Tracheoesophageal Voice Prosthesis: What to Expect

Losing your voice after a total laryngectomy can feel like the end of the world, but a tracheoesophageal voice prosthesis can help you speak again.

If you're wondering how it works and what challenges come with it, this guide breaks it all down in a simple and easy-to-understand way. Keep reading to explore how this voice restoration option can improve your quality of life and what to expect if you choose it.

What is a Tracheoesophageal Voice Prosthesis

A tracheoesophageal voice prosthesis is a device that helps you speak again by connecting your windpipe (trachea) to your food pipe (esophagus).

It is commonly used after a total laryngectomy, a surgery that removes your voice box to treat throat cancer. This procedure eliminates natural voice production, making alternative speech methods necessary.

This prosthesis creates a passage for air to travel from your lungs into your esophagus, causing the upper part of the esophagus to vibrate and produce sound for speech.

This method often provides a more natural-sounding voice compared to other options.

How the Voice Prosthesis Works

The voice prosthesis is a one-way valve placed in the tracheoesophageal puncture (TEP). When you cover your tracheostoma or stoma, a small surgically created opening from the trachea to the outside of the neck, air from your lungs moves through the valve into your esophagus.

As the exhaled air passes through the upper part of the esophagus, the surrounding tissue vibrates, creating sound. Your tongue and lips then shape these sounds into speech.

However, this method of voice production cannot start until the surgical incisions have fully healed.

A tracheoesophageal puncture (TEP) is a small opening between your trachea and esophagus. This can be created during your initial surgery (primary TEP) or after healing (secondary TEP).

Primary TEP allows you to start voice rehabilitation sooner, while secondary TEP is chosen if extra healing time is needed. Your speech-language pathologist (SLP) will help determine the best timing and whether a TEP is the right option for you.

Advantages of Using a Voice Prosthesis

A voice prosthesis helps restore speech after a laryngectomy, making communication more natural. With proper training, you can find it easy to use and integrate into your daily life.

Here are some advantages of voice prosthesis:

• Produces clearer and more natural speech compared to other speech restoration methods.
  
• Enhances your quality of life by making communication easier
  
• Easy to use, allowing for smoother speech communication.
  
• Offers the option to speak hands-free with special attachments for your convenience.
  
• Accessories are available to help cover the stoma, filter inhaled air, and maintain humidity in the lungs for comfort.
  

While a voice prosthesis has many benefits, it also comes with challenges and the need for proper care to prevent issues.

Challenges and Maintenance of Voice Prosthesis

A voice prosthesis requires ongoing care to ensure it functions properly. While it offers a natural way to speak, it also comes with maintenance needs and potential challenges:

• Regular cleaning is essential to prevent blockage or infection.
  
• Requires a higher level of daily maintenance compared to other speech restoration options.
  
• May need periodic replacement, requiring return visits to have the TEP changed.
  
• Leakage around the device or displacement can occur, but these issues are usually manageable with prompt medical attention.
  
• Some complications may require additional medical visits to address and ensure proper function.
  
• Not all patients with a total laryngectomy benefit from a voice prosthesis.
  

Who May Not Be a Suitable Candidate

A voice prosthesis may not be the best option for individuals with:

• Impaired lung function or mental health conditions that affect speech rehabilitation.
• Limited dexterity or poor eyesight, makes it difficult to handle the prosthesis.
• Inability to manage tracheostomy and prosthesis care, which is essential for long-term use.
• Frequent dislodging of the prosthesis leads to repeated issues with function and comfort.

These factors should be carefully assessed by a healthcare professional to determine if a voice prosthesis is the right choice.

When to Replace Your Voice Prosthesis

A voice prosthesis does not last forever and will eventually need to be replaced. On average, the prosthetic valve lasts several months, but some can last up to a year.

The lifespan depends on factors like how well it is maintained, how often it is used, and individual differences in saliva and diet.

Signs that your prosthesis may need a replacement include:

• Increased leakage of fluids through or around the prosthesis.
• Changes in voice quality, such as difficulty speaking or reduced sound clarity.
• Frequent coughing while drinking, may indicate leakage into the airway.

The replacement procedure does not require surgery and is typically painless. It can be done in a doctor’s office in under an hour, often by a SLP. You can also learn to change your prosthetic valve at home with proper training and guidance.

Your SLP will monitor your prosthesis and provide recommendations on when and how to replace it based on your needs. Regular check-ups help ensure your device functions properly and continues to support clear and comfortable speech.

Alternative Speech Solutions Post-Laryngectomy

Alternative speech solutions for post-laryngectomy patients extend beyond tracheoesophageal voice prostheses. Esophageal speech and electrolarynx offer different ways to regain your ability to communicate effectively.

Esophageal Speech or Burp Talking

Esophageal speech (also known as burp talking) is a method that involves taking and releasing air with your mouth to vibrate your esophagus and make a sound, which is often rough or hoarse.

Unlike other speech restoration options, esophageal speech does not require surgery or external devices. However, mastering this technique takes time and training, often with the guidance of a speech and language therapist.

Electrolarynx or Artificial Voice Box

An electrolarynx, also called an artificial voice box, is a small battery-powered device that helps you produce speech. It is placed against your neck and under your chin, where it generates vibrations that travel through your skin to your throat.

While the voice produced by an electrolarynx has an electronic tone, it is clear and easy to understand with practice.

A speech therapist can help you learn how to use the device effectively, whether as your primary communication method or as a backup to other speech options.

Conclusion

Tracheoesophageal voice prosthesis serves as a transformative solution after total laryngectomy surgery, allowing you to communicate effectively. While it provides clearer and more natural speech, it also requires regular maintenance, periodic replacements, and medical follow-ups to ensure it functions properly.

If you're considering a voice prosthesis or exploring other speech options, working with a speech-language pathologist (SLP) is essential. They can help you determine the best solution, provide training, and guide you through adjusting to life after a laryngectomy. With the right support, you can regain your ability to communicate and improve your quality of life.

Frequently Asked Questions

Can you eat with a TEP?

Yes, you can eat with a TEP, but you need to clean it afterward. But if you feel like it's going down the wrong pipe, it may be leaking. If that's the case, consult with your healthcare team.

What should you do if you cannot see the tracheoesophageal voice prosthesis within the puncture?

If you cannot see the tracheoesophageal voice prosthesis within the puncture, you should go to the Emergency Room for a chest X-ray to determine its location and potential removal if it's in the lungs.