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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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posted:10/26/2012
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