Main complaint: Increased voicing effort
Main complaint: Leakage
Air escaping underneath cough-relief valve
Alternative surgical technique of secondary puncture
Choosing the right prosthesis length
Closure of the membrane
General aspects of patient instruction
General Introduction
Important basic principles in voice rehabilitation in prosthetic speech
Introduction
Leakage around the prosthesis and the prosthesis is too long
Leakage through the prosthesis
Outline of voice therapy
Peristomal attachment
Problem solving
Provox FreeHands HME automatic speaking valve
Provox2 voice prosthesis
Some bleeding during and after removal of the prosthesis
Surgical technique
Surgical technique of secondary TE puncture and introduction of the Provox voice prosthesis
Surgical techniques of tracheostoma reconstruction
TE fistula deep down in trachea, making replacement troublesome
TE fistula migrated upwards outside the trachea, voicing problematic
Too much noise of cough-relief valve when coughing
Tracheostoma construction
Very frequent replacement due to leakage
General aspects of patient instruction
References
Chemical denervation of constrictor pharyngeus muscles with Botulinum toxin
Introduction
Provox2 voice prosthesis
Fluency
Maximum phonation time
Phrase length, speech rate, maximum phonation time
General aspects of patient instruction
References
Air leakage under membrane
Breath-support/breath-voice coordination
Choosing the membrane
Closure of the membrane
No voice sound
Provox FreeHands HME automatic speaking valve
Shortness of breath
Using the walk and talk position
Surgical technique of primary TE puncture and introduction of the Provox voice prosthesis
Surgical technique of secondary TE puncture and introduction of the Provox voice prosthesis
Conclusion
General Introduction
Provox FreeHands HME
Provox HME
Reference
References
Total laryngectomy
Alternative surgical technique of secondary puncture
Surgical technique of secondary TE puncture and introduction of the Provox voice prosthesis
TE fistula deep down in trachea, making replacement troublesome
Tracheostoma construction
Attachment of the valve
Choosing the right prosthesis length
Elevated intra-tracheal pressure and effort for voicing
Interfering hypertrophic tissue in the TEP area
Intratracheal fixation
Introduction
Local infection, prosthesis displaced
Local infection, prosthesis seems to be OK
Original Provox Voice Prosthesis
Patient maintenance
Pharyngeal reconstruction and prosthetic voice rehabilitation
Primary tonicity control of the PE-segment
Problem solving
Prosthesis has disappeared and seems to be ingested
Surgical technique of primary TE puncture and introduction of the Provox voice prosthesis
Surgical techniques of tracheostoma reconstruction
There seems to be a 'separation of the party wall'
Total laryngectomy
Tracheostoma construction
Voicing increasingly difficult, not improved after replacement
During retrograde insertion the guide wire gets stuck in the neoglottis
Introduction
Hypertonicity/spasm of the neoglottis
Preoperative screening
Primary tonicity control of the PE-segment
Problem solving
Surgical constrictor pharyngeus myotomy
Total laryngectomy
Voice sounds strenuous and speaking requires too much effort
Indications
Problem solving
Leakage around the prosthesis even with the shortest length (4.5 mm)
Outline of voice therapy
Surgical technique of primary TE puncture and introduction of the Provox voice prosthesis
Surgical technique of secondary TE puncture and introduction of the Provox voice prosthesis
Leakage around the prosthesis even with the shortest length (4.5 mm)
Surgical technique of primary TE puncture and introduction of the Provox voice prosthesis
Granulation tissue interfering with the prosthesis
Interfering hypertrophic tissue in the TEP area
General Introduction
References
Alternative surgical technique of secondary puncture
Anterograde insertion is difficult due to local infection
Assembling and disassembling the HME
Candida overgrowth
Choosing the membrane
Elevated intra-tracheal pressure and effort for voicing
General Introduction
Hypertonicity/spasm of the neoglottis
Indications
Insertion of a Provox voice prosthesis during TEP leading to leakage around the device
Introduction
Peristomal attachment
Pharyngeal reconstruction and prosthetic voice rehabilitation
Preoperative screening
Problem solving
Prosthesis extruding from the fistula tract
Prosthesis has disappeared and seems to be aspirated
Provox dilator
Provox FreeHands HME
Provox FreeHands HME automatic speaking valve
Provox LaryTube
Provox measure
Provox2 voice prosthesis
Replacement of other voice prostheses by Provox
Replacement of the Provox (1) voice prosthesis
Some bleeding during and after removal of the prosthesis
Surgical technique
Surgical technique of primary TE puncture and introduction of the Provox voice prosthesis
Surgical technique of secondary TE puncture and introduction of the Provox voice prosthesis
Troubleshooting
Voicing increasingly difficult, not improved after replacement
Decrease backpressure
During retrograde insertion the guide wire gets stuck in the neoglottis
Elevated intra-tracheal pressure and effort for voicing
Hypertonicity/spasm of the neoglottis
Hypotonicity of the neoglottis
Provox FreeHands HME
Seal of the adhesive does not last long
Weak/whispery/aphonic voice
Decrease backpressure
Hypertonicity/spasm of the neoglottis
Hypotonicity of the neoglottis
Weak/whispery/aphonic voice
Indications
References
Additional remarks in conjunction with prosthesis replacement
Air escaping underneath cough-relief valve
Air leakage under membrane
Alternative surgical technique of secondary puncture
Assembling and disassembling the HME
Attachment of the valve
Breath-support/breath-voice coordination
Candida overgrowth
Chemical denervation of constrictor pharyngeus muscles with Botulinum toxin
Choosing the membrane
Choosing the right prosthesis length
Closure of the membrane
Comments
Conclusion
Conclusions
Confusing hands-free TE-speech with esophageal speech
Cough-relief valve opens when patient is speaking loud
Decrease backpressure
Fluency
General aspects of patient instruction
General Introduction
Hypertonicity/spasm of the neoglottis
Hypotonicity of the neoglottis
Important basic principles in voice rehabilitation in prosthetic speech
Indications
Intelligibility
Intratracheal fixation
Introduction
Leakage through the prosthesis
No voice sound
Original Provox Voice Prosthesis
Outline of voice therapy
Patient maintenance
Peristomal attachment
Pharyngeal reconstruction and prosthetic voice rehabilitation
Phrase length, speech rate, maximum phonation time
Pitch, loudness, intonation
Preoperative counseling
Preoperative screening
Primary tonicity control of the PE-segment
Problem solving
Problems with intratracheal fixation
Proper adjustment of the cough-relief valve
Prosody
Provox dilator
Provox FreeHands HME
Provox FreeHands HME automatic speaking valve
Provox HME
Provox LaryTube
Provox measure
Provox2 Voice Prosthesis
Reference
References
Replacement of other voice prostheses by Provox
Replacement of the Provox (1) voice prosthesis
Replacement procedures
Seal of the adhesive does not last long
Shortness of breath
Shouting
Some points of attention for the ‘finishing touch’
Speech rate
Speech therapy. What to practice to optimize hands-free speech
Surgical constrictor pharyngeus myotomy
Surgical instruments
Surgical technique
Surgical technique of primary TE puncture and introduction of the Provox voice prosthesis
Surgical technique of secondary TE puncture and introduction of the Provox voice prosthesis
Surgical techniques of tracheostoma reconstruction
Too much noise of cough-relief valve when coughing
Total laryngectomy
Tracheostoma construction
Troubleshooting
Use of the cleaning container
Using the walk and talk position
Very frequent replacement due to leakage
Voicing problems
Weak/whispery/aphonic voice
Preoperative screening
Primary tonicity control of the PE-segment
Total laryngectomy
Reference
References
General Introduction
Provox2 Voice Prosthesis
Voicing increasingly difficult, not improved after replacement