Name of the Procedure:

Tracheo-esophageal Voice Prosthesis Insertion

• Common Name: Voice Prosthesis Insertion
• Technical/Medical Terms: Tracheo-esophageal puncture (TEP) prosthesis insertion

Summary

A tracheo-esophageal voice prosthesis insertion is a medical procedure where a small device is placed between the trachea and the esophagus. This device allows individuals who have had their larynx (voice box) removed to speak again.

Purpose

• Medical Conditions: Typically performed on patients who have had a laryngectomy (surgical removal of the larynx), often due to cancer.
• Goals/Outcomes: The primary goal is to restore the ability to speak. The voice prosthesis reestablishes a passage of air between the trachea and the esophagus, enabling sound production for speech.

Indications

• Symptoms/Conditions: Loss of natural voice due to laryngectomy.
• Patient Criteria: Patients must be sufficiently healed from laryngectomy surgery and have no significant esophageal disease.

Preparation

• Pre-procedure Instructions: Patients may be required to fast for a specified period before the procedure.
• Diagnostic Tests/Assessments: Physical examination of the tracheoesophageal puncture site. Patients may undergo imaging studies to ensure appropriate anatomy.

Procedure Description

1. Initial Assessment: The healthcare provider will examine the tracheoesophageal puncture site.
2. Insertion: Using specialized medical instruments, the provider carefully inserts the voice prosthesis through the existing puncture site.
3. Adjustment and Testing: The prosthesis is adjusted to ensure it fits properly and functions correctly.
4. Completion: Once securely in place and functioning, the provider will confirm there is no leakage.

• Tools/Equipment Used: Voice prosthesis device, insertion tools, stoma dilators, and endoscopic instruments.
• Anesthesia/Sedation: Generally performed under local anesthesia or with light sedation.

Duration

The procedure typically takes 15 to 30 minutes.

Setting

Performed in an outpatient clinic, surgical center, or a hospital setting.

Personnel

• Healthcare Professionals Involved: A licensed healthcare provider, such as an otolaryngologist (ENT specialist), along with a nurse and possibly a speech-language pathologist.

Risks and Complications

• Common Risks: Minor bleeding, discomfort at the puncture site.
• Rare Risks: Infection, prosthesis dislodgement, aspiration, or persistent leakage.

Benefits

• Expected Benefits: Restoration of speech shortly after the procedure.
• Realization Time: Immediate to a few days post-procedure as the patient adjusts to using the device.

Recovery

• Post-procedure Care: Instructions on care for the prosthesis, cleaning routines, and troubleshooting.
• Expected Recovery Time: Minimal downtime, with most patients returning to normal activities almost immediately.
• Follow-up Appointments: Regular check-ups to ensure the device is functioning properly and to make any necessary adjustments.

Alternatives

• Other Treatment Options: Electrolarynx devices, esophageal speech training.
• Pros and Cons: Electrolarynx may be easier to use but can sound more artificial. Esophageal speech requires extensive training and varies in effectiveness.

Patient Experience

• During the Procedure: Slight discomfort due to the instruments and puncture manipulation.
• After the Procedure: Mild pain and swelling at the puncture site, manageable with over-the-counter pain medications.
• Pain Management: Local anesthesia during the procedure and mild analgesics post-procedure.