Does prosthesis diameter matter? The relationship between voice prosthesis diameter and complications

Objective. To assess the impact of tracheoesophageal voice prosthesis diameter and treatment status on prosthesisrelated complications. Study Design. Historical cohort study. Setting. Single academic medical institution. Subjects and Methods. Patients who underwent total laryngectomy (TL) between 1996 and 2008 were divided into 2 subgroups according to prosthesis diameter: 16F (n = 19) and 20/22F (n = 71). Each patient only used 1 diameter of prosthesis. Time to leakage through the prosthesis, number of episodes of leakage around the prosthesis, number of prosthesis dislodgements, and length changes after the first 6 months were chosen as outcomes of interest. Results. Analysis included 90 patients. Analysis of selected complications by prosthesis diameter revealed no significant differences for time to leakage through the prosthesis, number of leaks around the prosthesis, or dislodgement. Larger diameter prosthesis use was associated with a greater number of length changes (P = .008). Multivariable regression analysis did not find any significant association between prosthesisspecific complications and prosthesis diameter when controlling for other variables. Prior radiation was associated with an increased number of size changes (β = 2.0, P = .004) and a decrease in time to leakage through the prosthesis (β = -4.4, P = .048), after controlling for other variables. Conclusions. Prosthesis diameter is not associated with an increased prevalence of certain voice prosthesis complications in laryngectomy patients, regardless of initial treatment modality, whereas prior radiation or chemoradiation is associated with complications. These data suggest that factors affecting tissue health, rather than prosthesis size, may be more responsible for prosthesis complications.