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Tracheoesophageal Prosthesis

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Amanda Council

on 8 May 2017

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Transcript of Tracheoesophageal Prosthesis

Tracheoesophageal Prosthesis
(TEP)

What is it?
possible treatment following a total laryngectomy
most likely due head/neck cancer, etc.
or trauma to larynx
my patient had cancer of his laryngeal wall (his brother too, actually)
men to women ratio, 4:1
one way valve, placed into a fistula, that was created by surgery
rarely, it may come dislodged
located in the wall between the esophagus and trachea
posterior wall of the trachea
anterior wall of the esophagus
CANNOT ASPIRATE!
for: voice rehabilitation
"improved speech outcomes and patients rated a higher satisfaction and QOL compared to other options of voice rehab" (Naunheim et al. 2015)
Advantages of TEP:
high success rate
speech is intelligible & develops faster
resembles laryngeal speech
easily reversible
can be performed after many forms of neck dissection (Thiagarajan, 2015)
Patient's Role
maintains the cleanliness of the prosthesis (if necessary)
occlude the stoma
in order for air to enter the anterior opening of the TEP
air then goes into the esophagus
vibrating the esophagus --> speech!
the articulators still assist in the speech output
Frank....
SLP sets up by cleaning the area (i.e. table, chairs, etc.)
places towels down to cover all surfaces
wears gloves and protective goggles
cleans the area around his TEP
removes the current valve (TEP)
uses a lubricant to allow for easy insertion of the dilator to hold the fistula while she prepares the new TEP
a gel capsule is broken in half and placed on the end of the new TEP, the capsule will dissolve and allow the end of the TEP to expand within the wall-- the SLP waits roughly 3 minutes
the valve has a lip on the end that has to be closed, when you look through the valve (TEP) you should see white, rather than flesh colored skin
have patient drink water to be sure none is leaking out of the valve
also counting to assess voicing
Case Study,
we will call him Frank
Patient uses Blom-Singer --one of the main distributors of the device (invented in 1980)
Non-indwelling voice prosthesis
typically maintained by the client
less expensive
Indwelling voice prosthesis
clinician manages
changed 3-6 months
He also drinks a lot of beer, therefore yeast builds up in the valve
infection
perception of voice



Our Role as the SLP


educate the patient and family
options for speech:
Esophageal speech
Esophageal speech via TEP/voice prosthesis-
Artificial larynx/electrolarynx
provide follow-up
cleaning (if necessary)
speech therapy
resonance
articulation
phrasing patterns
References
Leuin, S. C., & Deschler, D. G. (2013). The missing tracheoesophageal puncture prosthesis:
Evaluation and management. ENT: Ear, Nose & Throat Journal, 92(2), 1-4 4p.

Musfeldt, R. (2013). Tracheoesophageal Voice Restoration.

Naunheim, M. R., Remenschneider, A. K., Scangas, G. A., Bunting, G. W., & Deschler, D. G. (2016).

The Effect of Initial Tracheoesophageal Voice Prosthesis Size on Postoperative Complications
and Voice Outcomes. Annals Of Otology, Rhinology & Laryngology, 125(6), 478-484 7p. doi:10.1177/0003489415620426

Thiagarajan, B. (2015). Voice Rehabilitation Following Total Laryngectomy. Online Journal Of
Otolaryngology, 5(1.5), 62-83.
Full transcript