Tracheoesophageal Puncture
Feb 21, 2009
The tracheoesophageal puncture procedure for alaryngeal voice restoration is one method that a person who has had a total laryngectomy can use to talk following removal of the larynx. TE speech is often chosen because of its similarity to normal laryngeal speech. The method involves the creation of a tracheoesophageal puncture (TEP) at the time of the laryngectomy, or later when the patient is well healed. The opening is maintained by a prosthesis that acts as a one-way valve by allowing lung air to pass into the esophagus for sound production when the stoma is covered. At the same time, it prevents food and liquid from entering the trachea. When TEP is done after the laryngectomy, it usually involves a minor surgery that can be done on an outpatient basis.
The operation involves the creation of a small opening in the wall that separates the trachea (windpipe) and the esophagus. After the surgeon has performed the puncture, a small red rubber catheter is placed in the puncture to keep it from closing and to allow it to form adequately before the voice prosthesis is placed. The catheter is usually left in place 3-7 days before it is removed and the TE voice prosthesis is fit. Most patients do not complain of any discomfort while the catheter is in place and go about their daily routine without difficulty. During this short period of time, patients are usually able to eat and drink normally without problems.
There are many different kinds of prostheses. Selection depends upon the physical characteristics and comfort level of the patient. Most of the time, 3-5 visits are required to properly size, fit, and teach the TE speaker to manage and use the voice prosthesis. The TE speaker usually covers the stoma with a finger or a thumb to divert pulmonary air through the prosthesis into the esophagus for sound production. The actual sound is produced by the vibration of the walls of the esophagus. The sound is then shaped by the movement of the articulators, lips, tongue, teeth, etc. to form words and conversation just as the normal laryngeal speaker does. Some tracheoesophageal speakers are successful using a tracheostomal breathing valve instead of a finger to occlude the stoma. With this device, normal breathing is uninhibited, but the valve closes automatically during exhalation for speech production, enabling the patient to speak with both hands free.
Most patients are evaluated prior to TE puncture by a trained speech pathologist who assumes the responsibility for or participates with the physician in evaluating the potential of the esophagus for sound production to ensure TE speech success. Once the appropriate prosthesis has been fit, the TE speaker is taught to clean, remove, and reinsert the prosthesis. He or she is also shown how to apply and remove the tracheostoma valve should this device be used.
Care and maintenance of the prosthesis is not difficult. Most patients independently remove and replace it without problems. Other patients prefer to have their prosthesis replaced by their speech pathologist or physician. The average TE voice prosthesis lasts 2-3 months before it is removed, and a new one is reinserted. However, some patients are able to wear the prosthesis for much longer periods of time, up to and in some instances, beyond one year, before they need to remove it. Other patients find that they need to remove the prosthesis sooner. Again, the speech pathologist assists the TE speaker in selecting the appropriate prosthesis and developing a management routine to maximize the longevity of the voice prosthesis and to avoid problems.
The key to tracheoesophageal speech candidacy is good sound production. Usually the only contraindication to tracheoesophageal puncture is continued alcohol abuse and impaired cognitive-mental functioning. Pulmonary function must be adequate to support sound generation. Manual dexterity and good vision are important but not absolutely imperative for those patients who rely on the speech pathologist, physician or significant other to replace the prosthesis. The use of adaptive devices such as the tracheostoma breathing valve provide automatic diversion of airflow, thereby eliminating the need for digital occlusion for some patients.
There are several factors that are not considered contraindications to tracheoesophageal puncture procedures. These include diabetes, unilateral or bilateral neck dissections, and radiation therapy. The patient's medical status and surgical requirements should always be evaluated by the physician prior to tracheoesophageal puncture so as to ensure success postoperatively. Patients who have had extended surgical procedures including removal of other structures as well as the larynx may also be candidates. Good preoperative evaluation will determine appropriate candidacy.
The method of tracheoesophageal speech restoration offers many laryngectomees the potential for spontaneous, effortless speech production. It is important, however, that patients be evaluated properly and discuss their options with trained medical professionals prior to puncture to ensure postoperative TE speech success and avoid communicative frustration.
The operation involves the creation of a small opening in the wall that separates the trachea (windpipe) and the esophagus. After the surgeon has performed the puncture, a small red rubber catheter is placed in the puncture to keep it from closing and to allow it to form adequately before the voice prosthesis is placed. The catheter is usually left in place 3-7 days before it is removed and the TE voice prosthesis is fit. Most patients do not complain of any discomfort while the catheter is in place and go about their daily routine without difficulty. During this short period of time, patients are usually able to eat and drink normally without problems.
There are many different kinds of prostheses. Selection depends upon the physical characteristics and comfort level of the patient. Most of the time, 3-5 visits are required to properly size, fit, and teach the TE speaker to manage and use the voice prosthesis. The TE speaker usually covers the stoma with a finger or a thumb to divert pulmonary air through the prosthesis into the esophagus for sound production. The actual sound is produced by the vibration of the walls of the esophagus. The sound is then shaped by the movement of the articulators, lips, tongue, teeth, etc. to form words and conversation just as the normal laryngeal speaker does. Some tracheoesophageal speakers are successful using a tracheostomal breathing valve instead of a finger to occlude the stoma. With this device, normal breathing is uninhibited, but the valve closes automatically during exhalation for speech production, enabling the patient to speak with both hands free.
Most patients are evaluated prior to TE puncture by a trained speech pathologist who assumes the responsibility for or participates with the physician in evaluating the potential of the esophagus for sound production to ensure TE speech success. Once the appropriate prosthesis has been fit, the TE speaker is taught to clean, remove, and reinsert the prosthesis. He or she is also shown how to apply and remove the tracheostoma valve should this device be used.
Care and maintenance of the prosthesis is not difficult. Most patients independently remove and replace it without problems. Other patients prefer to have their prosthesis replaced by their speech pathologist or physician. The average TE voice prosthesis lasts 2-3 months before it is removed, and a new one is reinserted. However, some patients are able to wear the prosthesis for much longer periods of time, up to and in some instances, beyond one year, before they need to remove it. Other patients find that they need to remove the prosthesis sooner. Again, the speech pathologist assists the TE speaker in selecting the appropriate prosthesis and developing a management routine to maximize the longevity of the voice prosthesis and to avoid problems.
The key to tracheoesophageal speech candidacy is good sound production. Usually the only contraindication to tracheoesophageal puncture is continued alcohol abuse and impaired cognitive-mental functioning. Pulmonary function must be adequate to support sound generation. Manual dexterity and good vision are important but not absolutely imperative for those patients who rely on the speech pathologist, physician or significant other to replace the prosthesis. The use of adaptive devices such as the tracheostoma breathing valve provide automatic diversion of airflow, thereby eliminating the need for digital occlusion for some patients.
There are several factors that are not considered contraindications to tracheoesophageal puncture procedures. These include diabetes, unilateral or bilateral neck dissections, and radiation therapy. The patient's medical status and surgical requirements should always be evaluated by the physician prior to tracheoesophageal puncture so as to ensure success postoperatively. Patients who have had extended surgical procedures including removal of other structures as well as the larynx may also be candidates. Good preoperative evaluation will determine appropriate candidacy.
The method of tracheoesophageal speech restoration offers many laryngectomees the potential for spontaneous, effortless speech production. It is important, however, that patients be evaluated properly and discuss their options with trained medical professionals prior to puncture to ensure postoperative TE speech success and avoid communicative frustration.
0 comments:
Post a Comment