Post Laryngectomy Voice Rehabilitation and Gastroesophageal Reflux

The large detrimental potential of reflux on upper airways is well recognized and it has been assessed in several pathological conditions, moreover it has been proven that its control with proper therapy has been curative in most of such cases. An extreme of the harmful capability or the gastroesophageal reflux has been seen in laryngeal cancer, recognizing a relationship both as independent factor and as synergistic player with alcohol and tobacco in the development of the neoplasm. Nevertheless, among the several presentation forms that reflux could have, there are many not completely cleared and many pathological correlation just begin to loom, such as the role in voice rehabilitation failure after laryngectomy. Nowadays treatment options are mainly addressed toward functional surgery but there are still wide groups of patients needing more radical approaches and total laryngectomy yet remains one of the most debilitating form of cure. The loss of such organ links to two major physiological modifications: respiratory and phonatory. As the former is concerned, different process of adaptation develop both in the upper and in the lower airways, bringing to a new balance, which is not complete e.g. smell loss and epithelial modification but which is suitable for a normal life and can be assisted with different options e.g. heat moist exchange devices and pharmacological treatment. Conversely, phonation doesn’t have any form of physiological recovery and since the 1870 many paths have been followed towards the most efficient and affordable forms of rehabilitation. Today there are three possibilities: esophageal speech, electrolarynx and voice prosthesis. The last is the most important option for its intelligibility, naturalness and patient’s acceptance; however the use of prosthesis needs surgical preparations and, especially, continuous management. According to recent findings gastroesophageal reflux could play a major role in the failure of prosthesis use. Both literature review and Authors’ experience is analyzed to evaluate a significant correlation between the role of reflux and tracheoesophageal fistula related problems, considering that the acknowledgment of the causative role of reflux as limiting factor in voice rehabilitation could provide not only a better understanding of aethiopathogenetic process but, above all, could lead to targeted therapeutic options.