Letter to the Editor
In reference to Voice rehabilitation with voice prosthesis: Long-term results, complications, and risk factors
Con referencia a Rehabilitación de la voz con prótesis fonatorias: resultados a largo plazo, complicaciones y factores de riesgo
a Otorhinolaryngology – Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Galicia, Spain
b Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), Santiago de Compostela, Galicia, Spain
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The improvement of VP has not been accompanied by an increase in its duration,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> so studies of this type continue to be necessary.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">First, the results obtained regarding the duration of the VP are noteworthy (>7 months).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> These results are far from those obtained by other authors (2–3 months),<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4</span></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"><span class="elsevierStyleSup">5</span></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"><span class="elsevierStyleSup">4,5</span></a> What is this favorable data due to according to the authors?</p><p id="par0015" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">2–4</span></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"><span class="elsevierStyleSup">4</span></a> The prophylactic treatment with proton pump inhibitors<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>alginate may be justified in patients with substantial fistula enlargement.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></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"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">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 “<span class="elsevierStyleItalic">the longer the patients are followed, the greater number of replacements are</span><span class="elsevierStyleItalic">made</span>”, being one of the main conclusions of the study.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></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.</p><p id="par0025" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">2,3</span></a> so it would be interesting to clarify what kind of systematic approach has been used.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">There 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.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Voice rehabilitation with voice prosthesis: long term results, complications and risk factors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Martins de Sousa" 1 => "R. Matos" 2 => "H. Vilarinho" 3 => "M. Santos" 4 => "H. 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González-Botas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00405-018-5008-2" "Revista" => array:6 [ "tituloSerie" => "Eur Arch Otorhinolaryngol" "fecha" => "2018" "volumen" => "275" "paginaInicial" => "1827" "paginaFinal" => "1830" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29799083" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A one-year time frame for voice prosthesis management. What should the physician expect? Is it an overrated job?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Parrilla" 1 => "Y. Longobardi" 2 => "G. Paludetti" 3 => "M.E. Marenda" 4 => "L. D’Alatri" 5 => "F. 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