To the Editor.—The recent article, "Hypertrophic Scarring of Tracheoesophageal Fistula Causing Vocal Failure," by Modica in the November issue of the Archives1 contains a number of misleading conclusions that require comment. The author tabulates a series of operative complications of tracheoesophageal puncture for vocal restoration collected from a literature review. He attributes hematoma and esophageal reflux to me, which were from an article describing the adjunctive procedure for voice restoration of pharyngeal constrictor myotomy.2 Neither complication is the result of the endoscopic voice restoration procedure, nor can a cervical spine fracture or esophageal perforation be directly attributed to the puncture procedure.3,4
The statement that "almost all patients seem to have at least a minor degree of aspiration of saliva" is exagerated and false. The histopathologic finding described as "chronic active ulcer, squamous mucosa, with underlying granulation tissue and fibrosis" does not substantiate the conclusion that the
SINGER MI. Tracheoesophageal Procedures and Voice Restoration. Arch Otolaryngol Head Neck Surg. 1989;115(5):633. doi:10.1001/archotol.1989.01860290091022
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