Talking Again

 

 

 

TEP/Prosthesis Speech Samples

 

 

tracheoesophageal prosthesis

 

 

Tracheoesophageal Puncture and Prosthesis:

 

In this case, a doctor makes a small hole in the rear of your stoma leading to the esophagus. Once this puncture heals, a prosthesis is fitted and inserted into the opening. To speak, you occlude (cover) the stoma with your thumb or finger and simply force air through the prosthesis into the esophagus. This air movement vibrates the walls of the esophagus and you can create sounds and words normally with your lips, teeth, and tongue, etc. The prosthesis has a one-way valve in it to prevent swallowed food and liquids from entering your stoma. Additionally, your stoma can be covered with a special valve,  called a Hands-Free) that closes when you wish to speak, thus forcing air into the prosthesis. With this valve in place, you no longer need to occlude the stoma with your thumb/finger ... your hands are free.

 

(Permission to re-print provided by InHealth Technologies, Carpinteria, CA.)

 

Assorted TEP Prostheses
B-S Duckbill B-S
Low Pressure B-S
Indwelling Low Pressure

 

Bivona Duckbill
Provox2

 

WHAT IS A TEP?

A TEP (tracheoesophageal puncture) is a same-day, simple, surgery, where the doctor makes a small puncture in the wall between the trachea and esophagus. This puncture will hold a prosthesis, with a valve on the esophageal end, so that lung air can again be directed through the mouth by closing off the stoma during exhalation. Closing the stoma can be done with finger, thumb or hands free valve (see illustration above). This redirected column of air will pick up vibrations as it passes through a narrowed section of the esophagus, so talking is again possible for most people.

LEARNING TO TALK

Work on getting your breathing rhythmic and practice, practice. Read out loud. Let the air flow be soft, don't blow it. Don't strain. It takes very little air to speak, so concentrate on speaking clearly and quietly. Don't worry about volume.

 

WHAT DOES TEP SPEECH SOUND LIKE?

Sample of TEP Speech

 

TRAINING YOURSELF TO IMPROVE YOUR VOICE

When I was a boy, in the early 50s, I took voice lessons from an old maid named Elizabeth Otwell. my parents did not want me to grow up talking like a redneck sharecropper, so I went to voice lessons once a week for a couple of years. I thought it was a real waste of time. However, after my laryngectomy, and when I started with the TEP, I realized how beneficial all that training was. It is somewhat the same way with regard to the many football coaches I had from the time I was 12 until I was 21, and finally retired thanks to a bad knee. I never really understood the concept of "paying the price", and "overachieving" until I had a laryngectomy.

I have spent quite a bit of time standing in front of a mirror and talking to myself. I have done it in English, Spanish, French, some German, and a little bit of Thai. I have done it using the hands-free valve, various fingers to occlude with, and using esophageal speech. I did a limited amount of time with it on the one time I had a Cooper-Rand device, and once when I had a Servox. I did not have either one of the electronic devices long enough to get very proficient.

When I practice, I speak slowly. I try to enunciate each syllable. I use my tongue and my lips. I watch myself to see how I form the words. I try different sounds. I speak from my diaphragm, as opposed to my mouth. I work to control my breathing. I want to project my voice even when I speak softly, which is one of the things I learned I should do from Jim Shanks and Dan Kelly. The bane of the hands-free valve is to lose the seal. The length of time one can maintain a seal is directly related to the amount of back pressure placed on the seal. If you put on the valve, never talk, never sweat, and never get any mucus on the glue, then the seal should last forever. The less back pressure used in talking, the longer the seal will last.

It would be very good, for you to speak into a recorder, then play it back. Then do it again, and see if you're improving. I have watched videos of myself, and used them for what to do and to "not" do. When you speak, speak from the bottom of your stomach, project your voice, speak softly, enunciate each syllable, speak distinctly and precisely. (Philip Clemmons)

 

WAYS TO OCCLUDE LARGE STOMA

1. I occlude my stoma to speak (or to swim..see Keep Active) with a hand exercise ball manufactured by Theraband. The company manufactures these balls in three different colors but I recommend the yellow which is the softest and molds around the stoma. I have been using these balls to occlude the stoma for speech as I have a very large stoma and there is no way I can use a stoma adhesive and HME or a freehand valve. I have been using the Provox 2 prostheses for the last four years. Web site: http://www.thera-band.com/order.html Call The Hygenic Corporation for a Dealer near you. In the U.S. or Canada, call: (800) 321-2135 (Jose Cruz)

2. Use ping-pong ball (which can be washed).

3. A rubber thumb. The office supply covering that is worn on the thumb when you are sorting through files and papers. That would make the thumb larger.

4. Look at the grocery or drug store for a bottle, maybe shampoo, that has a large round top on it. I took one of those and glued it onto a dowel so I could hold it in my fist when I talk a lot. Helps when arthritis sets in the fingers.

I brought home some sample size bottles of shampoo and conditioner from a hotel. The little plastic bottle is very light and the round top is about an inch in diameter. Works great for a small stoma and, maybe, for a large one...but I have seen several in the Dollar store with a larger top. (Pat Sanders)

5. Try making a fist and using the big knuckle at the top of the forefinger. 

6. Almost any of these can work quite well if you don't try to push the air out. Unless you exhale in an easy manner, the air wil often escape around whatever you are using to occlude

 

CLEANING A PROSTHESIS IN PLACE

1. There are little brushes, 2 or 3 to a package, found where you would buy toothbrushes and floss. The brushes are straight or tapered and are the perfect size to insert "gently" into the prosthesis to clean out any mucous that might have it stopped up. Take care and don't push the brush in far enough to hit the esophagus. I store or clean my brush in a medicine cup of peroxide. (Pat Sanders)

2. I use the Provox brush, which is expensive but well worth it. I bought a dozen for $54.00. Each will last about six months, but I like to keep one in each bathroom, both vehicles, and in my Dopp kit so that I will not forget it if I go on a trip on short notice. I keep the new curved tube irrigation bulbs in the same places. along with a pair of blunt, straight tip tweezers, the kind with finger holes in the handle. That way, I'm always prepared to clean anywhere. I also carry a flashlight that looks like a ball point pen. Big help in poorly lit bathrooms---and that's nearly all of them. (Roger Jordan)

3. I found one of the small t-handle insertion tools for a TEP prosthesis works real well for a quick cleaning. It even has a built in stop, I carry one in my wallet for those times I suddenly can’t talk. If you have one in a size that matches your prosthesis, give a try. (Bill Parks)

 

IF THERE IS A LEAK

If you swallow and a drop or two leaks through the prosthesis, first you cough, than try this! Occasionally, food gets at the edge of the valve of the prosthesis and holds it open just enough that taking a drink will allow liquid to run into the trachea. This can cause spasms of coughing so you want to get it fixed as soon as possible. To check to see if this is the problem, I lean over so the water doesn't run down my trachea, use a light and mirror and sip a little water. Then I watch to see if it is dripping through the middle of the prosthesis. If it is, then a good flushing or cleaning should remove the food that has it blocked. I would clean with a brush (see hint above) and flush with the syringe/pipet. Drink some water and check it again. That should correct it, but, if you still have a leak, repeat the cleaning and flushing.

 

 

BULB TYPE IRRIGATION SYRINGE

From Wal-Mart or your local drug store, buy a bulb type irrigation syringe and an eye dropper (the kind with the black bulb on the end.) Take the little bulb off the dropper and insert syringe tip into glass tube...Voila!!!...if you press the bulb in, using a lubricant like KY jelly, it will slip on, lodge securely, and when the carrier (water) evaporates the bulb will never come out... well not without a LOT of pulling and pushing and twisting. No cutting or taping or gluing...great if you’re traveling and forgot to bring one. And, because the end of the tube is tapered, it fits perfectly into any prosthesis.

To fill: simply immerse in tepid water, squeeze the bulb, then let go. It really cleans well because it has the volume or pressure to do the job. You can vary the nozzle pressure by squeezing harder or lighter. To clean it all you have to do is simply flush the unit with hydrogen peroxide and then warm water. Total cost not much more than $3 -- even less if you steal the parts. Note: this is a little bit of YANKEE know-how. (Paul Galioni)

"SOME COMMENTS ON THE ESCALATION OF TRACHEOESOPHAGEAL VOICE PROSTHESIS DIMENSIONS"

Dr. Eric D. Blom, PhD, of Head and Neck Surgery Associates in Indianapolis, IN, had a Letter to the Editor published in Otolaryngology - Head & Neck Surgery on the above subject. The original letter from Volume 129 April 2003 is in the archives of the Journal of American Medical Association. An Adobe Acrobat (.pdf) format copy of a reprint is available for those who would care to read it in its entirety (to include its charts). Dr. Blom notes in his conclusion, based upon numerous independent clinical observations, that, "Although it is not irrefutably established that leakage around a tracheoesophageal voice prosthesis is predictably related to increased dimensional characteristics or the dilating effects of insertion, an awareness of a possible relationship seems warranted." One of the studies cited by Dr. Blom in his letter was "Downsizing of Voice Prosthesis Diameter in Patients with Laryngectomy", by Drs. Eerenstein, Grolman, & Schouwenburg, 2002. An Adobe Acrobat (.pdf) format copy of an AMA reprint of this study is also available, should you be interested in reading it.

 

TWO WAYS TO CUT TUBES FOR WEARING WITH PROSTHESIS

1. I use a modified trach tube to hold the Provox HME filter. Other brands of tubes could be modified this way also. I cut it off to an inserted length of about 3/8", then cut a U at the back of the stem to clear my prosthesis. I use silicon adhesive on the front and sides of the tapered flange. I let it dry for 15 minutes before inserting in my stoma. This prevents the transfer of the adhesive to my skin. It remains tacky and sticks to the skin around my stoma, but when I remove it (to cough or whatever) it pulls away gently. I pop it back in and it stays in place. It sort of acts like Velcro.

 

During the day, if I get mucus on it, which can ruin the adhesion, I rinse thoroughly in hot water, dry and pop it back into place. Each night before going to bed I give it the hot water rinse, so it will stay in through the night. The next morning, hot water rinse, add another coat of silicon adhesive. After about a week the adhesive build-up gets too thick so I remove the build-up with silicon adhesive thinner, using a 2x2 gauze pad, wash with soap and water and start another weeks cycle.

I hated the adhesive patch HME holders. Unless you are using a hands-free valve the procedure, the above works great and is much less expensive. (Kent Smith)

2. I use a trach button for holding my stoma open and to make it easier to occlude (This was the Bivona-Colorado template that they started selling to use as a button. Bivona has been bought out by Portex). The button is light weight, will fold and roll for easy insertion and comes with a small hole in it. By enlarging that hole to uncover the area where my prosthesis is, I am able to have the air flow into the button and into the prosthesis when I occlude. The small ridge at the back holds it in for me. (Pat Wertz Sanders)

 

 

 

TEP TRAVELERS

While I have an Indwelling TEP that is changed by the SLP, I always have a couple of the low pressure prostheses at home and carry a couple with me when traveling. I have been using the Indwelling for about 8 years, and once accidentally pulled it out with my tweezers when cleaning it. I replaced it with a low pressure that held fine until I got a new Indwelling installed the next day. I believe in being prepared. All of us should. (Roger Jordan)

Those little mustard or Jelly jars in the Hickory Farms type gifts? They make real good containers for soaking the prosthesis in and they don't leak so can be used in a travel kit. They are thick enough so it would take a lot of banging around to break one. Par Stratton

 

A LESSON FOR TEP USERS

I have been using TEP speech for approximately 12 years and have never had occur what happened to me today. I exchanged my prosthesis this morning for one that was ready to be reinserted and shortly thereafter mucous started coming from the stoma in copious amounts. I thought that somehow I had caught a severe cold. After putting up with this stream of mucous for about 20-30 minutes, I decided to investigate. The suddenness and the constant output puzzled me. It turned out the mucous wasn't coming from the inner stoma, but leaking out of the middle of the prosthesis. After inserting a brand new prosthesis everything magically cleared up. Lesson: A prosthesis doesn't last forever - sometimes you should change to a new prosthesis and discard the old one! (Irwin Title)


 

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