Get access

Reflux as a cause of tracheoesophageal puncture failure

Authors

  • Kavita M. Pattani MD,

    1. Department of Otolaryngology Head and Neck Surgery, Louisiana State University Health Sciences Center, Feist-Weiller Cancer Center, Shreveport, Louisiana, U.S.A.
    Search for more papers by this author
  • Matthew Morgan MS,

    1. Department of Otolaryngology Head and Neck Surgery, Louisiana State University Health Sciences Center, Feist-Weiller Cancer Center, Shreveport, Louisiana, U.S.A.
    Search for more papers by this author
  • Cherie-Ann O. Nathan MD, FACS

    Corresponding author
    1. Department of Otolaryngology Head and Neck Surgery, Louisiana State University Health Sciences Center, Feist-Weiller Cancer Center, Shreveport, Louisiana, U.S.A.
    • Louisiana State University Health Sciences Center, Department of Otolaryngology, Head & Neck Surgery, 1501 Kings Highway, Shreveport, LA 71130
    Search for more papers by this author

Abstract

Objective:

To evaluate the response to empiric reflux management in treatment of tracheoesophageal punctures (TEP) failures.

Methods:

A retrospective chart review of patients with failed TEP was performed (n = 37). Only those patients without any documented anatomic cause for failure (n = 22) were then further reviewed to determine if empiric treatment for reflux improved voicing. Evidence of reflux was determined by either using video flexible scope of the neopharynx, barium swallows, 24-hour pH probes, and /or transnasal esophagoscopy (TNE). In 13 of 22 patients who had voicing difficulties and no evidence of reflux on these tests, empiric treatment with antireflux medications had been documented. The 22 patients were closely monitored to determine the role of reflux therapy and subsequent voicing outcomes.

Results:

Of the 22 patients studied, 9 were noted to have granulation tissue on the tracheal side of the prosthesis. All nine patients had complete resolution of the granulation tissue after antireflux treatment, and seven of nine were able to voice again. Of the patients with no obvious reason for TEP failure who were empirically treated for reflux, 62% (8 of 13) had TEP voice after treatment. Seventy-seven percent of our patients (17 of 22) had a positive response to treatment with aggressive reflux therapy.

Conclusions:

Previous studies have demonstrated patients with a total laryngectomy and/or radiation therapy have increased reflux. This study addresses reflux as a potential cause of TEP voicing problems. We noted 41% (9 of 22) of patients with voicing difficulties had granulation tissue surrounding the prosthesis as a result of reflux. Aggressive antireflux therapy proved beneficial in eradicating this problem. Prophylactic antireflux therapy may be warranted for patients undergoing TEP to reduce voicing problems. Laryngoscope, 119:121–125, 2009

Ancillary