Role of Reflux in Tracheoesophageal Fistula Problems after Laryngectomy

• Published in: Annals of otology, rhinology & laryngology Vol. 119; no. 11; pp. 719 - 728
• Main Authors: Lorenz, Kai J., Grieser, Laura, Ehrhart, Theresa, Maier, Heinz
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-11-2010; Annals Publishing Compagny; SAGE PUBLICATIONS, INC
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Female; Gastroesophageal Reflux - etiology; Humans; Laryngeal Neoplasms - radiotherapy; Laryngeal Neoplasms - surgery; Laryngectomy; Larynx, Artificial; Medical sciences; Middle Aged; Mucous Membrane - radiation effects; Multivariate Analysis; Otorhinolaryngology. Stomatology; Pneumology; Prospective Studies; Respiratory system : syndromes and miscellaneous diseases; Tracheoesophageal Fistula - complications; Tracheoesophageal Fistula - pathology; complication; voice rehabilitation; reflux; pH monitoring; tracheoesophageal fistula; Diseases of the trachea; Respiratory disease; Esophageal disease; ENT; Tracheoesophageal fistula; Laryngectomy; Treatment; Surgery; pH; Digestive diseases; Complication; Voice; Monitoring
• ISSN: 0003-4894; 1943-572X
• DOI: 10.1177/000348941011901114

Objectives
The purpose of this 2-year prospective nonrandomized study was to investigate
the relationship between pathological supraesophageal reflux and the
occurrence of speech fistula complications, especially severe fistula
enlargement, in patients who underwent total laryngectomy and prosthetic
voice restoration.
Methods
We objectively assessed the presence of reflux disease using 24-hour
dual-probe pH monitoring in 60 laryngectomized patients, correlated the
incidence of tracheoesophageal fistula complications with the severity of
reflux, and assessed the risk of problems by determining the absolute number
of reflux events at the level of the speech fistula, the reflux area index
score, and the DeMeester score.
Results
All patients with fistula enlargement showed highly pathological results in
the diagnostic tests for reflux disease. Depending on reflux severity, the
relative risk of developing fistula complications was up to 10 times higher
for these patients.
Conclusions
We found a significant correlation between the occurrence of
tracheoesophageal fistula complications and the severity of supraesophageal
reflux. Potential chronic irritation of the esophageal and tracheal mucosa
can possibly contribute to the development of these problems. If the
presence of reflux disease has been confirmed by 24-hour dual-probe pH
monitoring, patients with fistula complications should be treated with
proton pump inhibitors.