Indications

Failure to obtain useful esophageal, and/or electrolarynx speech, or dissatisfaction with the results of either of the two, is the main indications for a secondary prosthetic voice rehabilitation procedure. The percentage of successful secondary prosthetic voice rehabilitations seems to be somewhat lower, compared with primary rehabilitation, probably due to the fact that the patient has not been using pulmonary driven speech for some time. Furthermore, there might be a negative selection aspect, because failed esophageal speakers might have more problems with hypertonicity of the PE-segment. Nevertheless, with proper training, and if necessary, treatment of hypertonicity of the PE segment, many secondary patients should be able to regain a useful prosthetic voice. In fact, we think that, as is the case for the primary prosthetic procedure, there are no real medical contraindications to this technique, with the exception of radiotherapy doses well exceeding 70 Gy in 7 weeks or the equivalent. As a matter of caution, it should be mentioned, that secondary punctures should not be performed within 6 weeks after completion of the irradiation. Severe stenosis of the pharynx, or a too narrow stoma are relative contraindications since in most patients these problems should be correctable. Also in patients in whom the pharynx and/or esophagus are reconstructed with a gastric pull-up procedure, the colon, a free tubed radial forearm flap, or a free revascularized jejunal graft, the method is applicable. If the patient is motivated enough, the method is worthwhile trying.