92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech

Name of the Procedure:

Evaluation for Use and/or Fitting of Voice Prosthetic Device to Supplement Oral Speech

Summary

This procedure involves assessing and fitting a special device called a voice prosthesis, which helps individuals who have lost their natural voice due to medical conditions speak more easily and clearly.

Purpose

The procedure aims to help individuals regain the ability to speak intelligibly after voice loss, often seen in patients who have undergone a laryngectomy (removal of the voice box). The goal is to improve the patient's quality of life by restoring verbal communication.

Indications

• Partial or complete loss of voice due to surgery, specifically a laryngectomy.
• Vocal cord paralysis or severe dysfunction.
• Tracheoesophageal puncture (TEP) patients who require a voice prosthesis.
• Patients who have tried other methods of voice restoration but found them ineffective.

Preparation

• Patients may be advised to refrain from eating or drinking several hours before their appointment.
• A thorough medical history and physical examination will be conducted.
• Imaging studies or endoscopic evaluations may be necessary to assess the anatomy and ensure a proper fit.

Procedure Description

1. Initial Assessment: The speech-language pathologist (SLP) evaluates the patient's vocal anatomy and overall health status.
2. Device Selection: Based on the assessment, the most suitable voice prosthesis is chosen.
3. Fitting the Device: The SLP or ENT specialist inserts the voice prosthesis into the tracheoesophageal puncture (TEP) site.
4. Adjustment and Training: The device is adjusted for optimal fit, and the patient is trained on how to use it effectively, perform daily maintenance, and manage hygiene.

Tools, Equipment, and Technology

• Voice prosthesis device
• Endoscope for visual examination
• Clinical tools for insertion and adjustment

Anesthesia or Sedation

Local anesthesia may be used during the fitting process to ensure patient comfort.

Duration

The entire evaluation and fitting process typically takes about 1 to 2 hours.

Setting

This procedure is usually performed in an outpatient clinic or an ENT specialist's office settings.

Personnel

• Speech-language pathologist (SLP)
• ENT specialist (Otolaryngologist)
• Nurses or medical assistants

Risks and Complications

• Common Risks: Discomfort, minor bleeding, or soreness at the TEP site.
• Rare Risks: Infection, prosthesis dislodgement, or leakage around the prosthesis.
• Management: Prompt care and treatment by the healthcare team to address any issues.

Benefits

• Regains the ability to speak clearly.
• Improved quality of life and communication.
• Patients may notice benefits immediately, though optimal function can take practice and adjustment.

Recovery

• Patients can typically resume normal activities soon after the procedure.
• Instructions on daily care and maintenance of the prosthesis will be provided.
• Follow-up visits to ensure proper device function and monitor any issues.

Alternatives

• Electrolarynx: An external device that generates sound, but may be less natural-sounding.
• Esophageal Speech: Requires learning a new method of speaking, which can be difficult for some.
• Pros and Cons: Voice prosthesis typically provides more natural speech compared to other alternatives but requires maintenance and regular check-ups.

Patient Experience

• During the procedure, patients may feel slight discomfort but are generally comfortable with the use of local anesthesia.
• Post-procedure, patients will be guided on using their new voice, which can be a positive and uplifting experience.
• Pain management is minimal, involving over-the-counter pain relievers if needed.