kaplan-Meier analyses assessed time to prosthesis change, and risks of complications, including fistula formation, local infection, prosthesis leak, aspiration pneumonia, and dysphagia, were calculated.

RESULTS: Among 4145 patients identified, diabetes was associated with increased risk of prosthesis leak and dysphagia. Hypothyroidism, GERD, and esophageal strictures were linked to higher rates of fistula formation, infection, prosthesis leak, aspiration pneumonia, and dysphagia. Primary TEP was associated with increased fistula and infection rates compared to secondary TEP. Radiation and tobacco use were significantly associated with dysphagia, and tobacco and alcohol use with higher infection and aspiration risks. Average time to TEP change was 72 days. Patients with GERD (HR 1.17, 95 % CI [1.06-1.29]) and esophageal stricture (HR 1.13, 95 % CI [1.02-1.26]) required more frequent prosthesis changes.

CONCLUSIONS: Understanding factors that affect TEP function and longevity can help optimize patient selection for TEP following TL. Patients at increased risk for complications resulting in the need for more frequent TEP changes should be carefully counseled during the discussion of voicing options following TL.