This book reviews, for the very first time, the causes of, and treatment options for, complications after surgical voice rehabilitation using voice prostheses.The authors, all with many years' experience in this field and with considerable involvement in developing treatment strategies, offer a comprehensive, practice-oriented review of the current state of knowledge on this issue and thereby provide a valuable guide for the management of complications - one that should be available in every ENT clinic.

1.Introduction131.1.Epidemiology131.2.Treatment approaches in laryngeal cancer131.3.History of laryngectomy131.4.Consequences of laryngectomy for the patient131.4.1.Loss of voice141.4.2.Loss of conditioning of inspired air141.4.3.Loss of the sense of smell141.5.Possibilities for voice rehabilitation141.5.1.Oesophageal voice141.5.2.Electronic speaking aids151.5.3.Surgical techniques for voice rehabilitation151.6.Value of voice rehabilitation with voice prostheses161.6.1.Prosthesis technique171.6.2.Indwelling/non-indwelling prostheses182.Physiology of voice production after laryngectomy222.1.Conservative methods for voice rehabilitation222.2.Voice-producing segment232.3.Possibilities for the differential diagnosis273.Change of voice prosthesis303.1.Operation technique303.1.1.Primary puncture and placement of a voice prosthesis303.1.2.Secondary placement of a voice prosthesis313.2.Changing the voice prosthesis333.2.1.Retrograde voice prosthesis replacement333.2.2.Antegrade voice prosthesis replacement343.2.3.Non-indwelling prostheses363.2.4.Practical procedure374.Complications after insertion of a voice prosthesis404.1.Major complications404.2.Minor complications404.3.Leaks414.3.1.Transprosthetic leakage414.3.1.1.Prosthesis-related problems424.3.1.2.Puncture-associated problems434.3.1.3.Phenomenon of negative thoracic pressure444.3.2.Periprosthetic leakage and tracheo-oesophageal puncture enlargement444.3.2.1.Incidence of periprosthetic leakage464.3.2.2.Pathology of the tracheo-oesophageal puncture464.3.2.3.Aetiology of periprosthetic leakage464.3.2.4.Leakage and prosthesis diameter474.3.2.5.Primary and secondary voice prosthesis placement484.3.2.6.Leakage and pharyngo-oesophageal stenosis/strictures484.3.2.7.Leakage and irradiation485.Importance of gastro-oesophageal reflux as a risk factor for enlargement of the tracheo-oesophageal puncture575.1.Molecular biology causes of reflux-induced enlargement of the tracheo-oesophageal puncture605.2.Other risk factors616.Treatment of periprosthetic leakage646.1.Supportive measures646.1.1.Prophylaxis of aspiration646.1.2.Ensuring food intake646.1.3.Drug treatment656.1.4.Management of enlargement of the tracheo-oesophageal puncture and periprosthetic leakage using pharmacological antireflux therapy656.2.Conservative measures666.2.1.Downsizing666.2.2.Silicon washers676.2.3.Shrinking of the puncture706.2.4.Puncture augmentation (injection treatment)716.2.5.Botulinum toxin injections736.3.Surgical measures746.3.1.Surgical closure techniques746.3.2.Stents and epitheses797.Special prostheses857.1.Biofilm colonisation857.2.Material fatigue867.3.Periprosthetic leakage868.Epitheses to cover defects and epitheses for tracheostomas908.1.Background908.2.Clinical features and reduction in quality of life908.3.Treatment approach using individually fitted fistula epitheses908.4.Anatomical types of pharyngotracheal/oesophagotracheal fistulae918.5.Functional results, complications and long-term outcomes939.Diagnosis and therapy of phonation problems in voice prosthesis users959.1.Tracheo-oesophageal speech959.2.Role of the voice prosthesis959.3.Prevention of phonation problems959.3.1.Tracheostoma959.3.2.Tonicity of the neoglottis969.3.3.Voice and speech rehabilitation969.3.4.Patient education969.3.5.Timing of TE puncture979.4.Voice rehabilitation979.4.1.Patient selection979.4.2.Preoperative counselling979.4.3.Patient education979.4.4.Postoperative voice and speech training979.4.5.Further optimisation999.4.6.Problem solving10310.Speech therapy11010.1.Communication the overriding goal11010.2.The route towards voice function11010.2.1.Information, counselling11010.2.2.Pseudo-whispering as the first possibility for verbal communication11110.2.3.Work on basic functions11110.2.4.Starting to produce a voice11210.3.Treatment focus at different time points of the rehabilitation process11410.3.1.Loudness/blowing pressure11410.3.2.Sound duration and phrase length11410.3.3.Pitch and modulation11510.4.Treatment options in phonation deficit problems and solutions11510.4.1.Unfavourable tone in the region of the PE segment11510.4.2.Oedema11610.4.3.Poor sealing of the tracheostoma11610.4.4.Dried secretions, mucus plug, Candida colonisation11610.4.5.Classic oesophageal speech11611.Provision of aids, tubes, creation of a tracheostoma11911.1.Pulmonary rehabilitation11911.2.How the use of an HME impacts on voice quality12011.3.New HMEs12111.4.Fixation of aids at the tracheostoma12111.5.Tracheostomy surgery12211.6.Treatment of haemorrhagic tracheitis12512.Quality of life and voice prostheses12813.Pre-treatment counselling of cancer patients134Index138