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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 NONINDWELLING Can stay in place for 3-6 Must be removed every 3-4 months days Requires SLP to Patient can change remove/replace prosthesis independently Less maintenance required More education is required Must have 2cm or greater for removal, cleaning ,etc. tracheostoma Must have 2cm or greater Must pass esophageal tracheostoma insufflation test 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 600 500 Fundamental 400 Frequency (Hz) 300 Minimum Range 200 Maximum Range 100 0 Old TEP New TEP Esophageal A comparison of voiced energy 70 60 50 Mean (dB) 40 Minimum Range 30 Maximum Range 20 10 0 Old TEP New TEP Esophageal Cycle to cycle changes in intensity 3.5 3 2.5 2 1.5 Shimmer (dB) 1 0.5 0 Old TEP New TEP Esophageal 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.
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