Seal of the adhesive does not last long

Complete and airtight seal of the adhesive/housing of the valve is one of the most important factors for successful use of the device. On average a seal of 6 to 8 hours can be considered satisfactory. If, despite applying the suggestions mentioned below, length of seal cannot be improved, it is advised to consider the use of an intratracheal device such as a LaryTube or Barton-Mayo button.

Factors to be considered if airtight seal of the adhesive is unsatisfactory:

• Lower the pressure used for speaking

• By lowering the pressure used for speaking the pressure exerted on the adhesive during speech is decreased. This can usually (except of course when the neoglottis is hypertonic) be achieved by asking the patient to speak softer and with a lower pitch. Using a manometer measuring the pressure at the trachea during speech during voicing might help to give the patient feedback in order to achieve lower pressure. Also, adjusting the cough-relief valve to a lower opening pressure could be considered to help the patient achieving a lower tracheal pressure during speech.

• Support the adhesive when coughing or remove the valve when a cough is coming up.

• After coughing carefully remove mucous in order to avoid mucous breaking the seal.

• Avoid using remover or alcohol that is containing oil.

• Support the neck with a pressure band (e.g. custom made or Dan Kelly band), a tie or stoma cover when the skin is moving outward due to back pressure during speaking.