Clancy K, et al. - Researchers conducted this investigation to analyze the outcomes of tracheoesophageal puncture voice prosthesis (TEP) placement in twice-radiated patients. After Institutional Review Board approval, they retrospective reviewed 80 individuals that had TEP from 2006 to 2017 at a single institution; of these 16 patients had undergone two courses of radiation. According to results, TEP removal was reported in half of the twice-radiated patients, with removal occurring at a median of 24.9 months after placement. Widening tracheoesophageal fistula, local recurrence, and dysphagia/esophageal stenosis were the reasons for the removal of prosthesis. There is a higher rate of TEP removal in the twice-radiated patient cohort and the need for surgical intervention for a complication associated with voice prothesis compared with a once-radiated cohort.