Laryngectomy Rehabiliation1


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  • Laryngectomy Rehabiliation1

    1. 1. Tracheoesophageal Prosthesis By Mimi Kimmet and Stephanie Smith
    2. 2. What is a Tracheoesophageal Prosthesis (TEP)? <ul><li>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). </li></ul><ul><li>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). </li></ul>
    3. 3. Types of TEP’s <ul><li>INDWELLING </li></ul><ul><li>Can stay in place for 3-6 months </li></ul><ul><li>Requires SLP to remove/replace </li></ul><ul><li>Less maintenance required </li></ul><ul><li>Must have 2cm or greater tracheostoma </li></ul><ul><li>Must pass esophageal insufflation test </li></ul><ul><li>NONINDWELLING </li></ul><ul><li>Must be removed every 3-4 days </li></ul><ul><li>Patient can change prosthesis independently </li></ul><ul><li>More education is required for removal, cleaning ,etc. </li></ul><ul><li>Must have 2cm or greater tracheostoma </li></ul><ul><li>Must pass esophageal insufflation test </li></ul>
    4. 4. NON INDWELLING <ul><li>Blom-Singer Prosthesis and insertion tool </li></ul>
    5. 5. INDWELLING <ul><li>Low pressure InHealth prosthesis and insertion tool with gel caps </li></ul>
    6. 6. OUR STUDY <ul><li>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. </li></ul>
    7. 7. Step 1: Removal of Old TEP <ul><li>Hemos were used to clamp and lock onto the TEP </li></ul><ul><li>The TEP was gently pulled outward </li></ul>
    8. 8. Step 2: Insertion of Catheter <ul><li>Upon removal of the patients old indwelling TEP, a catheter was immediately inserted </li></ul><ul><li>The purpose of the catheter was to expand the width of the puncture and to keep the site open for new TEP insertion </li></ul>
    9. 9. Step 3: Measuring <ul><li>A measuring tool was inserted into the puncture site to determine the size of prosthesis used in fitting </li></ul>
    10. 10. Step 4: Insertion of Non-indwelling TEP <ul><li>A 1.8cm Duckbill Blom-Singer voice prosthesis was inserted into the puncture site. </li></ul><ul><li>Surgi-lube was used to aid in the ease of insertion </li></ul><ul><li>The Duckbill was removed and immediately replaced </li></ul>
    11. 11. Step 5: Insertion of Indwelling TEP <ul><li>A Blom-Singer Low Pressure indwelling prosthesis was inserted into the puncture site. </li></ul><ul><li>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 </li></ul><ul><li>The insertion flap was then removed by cutting it off with scissors </li></ul>
    12. 12. Visual Representation of Esophageal Voice
    13. 13. Visual Representation of Old TEP Voice
    14. 14. Visual Representation of New TEP Voice
    15. 15. A comparison of pitch measures
    16. 16. A comparison of voiced energy
    17. 17. Cycle to cycle changes in intensity
    18. 18. What We Found: <ul><li>Overall there were no significant differences between the old TEP, new TEP, and esophageal speech. </li></ul><ul><li>Although the intensity measures with esophageal voicing were the lowest, this was the patients preferred method of voicing. </li></ul><ul><li>Fitting of the TEP was much easier than we expected and required a minimal amount of time to complete. </li></ul>
    19. 19. References: <ul><li>Singer, M. I., and Blom, E. D. (1980) An endoscopic technique for restoration of voice after laryngectomy. Ann Otolaryngology . 89, 529-33. </li></ul><ul><li>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. </li></ul><ul><li>Tracheoesophageal voice prosthesis (n.d.) Retrieved September 15, 2002 from ~ lleeper/pages/Prosth . </li></ul>
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