Provoxweb

  • General Introduction
  • Voice Rehabilitation
    • 1. The Provox System>
      • Provox1 Voice Prosthesis
        • Provox2 Voice Prosthesis
          • Provox Vega & SmartInserter
            • Provox ActiValve
              • Provox Sizer
                • Provox Dilator
                  • Provox XtraFlange
                    • Provox Brush-Flush-Plug
                      • Provox HME
                        • Provox FreeHands HME
                          • Provox LaryTube
                            • Provox LaryButton
                              • Provox Surgical Set
                              • 2. Surgery>
                                • Primary Prosthetic Voice Rehabilitation>
                                  • Total laryngectomy
                                    • Surgical technique primary TEP
                                      • Primary tonicity control PE-segment
                                        • Tracheostoma construction
                                        • Secondary prosthetic voice rehabilitation>
                                          • Indications
                                            • Preoperative screening
                                              • Surgical technique secondary TEP
                                                • Alternative technique secondary TEP
                                                • Secondary treatment PE segment hypertonicity>
                                                  • Introduction
                                                    • Hypertonicity treatment with Botox
                                                      • References
                                                        • Surgical constrictor pharyngeus myotomy
                                                        • Fistula closure>
                                                          • Indications
                                                            • Surgical technique
                                                            • Stoma revision>
                                                              • Introduction
                                                                • Surgical techniques of tracheostoma reconstruction
                                                                  • Comments
                                                                    • Conclusions
                                                                      • References
                                                                      • Pharynx reconstruction and voice rehabilitation>
                                                                        • References
                                                                      • 3. Replacement>
                                                                        • Indications
                                                                          • Replacement procedures>
                                                                            • Choosing the right prosthesis length
                                                                              • Provox Vega & Smart Inserter
                                                                                • Provox2 voice prosthesis
                                                                                  • Provox1 voice prosthesis
                                                                                    • Replacement of other voice prostheses by Provox
                                                                                    • Additional remarks on prosthesis replacement
                                                                                    • 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 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 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
                                                                                                                                                      • 5. Speech Therapy>
                                                                                                                                                        • Introduction
                                                                                                                                                          • Preoperative counseling
                                                                                                                                                            • Outline of voice therapy
                                                                                                                                                              • Important basic principles in voice rehabilitation in prosthetic speech
                                                                                                                                                                • Some points of attention for the 'finishing touch'
                                                                                                                                                                  • General aspects of patient instruction
                                                                                                                                                                    • Problem solving
                                                                                                                                                                      • Conclusion
                                                                                                                                                                      • 6. Hands-free Speech>
                                                                                                                                                                        • Introduction
                                                                                                                                                                          • Provox FreeHands HME automatic speaking valve
                                                                                                                                                                            • Attachment of the valve>
                                                                                                                                                                              • Peristomal attachment
                                                                                                                                                                                • Intratracheal fixation
                                                                                                                                                                                • Assembling and disassembling the HME
                                                                                                                                                                                  • Choosing the membrane
                                                                                                                                                                                    • Proper adjustment of the cough-relief valve
                                                                                                                                                                                      • Using the walk and talk position
                                                                                                                                                                                        • Use of the cleaning container
                                                                                                                                                                                          • Speech therapy. What to practice to optimize hands-free speech>
                                                                                                                                                                                            • Closure of the membrane
                                                                                                                                                                                              • Breath-support/breath-voice coordination
                                                                                                                                                                                                • Phrase length, speech rate, maximum phonation time
                                                                                                                                                                                                  • Pitch, loudness, intonation
                                                                                                                                                                                                    • Shouting
                                                                                                                                                                                                      • Decrease backpressure
                                                                                                                                                                                                        • Hypertonicity/spasm of the neoglottis
                                                                                                                                                                                                          • Hypotonicity of the neoglottis
                                                                                                                                                                                                            • Confusing hands-free TE-speech with esophageal speech
                                                                                                                                                                                                            • Conclusion
                                                                                                                                                                                                              • Troubleshooting>
                                                                                                                                                                                                                • No voice sound
                                                                                                                                                                                                                  • Weak/whisper/aphonic voice
                                                                                                                                                                                                                    • Air leakage under membrane>
                                                                                                                                                                                                                      • Air escaping underneath cough-relief valve
                                                                                                                                                                                                                        • Shortness of breath
                                                                                                                                                                                                                          • Cough-relief valve opens when patient is speaking loud
                                                                                                                                                                                                                            • Seal of the adhesive does not last long
                                                                                                                                                                                                                              • Problems with intratracheal fixation
                                                                                                                                                                                                                                • Too much noise of cough-relief valve when coughing
                                                                                                                                                                                                                                • References
                                                                                                                                                                                                                              • 7. Voice Research>
                                                                                                                                                                                                                                • Introduction
                                                                                                                                                                                                                                  • Perceptual evaluations
                                                                                                                                                                                                                                    • Acoustic analyses
                                                                                                                                                                                                                                      • Maximum phonation time
                                                                                                                                                                                                                                        • Videofluoroscopy
                                                                                                                                                                                                                                          • Summary
                                                                                                                                                                                                                                            • References
                                                                                                                                                                                                                                          • Pulmonary Rehabilitation
                                                                                                                                                                                                                                            • Introduction
                                                                                                                                                                                                                                              • Heat and Moisture Exchangers (HME's)>
                                                                                                                                                                                                                                                • Treatment aspects
                                                                                                                                                                                                                                                  • Prevention aspects
                                                                                                                                                                                                                                                  • Provox HME>
                                                                                                                                                                                                                                                    • Compliance aspects
                                                                                                                                                                                                                                                      • Improvements in compliance
                                                                                                                                                                                                                                                        • Improvements in voicing
                                                                                                                                                                                                                                                          • Early post-operative pulmonary hygiene
                                                                                                                                                                                                                                                            • Breathing resistance
                                                                                                                                                                                                                                                              • Newest Provox HMEs
                                                                                                                                                                                                                                                              • Treatment with inhalation medication
                                                                                                                                                                                                                                                                • Conclusions
                                                                                                                                                                                                                                                                  • References
                                                                                                                                                                                                                                                                  • Olfaction Rehabilitation
                                                                                                                                                                                                                                                                    • Introduction
                                                                                                                                                                                                                                                                      • Clinical research on postlaryngectomy olfaction
                                                                                                                                                                                                                                                                        • Clinical research on olfaction rehabilitation
                                                                                                                                                                                                                                                                          • Considerations on postlaryngectomy olfaction rehabilitation
                                                                                                                                                                                                                                                                            • References
                                                                                                                                                                                                                                                                            • Media etc.
                                                                                                                                                                                                                                                                              • References
                                                                                                                                                                                                                                                                                • Copyright information
                                                                                                                                                                                                                                                                                  • Media-downloads>
                                                                                                                                                                                                                                                                                    • Animations
                                                                                                                                                                                                                                                                                      • Video clips
                                                                                                                                                                                                                                                                                        • Sounds
                                                                                                                                                                                                                                                                                          • PDF

                                                                                                                                                                                                                                                                                        © The Netherlands Cancer Institute - 2003-11; ISBN 90-75575-05-X