For many patients, there is understandably a great deal of anxiety about how one will communicate after undergoing laryngectomy (surgical removal of the voice box). Fortunately, over the past several years the voicing options for such patients have improved dramatically. The primary reason for this has been the advent of the tracheoesophageal prosthesis (TEP). This device, which is inserted into a hole created between the laryngectomy stoma and the esophagus, allows patients to have a good quality, lung powered voice. The TEP, which is activated by the patient pressing on a button, works by forcing air into the esophagus and out the mouth. With the TEP, the majority of individuals are able to generate a remarkably clear and understandable voice that can even be used over the phone.
The puncture for the TEP may be placed at the initial surgery or during a subsequent procedure. TEP?s in general have a low incidence of complications, the most common being colonization of the tube by fungus that requires exchanging the tube for a new device. This is in general easy and can be done in the office. Less common complications include extrusion of the tube either into the esophagus or trachea, or aspiration caused by leakage of fluid around the tube from the esophagus. If the tube does fall into the esophagus or airway it will need to be retrieved, if fluid leaks around the tube, the TEP will likely be removed and the hole allowed to heal. A second puncture will be placed after the hole closes.
A second voicing options for patients not requiring a TEP, or for those who do not have the dexterity to use this device is the Servox artificial larynx. This is a handheld device that the patient holds near the mouth that generates sound. Historically these devices offered a very mechanical sound to the voice and were less understandable. However, recent advances in the Servox artificial larynxes offer a clearer and more realistic voice. This device therefore remains a viable alternative for patients unable or unwilling to undergo placement of a TEP.
If you have any questions about the voicing options after laryngectomy please give us a call.
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