Background: Effective voice restoration after total laryngectomy relies heavily on indwelling tracheoesophageal prostheses. This study describes our institutional experience with Provox device replacements over five years. This retrospective single-center study analyzed 147 Provox voice prosthesis replacements performed in 82 laryngectomized patients between December 2024 and February 2026. We also used data from the full institutional cohort (1059 procedures and 899 intervals from May 2020 to March 2026). Mixed-effects models with a random intercept for each patient were applied to evaluate factors influencing the time interval between replacements and binary outcomes (complications, prosthesis size change, and elective vs expedited status). Results: In this retrospective single-center study, 82 laryngectomized patients underwent a total of 147 voice prosthesis replacements (June 2024–February 2026). Analysis of the full historical cohort (1059 procedures, 899 intervals from May 2020 to March 2026) revealed a mean interval between replacements of 122.5 days (95% CI 114.5–130.4). Mixed-effects linear regression showed that a higher cumulative number of prior procedures was associated with shorter subsequent intervals (β = −3.70 days per procedure; 95% CI −5.84 to −1.56; p < 0.001), whereas planned elective replacements significantly prolonged the interval (β = +35.47 days; 95% CI 15.80–55.14; p < 0.001) and were less likely to require size change (OR = 0.33; p = 0.034). The overall complication rate was low, with complications occurring in 7 out of 147 voice prosthesis replacement procedures (4.8%). Central leakage accounted for ~50% of unscheduled replacements, peripheral leakage for 25%, and dysfunction of prostheses without phonation for 19%. Complications occurred in 7 of 147 voice prosthesis replacements (4.8%). They included granulation tissue formation (n=2), prosthesis displacement (n=3), and swallowing of the prosthesis (n=2). All were managed successfully without life-threatening events, confirming the high safety of outpatient voice prosthesis exchange. Conclusions: The complication rate was notably low, with adverse events occurring in only 7 out of 147 voice prosthesis exchanges (4.8%). These findings confirm the high safety profile of outpatient voice prosthesis replacement in a tertiary ENT setting. Moreover, our results suggest that proactive, scheduled prosthesis replacements are preferable, as they are associated with significantly longer device lifetimes, a reduced need for unscheduled emergency procedures, and an overall safer clinical course.

Background: Mounier-Kuhn syndrome is a rare disorder characterized by marked dilatation of the trachea and main bronchi, respiratory infections, bronchiectasis, and progressive respiratory failure. Lung transplantation (LTx) in this condition has only rarely been reported and may be technically challenging because of the abnormal size and structure of the main airways. Case presentation: We describe two consecutive patients with Mounier-Kuhn syndrome who underwent bilateral lung transplantation at our center. Both patients had advanced respiratory disease with marked tracheobronchial dilatation. In the first patient, preoperative planning included patient-specific three-dimensional reconstruction and printing of the trachea and proximal bronchi. Because of severe enlargement of the recipient bronchus, a telescopic bronchial anastomosis was used. The postoperative course was complicated by bronchial stenosis requiring repeated bronchoscopic interventions and stent placement. The second patient underwent bilateral LTx without major airway complications and had a favorable early postoperative course. Conclusions: Lung transplantation can be successfully performed in selected patients with end-stage respiratory failure due to Mounier-Kuhn syndrome. Careful preoperative airway assessment and individualized planning of bronchial anastomosis are crucial in such patients.

Background/Objectives: Indwelling tracheoesophageal prostheses have a limited lifespan and require repeated replacement. We examined the determinants of the replacement interval. Methods: This study conducted a retrospective single-center analysis of 147 consecutive Provox replacements in 82 laryngectomized patients (June 2024–February 2026), reported according to STROBE, using mixed-effects and gap-time recurrent-event models. Results: Median device survival was 141 days. Prior irradiation was associated with a shorter interval (−38.3 days; 95% CI −67.2 to −9.3; p = 0.010), with a gradient by treatment intensity: the median survival was 179, 136, and 84 days after primary surgery, radiotherapy alone, and chemoradiotherapy (log-rank p < 0.001; cluster-robust hazard ratios 2.19 and 5.13 against primary surgery). A higher cumulative replacement burden—in terms of lifetime exchanges per patient, with a median of eight and range of 1–28—was also associated with shorter intervals (β = −3.70 days per additional lifetime exchange; 95% CI −5.84 to −1.57), but it summarizes the same event process as the outcome and is reported as a phenotype marker. Intervals ending in elective exchange were longer (β = 35.47 days; 95% CI 15.80 to 55.14), but in the primary recurrent-event model, containing only covariates fixed at interval start and retaining censored intervals, elective placement showed no association with device lifetime (HR 0.574; 95% CI 0.309–1.066; p = 0.079); between-patient heterogeneity remained substantial (θ = 0.452; p = 0.002). Complications occurred in seven of 147 procedures (4.8%), which were all managed without life-threatening events. Conclusions: Prior oncological treatment, particularly chemoradiotherapy, is associated with materially shorter device survival and can be used to identify patients likely to require more frequent exchange. Outpatient exchange appears safe. The association between elective replacement and longer intervals reflects conditioning inherent in comparing scheduled with failure-driven exchange, not a benefit of scheduling.