In reference to Voice rehabilitation with voice prosthesis: Long-term results, complications, and risk factors

Mayo-Yáñez, Miguel; Cabo-Varela, Irma

doi:10.1016/j.otorri.2021.10.003

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The improvement of VP has not been accompanied by an increase in its duration,<a class="elsevierStyleCrossRef" href="#bib0035">2</a> so studies of this type continue to be necessary.<a class="elsevierStyleCrossRefs" href="#bib0035">2–4</a>First, the results obtained regarding the duration of the VP are noteworthy (>7 months).<a class="elsevierStyleCrossRef" href="#bib0030">1</a> These results are far from those obtained by other authors (2–3 months),<a class="elsevierStyleCrossRefs" href="#bib0035">2,4</a> some of which are cited in the article itself, and being more similar to data obtained in studies with methodological biases.<a class="elsevierStyleCrossRef" href="#bib0050">5</a> It would be interesting to know which type of Provox is used, since large statistically significant differences have been shown between one generation and another and that information is missing in the methodology.<a class="elsevierStyleCrossRefs" href="#bib0045">4,5</a> What is this favorable data due to according to the authors?Second, apart from individual predisposition, various factors that could influence the duration of the VP have been discussed in the literature.<a class="elsevierStyleCrossRefs" href="#bib0035">2–4</a> A direct correlation between the incidence of severe fistula enlargement and reflux disease, confirmed by impedance-pH monitoring, has been demonstrated in several studies.<a class="elsevierStyleCrossRef" href="#bib0045">4</a> The prophylactic treatment with proton pump inhibitors±alginate may be justified in patients with substantial fistula enlargement.<a class="elsevierStyleCrossRef" href="#bib0045">4</a> This study lacks a detailed explanation in its methodology about the evaluation of a possible reflux or the presence of anti-reflux therapeutic measures, being able to represent a source of biases.<a class="elsevierStyleCrossRef" href="#bib0030">1</a>Third, regarding the statistical analysis, a multiple linear regression does not seem to be indicated in this type of study. In the discussion, this fact is directly specified with the sentence “the longer the patients are followed, the greater number of replacements aremade”, being one of the main conclusions of the study.<a class="elsevierStyleCrossRef" href="#bib0030">1</a> It seems logical. In the study of VP replacements, it is more interesting to conduct a Kaplan–Meier curves or proportional hazards regression model with the replacement of the VP as the event of interest, to assess the effect of the different variables and control the effect of time.Finally, the management of laryngectomized patients and of voice prosthesis users is complex and requires a multidisciplinary care (otolaryngologists and speech therapists) by professionals with experience in the field in order to reduce replacements and complications,<a class="elsevierStyleCrossRefs" href="#bib0035">2,3</a> so it would be interesting to clarify what kind of systematic approach has been used.Conflict of interestThere was no conflict of interest and authors have nothing to declare. This research does not involve human participants and was approved by the Hospital's Ethics Committee." 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Acta Otorrinolaringológica Española, Órgano Oficial de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello, y de la Academia Iberoamericana de Otorrinolaringología, es la revista más importante en Español dedicada a la Otorrinolaringología. En ella se reflejan los continuos progresos científicos y técnicos de la especialidad, lo que la convierte en una importante herramienta para mantenerse actualizado. La revista publica colaboraciones originales (artículos de investigación básica e investigación clínica), artículos de revisión, comunicaciones breves, casos clínicos, e imágenes, los cuales son sometidos a un riguroso proceso de revisión por pares. Todos los artículos publicados están además disponibles en inglés.

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