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Long-Term Results of Provox ActiValve, Solving the Problem of Frequent Candida- and “Underpressure”-Related Voice Prosthesis Replacements

Authors

  • Jessica Soolsma MSc,

    1. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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  • Michiel W. van den Brekel MD, PhD,

    Corresponding author
    1. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
    2. Academic Medical Center, University of Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
    • Michiel W. van den Brekel, MD, PhD, Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX Amsterdam, The Netherlands.
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  • Annemieke H. Ackerstaff PhD,

    1. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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  • Alfons J. Balm MD, PhD,

    1. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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  • Bing Tan MD, PhD,

    1. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
    2. Academic Medical Center, University of Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
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  • Frans J. Hilgers MD, PhD

    1. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
    2. Academic Medical Center, University of Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
    3. Institute of Phonetic Sciences/ACLC, University of Amsterdam, Amsterdam, the Netherlands
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Abstract

Objectives: To assess the long-term results of the Provox ActiValve, a prosthesis for voice rehabilitation after total laryngectomy that was designed to lessen the need for frequent replacements caused by Candida and “underpressure.”

Patients and Methods: Retrospective assessment of device lifetime, indications for replacement, voice quality, and maintenance issues, measured by a structured trial specific questionnaire, in a cohort of 42 laryngectomized patients, experiencing a short Provox2 device lifetime (median, 21 days).

Results: The median device lifetime of Provox ActiValve, replaced for leakage through the device and those still in situ at the date of data collection (N = 32), was 337 days (mean 376 days): a statistically significant 16-fold increase compared to the Provox2 prosthesis (P < .001). In 10 patients, replacement was fistula-related (median after 86 days): esophageal pouch (N = 4), fistula granulation (N = 3), extrusion of the device (N = 2), and periprosthetic leakage (N = 1). Eighty-six percent of the patients used a special lubricant to diminish “stickiness” of the valve. Provox ActiValve was preferred by 90% of the patients who completed the trial-specific questionnaire.

Conclusions: For patients requiring frequent device-related replacements, Provox ActiValve, also long-term, provides a true solution and thereby is a valuable addition to prosthetic voice rehabilitation.

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