Provoxweb
  • Provoxweb
  • Voice--Speech Rehab
    • Speech Therapy >
      • Introduction
      • Preoperative counseling
      • Outline of voice therapy
      • Important basic principles in voice rehabilitation in prosthetic speech
      • Some points of attention for the 'finishing touch'
      • General aspects of patient instruction
      • Problem solving
      • Conclusion
  • Pulmonary Rehab
    • Introduction
    • Heat and Moisture Exchangers (HME's) >
      • Treatment aspects
      • Prevention aspects
    • Provox HME >
      • Compliance aspects
      • Improvements in compliance
      • Improvements in voicing
      • Early post-operative pulmonary hygiene
      • Breathing resistance
      • Newest Provox HMEs
    • Treatment with inhalation medication
    • Conclusions
    • References

Granulation tissue interfering with the prosthesis

Problem: granulation tissue is interfering with the voice prosthesis.

Formation of granulation tissue around the TE-fistula has been reported at a rate of approximately 5%. Mostly this is seen in conjunction with a local infection and treatment of such an infection will result in spontaneous disappearance of the granulation, as shown above. It is sometimes advisable to (temporarily) put in a longer prosthesis. If this is not the case or if immediate treatment is required in order to improve the voice, some sort of cauterization (electro-, chemo-, laser) of the area of the granulation may be considered. In conjunction with this, treatment with a broad-spectrum antibiotic is advisable. The figures right give an example of this: above priot to NdYAG laser excision, below the situation after 2 weeks. There is some circumstantial evidence of a causal relation between local infection and/or granulation tissue formation at the TEP site and gastroesophageal reflux. Therefore, it could be beneficial in treatment of refractory cases, to prescribe anti-reflux medication in order to break a ‘vicious circle’.

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© The Netherlands Cancer Institute - 2003-18; ISBN 90-75575-05-X