Voicing is blocked by finger pressure on the stoma/voice prosthesis

Problem: voicing is blocked by finger pressure on the stoma/voice prosthesis

If the prosthesis is too long, the patient might press the device with his finger into the back wall of the esophagus, thereby partly or even completely blocking the airflow (as simulated in the animation to the left). Aside from causing a voicing problem, this ultimately might lead to damage and/or necrosis of the back wall of the esophagus, which potentially is a serious complication. This problem can be encountered e.g. after an infectious episode, for which a longer device was inserted. After subsiding of the infection granulation and edema, the prosthesis will be too long. If this does not result in leakage around the device, this too long prosthesis might stay in situ for a prolonged period of time, ultimately causing the problem discussed here. Another cause might be the constant pressure of a cannula onto the voice prosthesis, pushing the prosthesis into the back wall of the esophagus.

In the first example, the obvious solution is replacement of the device with one of the proper size. In the second example, if insertion of a shorter prosthesis is not an option, it should be tried to lower the pressure onto the voice prosthesis by decreasing the diameter of the cannula or try to avoid the use of a cannula completely, e.g. carrying out a stoma plasty. Also, the use of an automatic speaking valve like the FreeHands HME can solve this problem, by taking away the digital pressure on the voice prosthesis.