Name of the Procedure:

Common names: Voice Prosthesis Insertion, TEP (Tracheoesophageal Puncture) Technical/medical term: Insert for Indwelling Tracheoesophageal Prosthesis, with or without Valve, Replacement Only

Summary

This procedure involves replacing a voice prosthesis in patients who have had their voice box (larynx) removed, typically due to cancer. The prosthesis helps them speak by squeezing air from their lungs through a small valve, creating sound.

Purpose

• Medical Conditions: Laryngeal cancer, failed previous voice prosthesis, prosthesis malfunction or wear
• Goals: Restore speech capability, improve quality of life, ensure effective communication

Indications

• Specific Symptoms: Difficulty speaking post-laryngectomy, malfunctioning existing prosthesis
• Patient Criteria: Post-laryngectomy patients with a tracheoesophageal puncture, candidates for prosthesis replacement

Preparation

• Instructions: Fasting may be required if general anesthesia is used. Follow the surgeon's specific guidelines which may include adjusting medications.
• Diagnostic Tests: Pre-procedure voice assessments, imaging studies if needed

Procedure Description

1. The patient is positioned comfortably, and the existing prosthesis is carefully removed.
2. Using specialized tools, the new tracheoesophageal prosthesis is inserted into the existing puncture.
3. The prosthesis is tested for fit and functionality.
4. If necessary, minor adjustments are made before finalizing the insertion.
   • Tools: Prosthesis insertion kits, scopes for visualization
   • Anesthesia: Local anesthesia and sedation, or general anesthesia in some cases

Duration

Typically, the procedure takes about 30 minutes to an hour.

Setting

This procedure is usually performed in an outpatient clinic or a hospital setting.

Personnel

• Healthcare Professionals: Otolaryngologists, speech-language pathologists, nurses, anesthesiologists (if sedation or anesthesia is required)

Risks and Complications

• Common Risks: Discomfort, minor bleeding, temporary hoarseness
• Rare Risks: Infection, dislodgement or malfunction of the prosthesis, airway complications, allergic reactions to anesthesia

Benefits

• Expected Benefits: Restoration of speech, immediate improvement in communication ability, enhanced quality of life
• Realization: Benefits are typically noticed immediately after insertion and adjustment.

Recovery

• Post-procedure Care: Follow-up visits for checking the prosthesis function, instructions on cleaning and care of the prosthesis
• Expected Recovery Time: Minimal downtime; normal activities can often be resumed within a day
• Restrictions/Follow-up: Attend all scheduled follow-up appointments, avoid strenuous activities initially

Alternatives

• Alternative Treatments: Electrolarynx devices, esophageal speech therapy, writing or electronic communication devices
• Pros and Cons: Alternatives may not provide the same natural speech quality; each option has unique benefits and limitations based on the individual patient's condition and preferences.

Patient Experience

• During Procedure: Mild discomfort if under local anesthesia, generally well-tolerated
• After Procedure: Some soreness or minor throat irritation, which can be managed with prescribed pain medications. Patients often feel a significant emotional upliftment due to regained speech ability.

Pain management includes prescribed medications and comfort measures like warm fluids and throat lozenges as advised by the healthcare team.