WebWhispers

A Brief History of the TEP
By Richard Crum

    The first laryngectomy was performed in the United States in about 1873. Imagine having a laryngectomy given the state of the art of anesthesia at that time! And yet the only alternative then to surgical removal of a cancerous larynx would have been a very hard death.  Compared to then, we are truly living like kings.

    It was many years later, in 1931, that a laryngectomee thought that if he could get air from his lungs into his esophagus, he could produce sound and form words to speak.  This man, a butcher, whose name is unknown, knew anatomy from the many hogs he had butchered over his lifetime.  So he experimented on himself.  He took a heated ice pick and punctured the back wall of his windpipe into his esophagus.   He then took a quill (hollow feather), tied a string around it, and inserted it into the puncture to keep it from leaking or closing.  Whenever he wanted to speak he would take out the quill, cover his stoma with his thumb, and divert air from his lungs via the open puncture and into his esophagus to produce sound with which he could speak.

    Several surgical methods were tried in the 1970's to reproduce this idea, but initially met with little success.  Most used a shunt to move air from the stoma into the esophagus, or involved a planned fistula (puncture) through which air could move from the lungs into the esophagus.  A valved prosthesis was developed by Dr. Taub, but this development did not achieve widespread use because of its complicated design and closeness to the major blood vessels of the neck. 

    An early voice prosthesis developed by Dr. Eric Blom was made from a red rubber catheter with a nylon ball in a “cage” which served as a valve.  This did not prove successful. His second attempt was a red rubber catheter with a slit valve tip.  The tip looked like a duck's bill and thence, the "duck bill” prosthesis got its name. But problems developed with some patients due to length of the prosthesis tip.  It was too long and allowed for leakage when the duck bill touched the back wall of the esophagus and was held open, or problems with speech would develop because the prosthesis opening would be kept shut by being pushed against the esophagus wall.

    In 1978, in Indianapolis, Indiana, a
 tracheoesophageal puncture procedure and valved
 silicone voice prosthesis were developed by Dr.
 Eric Blom, Dr. Mark Singer and Dr. Ronald Hamaker.
 This work developed into what is commonly known
 today as the “TEP method of voice restoration after
 total laryngectomy,” and is used successfully
 throughout the world.  Dr. Blom subsequently
 developed a low pressure voice prosthesis with a flap valve design.  It is called low pressure because it takes less pressure to open and move air for speech than the duck bill.

    Several manufacturers around the world have developed voice prostheses, however all of them are variations of Dr.'s Blom and Singer’s duck bill or low pressure flap valve prostheses.  In the mid 1990's an “indwelling” low pressure prosthesis was developed for extended wear.  The biggest advantage to an indwelling prosthesis is that it takes a lot less maintenance than with a patient inserted prosthesis.  The down side is that the indwelling prosthesis must be changed by a clinician (medical doctor or speech-language pathologist). 

    Currently the biggest problem with all commercially available prostheses is that the material used, silicone, permits yeast to colonize on the prosthesis causing it to deform and leak.  The standard treatment now being used is liquid Nystatin used twice daily and swished in the mouth and spit out or swallowed.  A great deal of research is currently underway to try to solve this problem of yeast formation.

    I have been using a voice prosthesis since 1988 and I find that I am able to work every day with few problems.  The use of the voice prosthesis enabled me to return to my daily routine rapidly and with a great degree of acceptance.  The loss of ones voice is not only the physical loss of the ability to speak, it is also a visible reminder to everyone you meet that something has happened to you.  A great many people have been involved in helping laryngectomees through their rehabilitation including those who have provided us with the option of TEP prosthesis speech.

Debi Austin Becomes WW Assistant Secretary

    In December, WW President Carter Cooper announced that Debi Austin had been appointed to the newly created position of Assistant Secretary in order to assist Secretary Darlene Parker with “the ever increasing number of tasks associated with maintaining our member records and administering the WebWhispers Loaner Closet.” 

    A laryngectomee for more than seven years, Debi is from Canoga Park, California, and is currently an officer with her local new voice club.  She is self-employed and, in addition to her work with local laryngectomees, is also a volunteer to the elderly, for her local food bank, and with a battered women's shelter.  She is also an anti-tobacco advocate and speaker. 

    Thanks for the help, Debi.  We all look forward to working with you.

Tis the Season to Humidify

    An inexpensive gauge for measuring indoor humidity is available in many stores, including Walmart, where we found the one pictured.  It cost less than $4, and was located with the humidifiers and water filters.  You might consider buying this or something similar and using it to help you regulate your indoor humidity.

    Winter months are typically the laryngectomee's toughest time of the year while we try to cope with the seasonal weather changes.  The issue during this season is the temperature and dryness of the air we breathe.  The outdoor air is colder and drier, and we tend to dry the indoor air even further with our heating systems.  The effect of breathing dryer air can be an uncomfortable tightness, increased mucous production with the inherent clogging of prostheses, and cracking and bleeding of the skin in and around the stoma and TEP puncture.

     More skin creams, lotions, and products like Chapstick (or other lip balms) are used this time of year than any other in an effort to combat this dryness.  But the use of creams in and around the stoma can be risky, and they need to be kept out of stoma and trachea. 

    The best way of dealing with our increased dryness this time of year is to humidify.  We do this by using humidifiers, HMEs (Heat and Moisture Exchange filters), or dampened stoma covers. Some laryngectomees periodically “irrigate” their stomas by squirting a little sterile water into them.  This moistens tissues as well as thins mucous and allows inhaled particles to be more readily coughed up.

    The humidity problem is especially troublesome since it is not as easily measured and maintained as temperature.  Few homes have gauges which measure the humidity (hydrometers), and most of us do not have any idea what the humidity reading is in our homes.  A hydrometer can tell us what the humidity is and help keep it in balance. 

    Most people feel comfortable with a humidity reading of between 40-60%. But the laryngectomee is likely to feel dried out and uncomfortable unless this is increased.  The reason is that the humidity in your trachea and lungs before your operation was close to 100% relative humidity, and the temperature of the air reaching your lungs was around 98 degrees (the same as your body temperature).  After the operation and without the air passing through mouths and noses, the humidity can drop to less than half of that, and the temperature of the air can be thirty degrees cooler.  We need to raise the humidity by either adding water vapor to all of our indoor air, or at least to the air that goes down our stomas by following the suggestions above.

    If you add too much water vapor to the air in your house with a humidifier you can encourage the growth of molds and mildew as well as warp wooden furniture and floors.  Combining these ways of humidifying by measuring the humidity in the house and keeping it to the high end of the 60% comfort zone, and then adding a little more with a dampened filter or stoma cover can keep you well moisturized during the season.

Making and Using a Lary Whistle

    You can modify an ordinary “police” style whistle by attaching it to a baby bottle nipple and blow it using air from your stoma.  Some laryngectomees report that they can produce enough air in their mouths and cheeks to blow this type of whistle without adapting it, and some TEP wearers say they are able to move enough air through their prostheses to do so.  But many of us need lung power through the stoma to blow one loudly enough.

    Such a whistle can be handy for personal safety to call a family member in an emergency, summon a pet from a distance, etc.  You might want to keep one near your bed, on your key chain, and in your car.  You could also use the process described to make it possible for a laryngectomee to play any instrument which requires breath such as a recorder or simple flute as long as the mouthpiece of the instrument has a diameter smaller than the baby bottle nipple.

Materials: 
    1. Whistle - “police” type (available in toy, military surplus, sporting goods stores, etc.). 
    2. a baby bottle nipple (the large two inch diameter clear silicone baby bottle nipple with the squared or rounded nipple end is recommended since it should fit over any size or shape stoma.  Some brands and prices : Munchkin - two for $1.55, Luv n’ Care - two for $1.96, or Playtex - two for $3.17; at Walmart)
    3. a pair of scissors (small sharp ones such as toenail scissors work well)

Construction: 
    1. cut a hole in the top of the nipple which is smaller than the part of the police whistle you blow into.  It must be smaller since it will be held in place by friction and not glue.

    2. push the whistle into the nipple all the way and then back it out so the whistle mouthpiece is held by the nipple plastic, but will not come in direct contact with your stoma.  The insertion of the whistle into the nipple can be eased by using a water soluble lubricant such as K-Y Jelly.  Just wash the excess off with water. 

    To use, just put the nipple end over your stoma and blow.  It works great.

Origin of the idea:
    The original idea for this lary whistle came from the UK website newsletter archives.  Here is the original source of the idea which uses a British police style whistle.

SLP Paula Sullivan Moves to Wisconsin

    Florida’s loss is Wisconsin’s gain as speech-language pathologist Paula Sullivan leaves the Sunshine State and moves north to cheese (and snow) country.  Paula has already left her position at the University of Miami and taken a similar position at the University of Wisconsin School of Medicine.

    Paula has been a major force in service to laryngectomees on the local, state, and national levels.  Her accomplishments are many, and include being heavily involved in the training of other SLPs and voice therapists as a faculty member of the Florida Laryngectomee Association and the IAL Voice Institutes.  She was also a founding member of a local lary support group in the Tampa area, an expert in the area of swallowing problems in cancer patients, and an experienced trainer in the fitting and use of the Larkel swimming device.

    Paula is fond of saying that she has “. . . been blessed with the opportunity to work almost exclusively with individuals and their families touched by laryngeal cancer,” and that this experience has provided her with “the greatest professional and personal satisfaction” with these cancer survivors and their families serving as her “motivation and inspiration”.

    WW member Jim Sansing said of Paula, “We will find someone to take her place, but we will not find someone to replace her”.  “She has brought to the laryngectomee community . . . much knowledge and expertise that we so often can not find” and which she has “always been ready to give, and never asked for anything in return”. 

    We wish Paula good luck in her continued service to the laryngectomee community from her new location in Wisconsin, and look forward to seeing her again in Nashville next August. 

Becoming a WW Voting Member

    You become a full WebWhispers Voting Member by contributing a minimum of $5.00 per year.  Funds are used for a number of purposes including our monthly Internet access bill.  Treasurer Terry Duga is now accepting donations from those who wish to contribute to the Club and become voting members for calendar year 2000.  All checks should be made out to the "WebWhispers Nu-Voice Club" and be mailed to our Treasurer, Mr. Terry Duga, 6115 North Park Ave., Indianapolis, IN 46220.

Lary Laughs:

Cartoon by Judy Greiwe
(Note: Judy is the spouse of larygnectomee Dave Greiwe.  They live in Columbus, Indiana.  Thanks for the contribution, Judy!)

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