General Introduction
The Provox System
Surgery
Replacement
Troubleshooting
    Introduction
    Device-related replacement issues
    Fistula-related issues and problems
       Leakage around the prosthesis and the prosthesis is too long
       Insertion of a Provox voice prosthesis during TEP leading to leakage around the device
       Leakage around the prosthesis even with the shortest length (4.5 mm)
       Local infection, prosthesis seems to be OK
       Local infection, prosthesis displaced
       Prosthesis extruding from the fistula tract
       Granulation tissue interfering with the prosthesis
       Interfering hypertrophic tissue in the TEP area
       Voicing increasingly difficult, not improved after replacement
       Anterograde insertion is difficult due to local infection
       Voice sounds strenuous and speaking requires too much effort
       There seems to be a 'separation of the party wall'
       Voicing is blocked by finger pressure on the stoma/voice prosthesis
       Elevated intra-tracheal pressure and effort for voicing
       Some bleeding during and after removal of the prosthesis
       Prosthesis has disappeared and seems to be ingested
       Prosthesis has disappeared and seems to be aspirated
       TE fistula too wide to hold a voice prosthesis, surgery not an option
       Stenosis of the neopharynx
       Anterograde replacement is difficult due to a small stoma
       Deep stoma interfering with application of peristomal devices
       TE fistula deep down in trachea, making replacement troublesome
       TE fistula migrated upwards outside the trachea, voicing problematic
       During retrograde insertion the guide wire gets stuck in the neoglottis
       How much to downsize in case of shortening of the fistula tract
       Is it possible to remove the prosthesis by pushing the device into the esophagus
    Voicing problems
    Algorithm for troubleshooting
Speech Therapy
Hands-free Speech
Research
Pulmonary Protection
Olfaction
References
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