In the past 30 years, the use of a
voice prosthesis has become the treatment of choice for the restoration of speech following
laryngectomy. Not only is the placement of a
voice prosthesis a simple
surgical procedure, but it is also associated with a low rate of complications and an excellent success rate. Approximately, 20-30 % of all patients with
voice prostheses, however, develop periprosthetic leakage with aspiration over time. Periprosthetic leakage is usually caused by an enlargement of the tracheo-oesophageal
fistula and substantially affects the quality of life of the patients concerned. In a retrospective analysis of our patients, the incidence of periprosthetic leakage was 35.7 % in a total of 232 patients who underwent
laryngectomy during a period of 20 years. Substantial enlargement of the tracheo-oesophageal
fistula which required multiple treatments occurred in 12.5 % of the patients. In this review, the various causes of
fistula enlargement are discussed on the basis of the literature and the experience that we have accumulated during the past 20 years in the management of patients with
voice prostheses.