4. Troubleshooting
Introduction
Device-related replacement issues
Leakage through the prosthesis
Candida overgrowth
Very frequent replacement due to leakage
Fistula-related issues and problems
Leakage around the prosthesis and the prosthesis is too long
Insertion of 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 to 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 had 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
Main complaint: Leakage
Main complaint: Increased voicing effort
Introduction
Device-related replacement issues
Leakage through the prosthesis
Candida overgrowth
Very frequent replacement due to leakage
Fistula-related issues and problems
Leakage around the prosthesis and the prosthesis is too long
Insertion of 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 to 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 had 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
Main complaint: Leakage
Main complaint: Increased voicing effort
