It is not possible to be specific as to when an indwelling prosthesis should be changed. For most people, I suspect the determinant is when leakage becomes a problem. But one should always try to make certain that the leakage is not just a temporary occurrence caused by insufficient or careless brushing before taking the more drastic step of replacing the TEP.
N2 - IMPORTANCE Voice prosthesis (VP) device life is a limiting factor of tracheoesophageal (TE) voice restoration that drives patient satisfaction, health care costs, and overall burden. Historic data suggest that TE VPs have an average device life of generally 3 to 6 months, but these data are typically derived from small samples using only 1 or 2 devices. OBJECTIVE To reexamine current device life in a large, contemporary cancer hospital in the United States that uses a wide assortment of VPs. DESIGN, SETTING, AND PARTICIPANTS This retrospective observational study included 390 laryngectomized patients with a tracheoesophageal puncture (TEP) who had VP management at MD Anderson Cancer Center between July 1, 2003, and December 31, 2013. MAIN OUTCOMES AND MEASURES Tracheoesophageal voice-related outcomes were: (1) device life duration to VP removal, and (2) treatment-related and prosthetic-related factors influencing device failure. Primary independent variables included treatment history (extent of surgery and radiation history), VP type (indwelling vs nonindwelling, size, specialty features), and reason for removal (leakage, complication, other). Duration was examined using Kaplan-Meier analysis. Disease, treatment, and patient-specific factors were analyzed as predictors of duration. RESULTS Overall, 3648 VPs were placed in the 390 patients (median [range] age, 62 [34-92] years). Indwelling prostheses accounted for more than half (56%) of the devices placed (55%, 20-Fr diameter; 33%, 8-mm length). More than two-thirds (69%) of prostheses were removed because of leakage, while the rest were removed for other reasons. Median device life was 61 days for all prostheses. Indwelling and nonindwelling VPs had median device lives of 70 and 38 days, respectively. There was no significant difference between specialty prostheses compared with standard devices (median duration, 61 vs 70 days, respectively). The Provox ActiValve (Atos Medical) had the longest life. Neither radiation therapy nor extent of surgery had a meaningful impact on device life. CONCLUSIONS AND RELEVANCE Our data suggest that VP duration demonstrates a lower durability than historically reported. This may reflect the intensification of treatment regimens that complicate TEP management in an era of organ preservation; however, further investigation is needed.
Tracheoesophageal voice prosthesis (TEP) - Laryngopedia
N2 - Objective: To analyze the initial experience at Oregon Health Sciences University, Portland, with the use of long-term indwelling tracheoesophageal voice prostheses. Design: Retrospective case series. Selling: Tertiary referral academic medical center. Patients: Thirty patients undergoing speech rehabilitation after laryngectomy during a period of 18 months. Intervention: Insertion of a long-term indwelling tracheoesophageal voice prosthesis. Main Outcome Measures: Duration of use, complications. Results: The mean duration of placement for a single prosthesis was 4.9 months (148 days), with a range of 14 to 330 days. Sixteen of the 30 patients encountered problems with leakage because of fungal colonization, the majority of which (15 of 16 cases) were solved with either oral or topical application of nystatin. Size matching in terms of prothesis length and tract length was critical, and problems of this nature were encountered in 11 of 30 patients. The incorporation of a second system of prostheses that offered an increased number of size options solved these problems in all of these patients. Ultimately, 27 of 30 patients were able to successfully wear these prostheses. Conclusions: The indwelling tracheoesophageal voice prosthesis offers patients all the advantages of tracheoesophageal speech rehabilitation after laryngectomy without the inconvenience of frequent prosthesis changes. With careful attention to the details of fitting and care, it can be worn by the majority of patients successfully.
Tracheo-oesophageal puncture - Wikipedia
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.
Tracheo-oesophageal puncture Tracheo ..
The first step in decision-making for patients with cancer of the larynx is accurate diagnosis and staging. This requires adequate tissue biopsy and histologic interpretation by a pathologist. Generally, these cancers are not difficult to diagnose by the pathologist, but if the clinical presentation is unusual (i.e. cancer in a younger person or non-smoker), or if the appearance is not typical or the growth is too slow or too fast, a second interpretation or re-biopsy may be warranted.
The treatment of choice for alaryngeal speech rehabilitation
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)