General aspects of patient instruction
Instruction should be given to patients about daily cleaning of the TEP voice prosthesis with a brush or flushing unit. Occluding the stoma and producing a loud sound also cleans the TEP voice prosthesis. The patient should be aware of the fact that the prosthesis will stay cleaner by speaking regularly. Patients should be provided with a proper explanation about the fact that at a given time the valve of the prosthesis will become incompetent and that leakage of liquids can occur. The first reaction should be to properly clean the prosthesis with a brush or flush. If this does not solve the problem, replacement probably is indicated. However, temporary control of leakage through the prosthesis can be obtained by using a special plug if the patient is unable or unwilling to make an appointment at short notice with the clinician, for instance during weekends or holidays. The patient should be instructed how to use this plug during the consumption of liquids (solid food rarely causes problems).
Patients are always given the opportunity and are encouraged to learn esophageal speech as well. In contrast to the situation in the USA, in the Netherlands electrolarynx use is limited to patients failing both prosthetic and esophageal voice. However, the use of an electrolarynx as an alternative alaryngeal communication and, thus, as a back-up method, deserves more attention.
In our institute, the use of an automatic speaking valve for hands-free speech is encouraged only after the patient has mastered all daily practical aspects of prosthetic speech and has developed a fluent, not too strained voice. It appears to be important that the patient has enough dexterity to handle these devices comfortably (Van den Hoogen, Meeuwis, Oudes, Janssen, & Manni, 1996). In daily practice, success rates are still relatively low with less than a quarter of the patients achieving a full-day unrestricted use, which is comparable to the results reported by Van den Hoogen et al (1996) However, results with the novel automatic speaking valve Provox FreeHands HME are not available yet, since this device has been developed and introduced only recently. For the practical aspects of the use of the Provox FreeHands HME, see the following chapter.
Patients are always given the opportunity and are encouraged to learn esophageal speech as well. In contrast to the situation in the USA, in the Netherlands electrolarynx use is limited to patients failing both prosthetic and esophageal voice. However, the use of an electrolarynx as an alternative alaryngeal communication and, thus, as a back-up method, deserves more attention.
In our institute, the use of an automatic speaking valve for hands-free speech is encouraged only after the patient has mastered all daily practical aspects of prosthetic speech and has developed a fluent, not too strained voice. It appears to be important that the patient has enough dexterity to handle these devices comfortably (Van den Hoogen, Meeuwis, Oudes, Janssen, & Manni, 1996). In daily practice, success rates are still relatively low with less than a quarter of the patients achieving a full-day unrestricted use, which is comparable to the results reported by Van den Hoogen et al (1996) However, results with the novel automatic speaking valve Provox FreeHands HME are not available yet, since this device has been developed and introduced only recently. For the practical aspects of the use of the Provox FreeHands HME, see the following chapter.
