Inverse correlation between acid reflux and dwell time of voice protheses (Provox^®) in laryngectomy/laryngopharyngectomy patients: a retrospective analysis of a prospective cohort

To evaluate the impact of extraesophageal acidic reflux and proton pump inhibitor (PPI) therapy on the dwell time of Provox^® voice prostheses.

This is a retrospective review of prospectively recruited patients with total laryngectomy/ laryngopharyngectomy and rehabilitation with Provox^® voice prosthesis who underwent 24 h pH monitoring study. Associations between multiple acid exposure metrics (percentage of time at pH < 6.5, < 6.0, < 5.5, < 5.0, and Ryan score), clincal history and mean dwell time of the last three voice prostheses were assessed using linear regression analysis.

Twenty-two patients were included. Regression analysis showed an inverse relationship between acid exposure and the average dwell time in days of the voice prostheses (β = −1.85, 95% CI: −2.90 to −0.80, p = 0.0014, R2 = 0.40 for pH < 6.5 resp. β = −1.74, 95% CI: −2.95 to −0.52, p = 0.0071, R2 = 0.30 for pH < 6.0). Twelve patients were on regular PPI treatment, 10 patients were off PPI. Patients with PPI usage did not show a significantly different acid exposure in the neopharynx. No difference in the dwell time between the patients with and without regular PPI therapy was observed.

In our cohort, acid reflux exposure is inversely correlated with the dwell time of Provox^® voice prostheses. PPI treatment was not associated with a reduced acid exposure and prolonged dwell time of the voice prostheses, indicating insufficient effect or other mechanisms involved. Further studies are needed to identify effective therapeutic strategies in prolonging voice prostheses dwell times.