Objective: To discuss the best position of the prosthesis after total laryngectomy and the possible way to improve.
Method: Thirty-three patients with vocal prosthesis after total laryngectomy through April 1994 and July 2004 were selected. Among them, 10 cases were selected from 12 nonspeakers were defined as the experiment group; 10 cases with the same gender and nationality and closed occupation, age, the type of pathology,ways of the operation were selected from the rest cases who had got voice as the contrasted group. And intraesophageal pressure measurements, esophageal insufflation testing, esophageal barium solution x-ray, laryngofiberscopy were performed. Paired-samples t-test was adopted.
Result: The distances from nostril to the entrance of esophagus, the best vocal position and the level of vocal prosthesis have no significant difference between two groups. The esophageal insufflation testing showed there was no one case got the voice in the experiment group and there were 7 cases got voice in the contrasted group. The best voice position of the experiment group were at 3.6 cm above the prosthesis, and the contrasted group were at 2 cm above the prosthesis. The pressure of superior esophagus suggested that the pressure of 1 cm below the entrance of esophagus and 2 cm below the prosthesis were lower and there were no significant difference (P > 0.05) between two groups, but the pressures of the level of prosthesis were higher and there were significant difference (P < 0.01) between them.
Conclusion: The pressure at the level of the prosthesis in experiment group were more higher than the contrasted group was the main factors for failure to get voice. The best voice position could be found in both groups below the entrance of the esophagus, and below it was the level of the prosthesis with the highest pressure which could effectively prevent the air from flowing into the stomach. Allow the air flow into the position by operations and the reform of the prosthesis could solve the problem of could not get the voice and improve the rate of success to get voice.