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How Does a Tracheoesophageal Puncture Work?

Tracheoesophageal puncture (TEP)
Tracheoesophageal puncture (TEP) restores the person’s ability to speak after the vocal cord (voice-box) has been removed.

Tracheoesophageal puncture (TEP) is a surgical procedure in which a hole is created between the trachea (windpipe) and esophagus (gullet). It is usually performed in people who undergo surgical removal of the larynx (voice-box) called a total laryngectomy (TL). This puncture restores the person’s ability to speak after the vocal cord (voice-box) has been removed.

In this procedure, the surgeon makes an opening (a hole) between the trachea (windpipe) and esophagus and places a small plastic or silicone one-way valve into it. This valve allows air to pass from the trachea to the esophagus but blocks water and food out of the trachea.

After TEP, the patient covers this opening (stoma) with the finger and swallows air into the esophagus through the valve. This forceful air vibrates the walls of the throat and remnant gullet sphincter. This vibration produces sound, which is very much like natural speech. This is called esophageal speech. Sometimes, instead of using the vocal fold vibration, pharyngeal (throat) wall vibrations are used as the sound source.

TEP is generally performed 3-6 months after the complete removal of the larynx (TL) because this provides time for the body to heal before proceeding with the prosthesis. The procedure is performed under general anesthesia. Initially, a temporary prosthesis will be placed, which will then be replaced with the voice prosthesis in approximately 1 week. A speech therapist will help patients to use this prosthesis.

Many people can achieve a certain degree of speech in this technique, but fluency remains a challenge. Regular practice sessions with a speech therapist may increase fluency and clarity in speech. This technique does not require any major prosthesis or external devices, which is a major advantage. Multiple advances have been made in the valve prosthesis design and construction (including the advent of hands-free adjuvant devices), different surgical techniques, and the timing of the procedure.

When will the doctor suggest TEP?

The doctor will only perform TEP in a person who has undergone complete removal of voice-box/vocal cord (total laryngotomy) and desires TEP phonation.

When will the doctor not suggest TEP?

The doctor may not recommend TEP if a person has:

  • Partial removal of the larynx (subtotal laryngectomy).
  • A TL with stomach pull-up (to avoid infection or pus-collection).
  • A small laryngectomy opening (stoma).
  • Poor lung function, which may decrease the ability to use the prosthesis because it requires relatively higher positive pressure in the trachea (windpipe).
  • Been drinking excessive alcohol.
  • Not been able to produce speech or sound.
  • Inconsistent or unreliable follow-up.
  • No financial support to obtain subsequent TEP care or replacement.

What are the complications of TEP?

The complications of TEP include:

  • Complications related to anesthesia
  • Allergic reactions to medication
  • Breathing problem
  • Infection
  • Bleeding
  • Aspiration of a foreign body
  • Leaks around the prosthesis
  • Failure of prosthesis
  • Injury to the trachea (windpipe)
  • Injury to the esophagus (gullet)
  • Enlargement of openings (fistula) over time

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