Management of leaking tracheoesophageal puncture with hyaluronic acid injection

BACKGROUND: Tracheoesophageal puncture (TEP) with voice prosthesis is a widely used technique for voice restoration in laryngectomy and pharyngolaryngectomy patients. Complications include leakage around the prosthesis or a persistent TEP postremoval of the prosthesis. METHODS: We describe a method for managing leakage around voice prosthesis or persistent TEP using hyaluronic acid injection. We also present a retrospective audit of our practice. RESULTS: This study had 8 patients who were treated over a 32-month period. All cases had immediate cessation of salivary leak. Duration of efficacy was variable. Five of the 8 cases had permanent resolution of their symptoms after multiple injections. Two cases of persistent TEP were treated surgically after multiple injections. One patient with peripheral leakage continues to have regular injections. CONCLUSION: Hyaluronic acid injection in the treatment of persistent TEP or peripheral leak around a voice prosthesis is a useful treatment option to provide immediate and occasionally long-lasting relief from symptoms.