Prosthetic voice restoration with the tracheostomal valve: A clinical experience

Abstract

Introduction: Tracheoesophageal puncture (TEP) and use of a voice prosthesis is not a panacea for all laryngectomies. This report presents results of longitudinal treatment of 24 patients with secondary TEP followed longitudinally for 10 years in a private practice setting. Unique to this report is a focus on the use of the entire voice restoration system including both the voice prosthesis and the automatic tracheostomal valve. Methods: All patients referred for secondary TEP between 1982 and 1992 are included. Voice quality and the longevity of vocal restoration were ascertained. Clinical problems and their solutions are reported. Results: Immediate vocal restitution was achieved in 19 of 24 patients. Voicing was produced in two more patients within a few weeks. Four patients were not available for long-term follow-up because of death due to recurrent disease. Overall, 60% of patients were rated excellent and 5% rated fair in communication over a long-term period. Thirty-five percent were rated failure. Discussion: TEP and the use of the voice restoration system enabled both hands to be free during speaking and is achieved by many laryngectomies. Patient evaluation, training, and follow-up with team problem-solving may increase success rates using this approach.