[Voice rehabilitation after total laryngectomy. Voice prostheses or esophageal replacement voice?].

Background: During the last years tracheoesophageal fistula has a well established role and in several units is now the principal means of speech rehabilitation following laryngectomy. The purpose of this study is to present the long term results after using the Provox voice prosthesis and to compare the phonetic results obtained with this means of speech rehabilitation with esophageal speech.

Patients, Methods, And Results: During the last 7 years, 265 laryngectomy patients were trained in our Department in an effort to develop esophageal speech. One hundred and twelve of them developed comprehensive speech of various quality. In another group consisting of 35 patients, a Provox low-resistance, self-retaining prosthesis was fitted. Twenty-nine of them developed a very good voice. Ten patients of each group were tested in order to estimate the quality of voice of the two methods. Three measurements were obtained from each patient: the maximal intensity, the maximal phonation time, and the number of syllables with one breath.

Conclusion: All the results confirmed the better quality of the tracheo-esophageal speech. The main two advantages of the prosthesis are the effortless speech due to the low resistance of the valve and the simple maintenance by the patient. The most important disadvantage is the cost and the need to occlude the stoma during phonation. Conclusively each method of speech rehabilitation should be selected individually according to the needs, desire, and abilities of every patient.