Tracheoesophageal Prosthesis

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Tracheoesophageal Prosthesis

• By
• Mimi Kimmet
• and
• Stephanie Smith

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What is a Tracheoesophageal Prosthesis (TEP)?

• A TEP is a one way valve inserted through the
  tracheostoma and placed between the posterior
  tracheal wall and the anterior esophageal wall
  (Wetmore et. al, 1985).
• The TEP diverts the airflow from the lungs
  through the trachea and into the esophagus,
  allowing the laryngectomee patient to produce
  voice (Singer and Blom, 1980).

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Types of TEPs

• INDWELLING
• Can stay in place for 3-6 months
• Requires SLP to remove/replace
• Less maintenance required
• Must have 2cm or greater tracheostoma
• Must pass esophageal insufflation test

• NONINDWELLING
• Must be removed every 3-4 days
• Patient can change prosthesis independently
• More education is required for removal, cleaning
  ,etc.
• Must have 2cm or greater tracheostoma
• Must pass esophageal insufflation test

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NON INDWELLING

• Blom-Singer Prosthesis and insertion tool

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INDWELLING

• Low pressure InHealth prosthesis and insertion
  tool with gel caps

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OUR STUDY

• The purpose of our study was to size and fit a
  TEP. Vocal characteristics of a sustained /i/
  were obtained and measured with the patients old
  TEP, his new TEP, and while using esophageal
  speech.

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Step 1 Removal of Old TEP

• Hemos were used to clamp and lock onto the TEP
• The TEP was gently pulled outward

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Step 2 Insertion of Catheter

• Upon removal of the patients old indwelling TEP,
  a catheter was immediately inserted
• The purpose of the catheter was to expand the
  width of the puncture and to keep the site open
  for new TEP insertion

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Step 3 Measuring

• A measuring tool was inserted into the puncture
  site to determine the size of prosthesis used in
  fitting

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Step 4 Insertion of Non-indwelling TEP

• A 1.8cm Duckbill Blom-Singer voice prosthesis was
  inserted into the puncture site.
• Surgi-lube was used to aid in the ease of
  insertion
• The Duckbill was removed and immediately replaced

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Step 5 Insertion of Indwelling TEP

• A Blom-Singer Low Pressure indwelling prosthesis
  was inserted into the puncture site.
• A gel cap was used to provide aid in insertion,
  which dissolved within seconds, allowing the
  prosthesis to expand and adhere to the anterior
  esophageal wall
• The insertion flap was then removed by cutting it
  off with scissors

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Visual Representation of Esophageal Voice
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Visual Representation of Old TEP Voice
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Visual Representation of New TEP Voice
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A comparison of pitch measures
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A comparison of voiced energy
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Cycle to cycle changes in intensity
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What We Found

• Overall there were no significant differences
  between the old TEP, new TEP, and esophageal
  speech.
• Although the intensity measures with esophageal
  voicing were the lowest, this was the patients
  preferred method of voicing.
• Fitting of the TEP was much easier than we
  expected and required a minimal amount of time to
  complete.

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References

• Singer, M. I., and Blom, E. D. (1980) An
  endoscopic technique for restoration of voice
  after laryngectomy. Ann Otolaryngology. 89,
  529-33.
• Wetmore, S. J., Krueger, K., Wesson, K.,
  Blessing, M. L. (1985). Long-term results of the
  Blom-Singer speech rehabilitation procedure.
  Archives of Otolaryngology. 111(2), 106-9.
• Tracheoesophageal voice prosthesis (n.d.)
  Retrieved September 15, 2002 from
  http//web.nmsu.edu/ lleeper/pages/Prosth.