The Performance of Automatic Speaking Valves and Fixation Devices Enabling Hands-Free Speech Following Total Laryngectomy-A Systematic Review.

BACKGROUND: The percentage of daily automatic speaking valve use (AU) in laryngectomized patients has remained at ~25% since their invention. To increase this percentage, understanding the performance of existent devices is essential. Therefore, we reviewed studies reporting AU, fixation device lifetime (FDL), compliance, and voice and speech assessment outcomes (VSAOs). METHODS: Studies published until 23 April 2025 were included. Quality assessment was performed using RoB2, ROBINS-I, and JBI tools. RESULTS: Twenty studies were included, which were of poor methodological quality. AU and FDL were 3-13.25 h/day and 0.17-24 h/day. Baseline daily ASV compliance rate was 25%, increasing short-term but decreasing long-term. Reasons for non-compliance were inadequate fixation, skin problems, and voicing being too tiresome. There were no significant differences across ASVs in VSAOs. CONCLUSION: No single ASV or fixation device outperformed others. Personalized approaches, tailored to ASV experience, tracheostoma anatomy, and patient needs, may increase AU, FDL, and long-term compliance.