Duke speech pathologist Gina Vess talks to a patient who has a tracheoesophageal prosthesis. Show
Overview People with throat or voice box cancers who lose their ability to speak following the removal of of their larynx (voice box) can learn to produce near natural-sounding speech thanks to an advanced procedure and prosthesis offered at Duke Health. “Tracheoesophageal puncture or ‘TEP’ surgery allows patients who undergo a total laryngectomy to have a voice when they otherwise would not,” said Trinitia Cannon, MD, a head and neck surgeon at Duke Cancer Center Raleigh. “It’s a game-changer.” Here, Dr. Cannon and Duke speech-language pathologist Gina Vess answer frequently asked questions about TEP surgery and tracheoesophageal speech, which they call the “gold-standard in post-laryngectomy communication.” Who is eligible for TEP surgery?Content People who have undergone a total laryngectomy to remove their voice box are eligible for TEP surgery, but the procedure is not recommended for those with poor lung function, poorly controlled diabetes, severe hypothyroidism, or problems with the integrity of the skin on the neck. What happens during TEP surgery?Content According to Dr. Cannon, the TEP procedure is often done at the same time as total laryngectomy surgery, although it can be done months or years later. During a laryngectomy, the larynx is removed, and the connection between your windpipe (trachea) and mouth is severed. The bottom half of the windpipe is rotated forward and connected to the skin, creating a permanent opening for breathing called a stoma. During the TEP procedure, a surgeon creates a small hole about the size of a pencil eraser in the wall between your trachea and your esophagus, the tube that moves food from your mouth to your stomach. A small one-way valve, called a tracheoesophageal voice prosthesis, is placed inside the hole to direct air into the throat. How could a tracheoesophageal voice prosthesis help me speak?Content Since the vocal cords are completely removed during total laryngectomy surgery, your sound source is lost, Vess explained. TEP surgery with a prosthesis creates a path for air to move from your lungs to the esophagus. This air causes the top of the esophagus to vibrate -- producing a new tracheoesophageal voice. Is a tracheoesophageal voice prosthetic difficult to use?Content Although it takes guidance and practice, “it’s not complicated to learn how to use the prosthesis,” Vess said. Most people only need a few speech therapy sessions to master covering their stoma, coordinating their breath, and cleaning the prosthesis. Accessories can make it easier to cover your stoma, while also filtering the air you inhale and maintaining humidity in your lungs. Does the prosthetic need to be replaced?Content According to Vess, the prosthetic valve lasts several months on average, but it can last up to a year. The replacement procedure does not require surgery and is usually painless. It can be done in a doctor’s office in under an hour, often by a speech-language pathologist. You can also learn to change your prosthetic valve at home. Your speech pathologist will provide guidance about when your prosthesis needs to be replaced. Are there other options?Content Since TEP isn’t for everyone, Dr. Cannon said other options are available for creating speech after a total laryngectomy, including artificial voice boxes and esophageal speech. An artificial voice box (also called an electrolarynx) is a small battery-operated device that is placed against your neck when you want to speak. The device produces vibrations that travel to your throat to help you create electronic-sounding speech. Esophageal speech (also called “burp talking”) requires you to swallow and release air to vibrate your esophagus. Because the tracheoesophageal voice method sounds more natural than an artificial voice box or esophageal speech, Vess said people are happy to learn about this option. This chart is a list of the most common health insurance plans we accept. This list is subject to change. Please check your individual plan to confirm their participation and the coverage allowed. Due to the different physician groups and hospitals within the Wake Forest Baptist system, physician services and hospital services are billed separately. Please remember that health insurance coverage varies, so some services may not be covered. If you don’t see your plan or you have questions, please call our Customer Service Center at 877-938-7497. We will do our best to work with you and your plan. KeyWFUHS - Wake Forest University Health Sciences (professional services) Wake Forest Baptist Health Managed Care/MA Contracts - January2022AETNA CONNECTED ACA/Exchange: Accepted at all locations AETNA (PPO & HMO): Accepted at all locations AETNA MEDICARE: Accepted at all locations AETNA WHOLE HEALTH: Accepted at all locations ALIGNMENT HEALTHCARE MEDICARE ADVANTAGE: Accepted at WFUHS, NCBH, Davie, LMC, CHC and Wilkes (not applicable to services provided at High Point) AMBETTER OF NC: Accepted at all locations AMERIHEALTH CARITAS NEXT ACA/Exchange: Accepted at all locations APEX MEDICARE ADVANTAGE: Accepted at all locations BCBSNC (PPO & HMO): Accepted at all locations BCBS HIGH PERFORMANCE (NATIONAL NETWORK): Accepted at all locations BLUE LOCAL (WFBH INDIVIDUAL & WFBH X_Group): Accepted at all locations BLUE MEDICARE: Accepted at all locations BLUE VALUE: Accepted at all locations CAROLINA BEHAVIORAL HEALTH: Accepted at WFUHS, NCBH and CHC (not applicable to services provided at Davie, LMC, Wilkes and High Point) CIGNA: Accepted at all locations CIGNA BEHAVIORAL HEALTH: Accepted at NCBH and High Point (not applicable to services provided at Davie, LMC, CHC and Wilkes) CIGNA HEALTHSPRING MEDICARE ADVANTAGE: Accepted at WFUHS, NCBH, Davie, LMC, CHC and High Point (not applicable to services provided at Wilkes) CIGNA LIFESOURCE (TRANSPLANTS): Accepted at WFUHS and NCBH (not applicable to services provided at Davie, LMC, CHC, Wilkes and High Point) COVENTRY/WELLPATH: Accepted at all locations CRESCENT PPO (ASHEVILLE): Accepted at WFUHS and NCBH (not contracted, very low to no volume for Davie, LMC, CHC, Wilkes and High Point) DIRECT NET: Accepted at WFUHS, NCBH, Davie, LMC, Wilkes and High Point (not contracted, very low to no volume for CHC) FIRST HEALTH (COVENTRY): Accepted at all locations FIRSTCAROLINACARE (PINEHURST, NC): Accepted at NCBH (not contracted, very low to no volume for WFUHS, Davie, LMC, CHC, Wilkes and High Point) GATEWAY HEALTH ALLIANCE (VIRGINIA): Accepted at WFUHS and NCBH (not contracted, very low to no volume for Davie, LMC, CHC, Wilkes and High Point) GOLDEN RULE INS (UNITED): Accepted at all locations HEALTHGRAM (formerly PRIMARY PHYSICIAN CARE): Accepted at WFUHS, NCBH and LMC (not contracted, very low to no volume for Davie, CHC, Wilkes and High Point) HEALTHTEAM ADVANTAGE: Accepted at all locations HUMANA CHOICECARE: Accepted at all locations HUMANA MEDICARE ADVANTAGE: Accepted at all locations LIBERTY ADVANTAGE (MEDICARE ADVANTAGE): Accepted at WFUHS and NCBH (not applicable to services provided at Davie, LMC, CHC, Wilkes and High Point) MAGELLAN (BEHAVIORAL HEALTH): Accepted at WFUHS, NCBH and CHC (not applicable to services provided at Davie, LMC, Wilkes and High Point) MEDCOST: Accepted at all locations MEDCOST ULTRA: Accepted at WFUHS, NCBH, Davie, LMC, Wilkes and High Point (not applicable at CHC) OPTUMHEALTH (TRANSPLANTS - APPLICABLE TO NCBH/WFUHS ONLY): Accepted at WFUHS and NCBH (not applicable to services provided at Davie, LMC, CHC, Wilkes and High Point) PREFERRED CARE OF VA INC: Accepted at WFUHS and NCBH (not contracted, very low to no volume for Davie, LMC, CHC, Wilkes and High Point) SOUTHERN HEALTH SVCS (COVENTRY-PPO ONLY): Accepted at WFUHS, NCBH, Davie and CHC (not contracted, very low to no volume for LMC, Wilkes and High Point) TWIN COUNTY (VIRGINIA): Accepted at WFUHS and NCBH (not contracted, very low to no volume for Davie, LMC, CHC, Wilkes and High Point) UNITED BEHAVIORAL HEALTH: Accepted at WFUHS, NCBH, CHC and High Point (not applicable to services provided at Davie, LMC and Wilkes) UNITED BEHAVIORAL HEALTH INTENSIVE OUTPATIENT PROGRAM (WFUHS ONLY): Accepted at WFUHS (not applicable for services provided at NCBH, Davie, LMC, CHC, Wilkes and High Point) UNITED HEALTHCARE: Accepted at all locations UNITED HEALTHCARE ESSENTIALS ACA/EXCHANGE: Accepted at all locations UNITED HEALTHCARE MEDICARE: Accepted at all locations VA CCN: Accepted at all locations WELLCARE: Accepted at all locations WELLPATH (COVENTRY): Accepted at all locations Key WFUHS - Wake Forest University Health Sciences (professional services) Can you whisper after laryngectomy?Patients who have undergone partial or full laryngectomy are typically unable to speak anything more than hoarse whispers, without the aid of prostheses or specialized speaking techniques.
Which of the following nursing intervention is a priority for a patient with laryngectomy?Airway maintenance
A priority for patients who have undergone a total laryngectomy is for them to learn how to care for their new airway. The lower airway is no longer connected to the upper airway, so patients must pay critical attention their only source of breathing—the stoma.
What are the main methods of voice restoration after a total laryngectomy?There are 3 main methods of voice restoration: esophageal speech, usage of the electrolarynx, and tracheal-esophageal puncture for tracheal-esophageal speech, which can be performed primarily or secondarily. Although all 3 methods have potential benefits, the gold standard is tracheal-esophageal speech.
What should the nurse include in discharge teaching for the patient with a total laryngectomy?Incision and stoma care. Check your incision site daily for 1 week after discharge. ... . Bathe in shallow water. ... . Use a waterproof bib to cover your stoma when you shower.. Don't swim.. Learn to care for your stoma. ... . Wear a stoma cover to keep moisture from being lost when you breathe.. Use a cool-mist humidifier by your bedside.. |
Which options for communication immediately after total laryngectomy would be best for the client to use?
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