Post-laryngectomy voice rehabilitation: Comparison of primary and secondary tracheoesophageal puncture

Dan Guttman, Aviram Mizrachi*, Tuvia Hadar, Gideon Bachar, Yaniv Hamzani, Sari Marx, Jacob Shvero

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Voice restoration following total laryngectomy is an important part of patients' rehabilitation and long-term quality of life. Objectives: To evaluate the long-term outcome of indwelling voice prostheses inserted during (primary procedure) or after (secondary procedure) total laryngectomy. Methods: The study group included 90 patients who underwent total laryngectomy and tracheoesophageal puncture (TEP) with placement of voice prosthesis at a tertiary medical center during the period 1990-2008. Background, clinical and outcome data were collected by medical file review. Findings were compared between patients in whom TEP was performed as a primary or a secondary procedure. Results: TEP was performed as a primary procedure in 64 patients and a secondary procedure in 26. Corresponding rates of satisfactory voice rehabilitation were 84.4% and 88.5% respectively. There was no association of voice quality with either receipt of adjuvant radiation/chemoradiation or patient age. The average lifetime of the voice prosthesis was 4.2 months for primary TEP and 9.06 months for secondary TEP (p = 0.025). Conclusions: Primary TEP provides almost immediate and satisfactory voice rehabilitation. However, it is associated with a significantly shorter average prosthesis lifetime than secondary TEP. Chemoradiotherapy and patient age do not affect voice quality with either procedure.

Original languageEnglish
Pages (from-to)565-567
Number of pages3
JournalIsrael Medical Association Journal
Issue number9
StatePublished - Sep 2013


  • Alaryngeal speech
  • Laryngeal cancer
  • Laryngectomy
  • Tracheoesophageal fistula
  • Tracheoesophageal puncture (TEP)
  • Voice prosthesis


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