The hallmarks of successful alaryngeal voice rehabilitation following a total laryngectomy using tracheo-esophageal puncture with voice prosthesis : perspectives of key role players.

Abstract

A total laryngectomy (TL) affects the quality of life (QoL) of individuals who have undergone this surgical procedure, as changes are seen in respiration, swallowing and communication. The aim of this study was to gather perspectives of the hallmarks of successful alaryngeal voice rehabilitation by tracheo-esophageal puncture (TEP) with voice prosthesis of laryngectomy patients from key role players based at a public hospital in Gauteng Province, South Africa. A qualitative method of inquiry was used, namely a single-program, collective case study. A focus group, comprising of four individuals who had undergone a total laryngectomy, was held to identify the participants‟ views about successful voice rehabilitation. From this focus group, one successful communicator was identified to be interviewed individually. Five semi-structured, face-to-face individual interviews using open-ended questions were conducted with five key role players in alaryngeal voice rehabilitation. The interviewees comprised of the successfully rehabilitated person with total laryngectomy (PWTL), his caregiver, an ear, nose and throat surgeon, speech-language pathologist and specialist nurse, to gather their perspectives on the factors that contributed to successful alaryngeal voice rehabilitation using TES. The Thematic Framework Approach was used to qualitatively analyze the data. Factors identified as contributing to success included patient selection for tracheo-esophageal puncture, information provision, support in the form of support groups, spiritual as well as family support, stomal care, the skill of the team and key management issues. Issues related to finance adversely affect the provision of voice prostheses and/or the provision of correctly sized prostheses and accessories. Systems have been implemented at the hospital to provide the option of TEP with voice prosthesis without much consideration to the other two alaryngeal options; namely esophageal speech and electrolarynx speech. Implications for clinical practice have been identified especially the need to provide more social support services to persons with TL.