Tracheoesophageal Prosthesis

By

Mimi Kimmet

and

Stephanie Smith

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).

Types of TEP’s

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

NON INDWELLING

Blom-Singer Prosthesis and insertion tool

INDWELLING

Low pressure InHealth prosthesis and

insertion tool with gel caps

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.

Step 1: Removal of Old TEP

Hemos were used to clamp and lock onto the TEP

The TEP was gently pulled outward

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

Step 3: Measuring

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

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

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

Visual Representation of Esophageal Voice

Visual Representation of Old TEP Voice

Visual Representation of New TEP Voice

A comparison of pitch measures

0

100

200

300

400

500

600

Old TEP New TEP Esophageal

FundamentalFrequency (Hz)

MinimumRangeMaximumRange

A comparison of voiced energy

0

10

20

30

40

50

60

70

Old TEP New TEP Esophageal

Mean (dB)Minimum RangeMaximum Range

Cycle to cycle changes in intensity

0

0.5

1

1.5

2

2.5

3

3.5

Old TEP New TEP Esophageal

Shimmer (dB)

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.

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.