Investigation of tracheoesophageal voice prosthesis leakage patterns: patient's self-report versus clinician's confirmation.

BACKGROUND This study investigated the patient's self-report and clinician's confirmation of tracheoesophageal voice prosthesis leakage patterns (through or around) with or without the cough reflex and whether prosthesis diameter affected the leakage route. METHODS Sixty-six consecutive participants with a total of 200 patient-initiated reasons for prosthesis changes were enrolled prospectively. Patient's self-report of leakage and cough reflex were recorded prior to clinician's confirmation. RESULTS One-hundred eight (54%) of the 200 patient-initiated reasons for prosthesis changes were leakage through or around the voice prosthesis. Leakage was unrecognized in 21 (23%) of 92 instances, even though 15 (71%) of those 21 instances exhibited a cough reflex. Clinician's confirmed leakage in 118 (59%) of 200 patient-initiated reasons for prosthesis changes. Coughing occurred significantly less with leakage around (9 [53%] of 17 instances) than that with leakage through the voice prosthesis (80 [88%] of 91 instances) (chi(2) [1, N=108], p< .05). Leakage around the voice prosthesis occurred more with 20-Fr diameter prostheses (16 [76%] of 21 instances). CONCLUSIONS Patient education is important for reliable identification of leakage for prompt prosthesis replacement. Leakage around the voice prosthesis can be minimized or avoided by initially fitting and continuing the use of smaller diameter (16 Fr) voice prostheses.