Name of the Procedure:

Artificial larynx, any type (HCPCS Code: L8500)

Summary

An artificial larynx is a device that helps individuals who have lost their voice box (larynx) to speak. This device can be electronic or mechanical and is commonly used following a laryngectomy, a surgical procedure to remove the larynx, often due to conditions like cancer.

Purpose

The artificial larynx addresses the loss of natural voice production due to the removal or dysfunction of the larynx. The primary goal is to enable the patient to speak again, restoring their ability to communicate verbally.

Indications

• Total laryngectomy (removal of the larynx) due to cancer or other medical conditions.
• Severe injury or trauma resulting in loss of laryngeal function.
• Patients requiring voice restoration when other vocal rehabilitation techniques are not viable.

Preparation

• No specific fasting or medication adjustments typically required.
• Pre-procedure assessments include a thorough medical history and an evaluation of the patient’s physical and emotional readiness for the device.
• Training sessions with a speech-language pathologist (SLP) to understand the device's usage.

Procedure Description

1. Selection: The appropriate type of artificial larynx is selected based on the patient’s needs and physical condition.
2. Training: The patient undergoes training with a speech-language pathologist to learn how to use the device effectively.
   • Electronic Device: Held against the throat, it produces vibrations that the mouth shapes into speech.
   • Mechanical Device: Placed in the mouth and powered manually, which also aids in shaping sounds into recognizable speech.
3. Adjustment: Initial adjustments and fine-tuning to ensure optimal performance and clarity.

Duration

• Initial fitting and training sessions may take several hours distributed over a few days.
• Ongoing adjustment sessions as needed.

Setting

Primarily performed in an outpatient clinic or a speech therapy center under the supervision of a speech-language pathologist.

Personnel

• Speech-language pathologist (SLP) for training and adjustment.
• Otolaryngologist (ENT specialist) for medical oversight.
• Medical technicians for device fitting and education.

Risks and Complications

• Common: Initial discomfort, learning curve in mastering the device.
• Rare: Skin irritation, device malfunction, or infection if not properly maintained.

Benefits

• Restoration of verbal communication.
• Improved quality of life and ability to engage in social and professional interactions.
• Immediate benefit once the patient becomes proficient in using the device.

Recovery

• Post-procedure care involves practice and ongoing training to effectively use the device.
• Regular follow-up with the SLP and ENT specialist for adjustments.
• Few physical restrictions; focus mainly on speech practice and device maintenance.

Alternatives

• Esophageal speech: Learning to speak using the esophagus to create sound.
• Tracheoesophageal puncture (TEP): A surgical option where a valve is placed to create sound via the stoma.
• Pros/cons: Other methods may require more extensive training or surgery but can offer more natural-sounding speech for some patients.

Patient Experience

• Initial adaptation period where the patient learns to use the device.
• Possible initial frustration with learning but improves with practice.
• Pain management is generally unnecessary, as the procedure is non-invasive.
• Support from SLPs provides strategies for comfort and improved communication skills.