Voice prosthesis

During a total laryngectomy, the entire voice box (larynx) is removed and the windpipe (trachea) and food pipe (esophagus) are separated from each other.

[1] In 1873 Theodor Billroth made a total laryngectomy (in steps) and implanted an artificial voice box.

In 1980, the first commercially available prosthesis was introduced by Singer and Blom:[5] the 'Blom-Singer® Duckbill', a 16 French diameter, non-flanged device that the patient could remove, clean and replace him- or herself (non-indwelling).

Like the Blom-Singer® Advantage® Indwelling Voice Prosthesis it is only inserted or replaced by medical professionals, such as speech pathologists or physicians.

It comes in different sizes and lengths and often has a noticeable color, e.g. blue or white to enhance visibility for self-replacement and maintenance.

Disadvantages of the non-indwelling prosthesis are a certain amount of risk when inserting them by oneself and the devices have a shorter lifetime and need to be changed more often.

The choice between 'non-indwelling' and 'indwelling' devices is really individual, depending on physical condition, maintenance and cost and can be alternated over a period of time to find out which one is most suitable.

A voice prosthesis has a one-way valve near the esophageal flange that enables pulmonary air to pass into the esophagus and pharynx for sound production and prevents content from the food pipe, such as liquids or saliva, from entering the trachea.

[16] It is important to clean the voice prosthesis regularly, as the silicone material is exposed to yeast (candida) and bacteria in the food pipe, which is normally present in these areas.

[17] If yeast begins growing on or in the area of the valve flap of the voice prosthesis, it may not close well enough anymore.

It is recommended that the patient cleans the voice prosthesis regularly to keeps it open for speech and improve the device lifetime.

This causes leakage of saliva or drinks, which enters the wind pipe and makes the person concerned cough.

The device lifetime can range from a couple of weeks up to two years, depending on individual circumstances.

[24] An individual combination of voice prosthesis, heat and moisture exchanger after laryngectomy and attachment is important for good speech and pulmonary rehabilitation.