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In this case, a doctor makes a small hole in the rear of your stoma leading to the esophagus. Once this puncture heals, a prosthesis is fitted and inserted into the opening. To speak, you occlude (cover) the stoma with your thumb or finger and simply force air through the prosthesis into the esophagus. This air movement vibrates the walls of the esophagus and you can create sounds and words normally with your lips, teeth, and tongue, etc. The prosthesis has a one-way valve in it to prevent swallowed food and liquids from entering your stoma. Additionally, your stoma can be covered with a special valve, called a Hands-Free) that closes when you wish to speak, thus forcing air into the prosthesis. With this valve in place, you no longer need to occlude the stoma with your thumb/finger ... your hands are free.
Step 2. If the problem is with the prosthesis (voice is good open tract), the puncture should be dilated a sufficient length of time, and then the puncture tract length is carefully measured (not just a guess!). The prosthesis is inserted. Wait a few minutes if a gel cap insertion is used, so the capsule will completely dissolve. If the prosthesis is the correct length and properly inserted, it should rotate freely in the tract while it is still attached to the insertion tool. And if it is correctly inserted, you should feel resistance to gently trying to pull it back out while still attached to the inserter, because the esophageal flange is fully deployed in the esophagus. In many laryngectomees, you can see the esophageal flange of the prosthesis by passing a flexible endoscope through the nose and down into the upper esophagus. If the prosthesis is seen, you know that you have the correct size and that it is fully inserted into the puncture. It can be hard to see it sometimes because of secretions, the way healing occurs after surgery, and the absence of the usual landmarks that are there before surgery. Some tricks to get a good view: the scope is advanced slightly below the prosthesis. The examiner can tell where the scope is because the light of the scope will shine through the tissue allowing you to see it on the outside of the neck. You should occlude the stoma and try to voice on a long 'ahhhh' or 'eeeee' as the examiner very slowly removes the scope, and usually the prosthesis will be seen for a brief instant. It helps to record the exam and play it back because sometimes you think that you see the prosthesis but aren't sure. If the prosthesis isn't visualized with the scope, it may still be correctly inserted, just not easily visible. If the voice is worse with the prosthesis inserted in the puncture compared to open tract voicing, the prosthesis may be the wrong length or not correctly inserted, or you may need a prosthesis that has a lower resistance to the flow of air. The different types of prostheses have different levels of resistance.
My Voice: Tracheo-esophageal voice prosthesis use and …
This link takes you to #1 of 60, from which you can play them straight through. This one relates to body posture to counter hypotonicity (air coming through, little sound) with the patient using a TE prosthesis:
1. If you swallow and a drop or two leaks through the prosthesis, first you cough, than try this! Occasionally, food gets at the edge of the valve of the prosthesis and holds it open just enough that taking a drink will allow liquid to run into the trachea. This can cause spasms of coughing so you want to get it fixed as soon as possible. To check to see if this is the problem, I lean over so the water doesn't run down my trachea, use a light and mirror and sip a little water. Then I watch to see if it is dripping through the middle of the prosthesis. If it is, then a good flushing or cleaning should remove the food that has it blocked. I would clean with a brush (see hint above) and flush with the syringe/pipet. Drink some water and check it again. That should correct it, but, if you still have a leak, repeat the cleaning and flushing.
Tracheo-esophageal voice prosthesis use ..
A TEP (tracheoesophageal puncture) is a same-day, simple, surgery, where the doctor makes a small puncture in the wall between the trachea and esophagus. This puncture will hold a prosthesis, with a valve on the esophageal end, so that lung air can again be directed through the mouth by closing off the stoma during exhalation. Closing the stoma can be done with finger, thumb or hands free valve (see illustration above). This redirected column of air will pick up vibrations as it passes through a narrowed section of the esophagus, so talking is again possible for most people.
3. If you can't stop a leak coming through the prosthesis when you eat or drink, there are now plugs to use to stop up the passage through the prosthesis on a temporary basis untill you can get to your SLP for a change.
My Voice: Tracheo-esophageal voice prosthesis use …
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1. I have been using indwelling prostheses for just over a year now. Every one that my SLP has inserted has leaked liquid thru the middle when I do the swallow test. I live about an hour from the SLP and I just leave the TEP in and go home. By the time I get home the prosthesis has stopped leaking and I have no further problems. I am of the opinion that the process of folding the flange, inserting it in a gel cap, etc.. causes the TEP to be warped out of shape a little. It also takes some time for all of the gel cap to dissolve and disappear and also any KY jelly or other lubricant that was used during insertion.
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Step 1. Determine whether the problem with getting voice is a problem with the prosthesis, or with the patient's anatomy & physiology. To do this, we usually remove the prosthesis from the puncture and have the pt try to voice "open tract" on a prolonged 'ahhhhhh'. Don't swallow when there is nothing in the puncture or you will get saliva leaking through the puncture into your trachea. If the voice is good, the problem is with the prosthesis and you go to Step 2. If the voice is not improved, the problem is with the pt. Skip Step 2, and Go to Step 3.
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