TE fistula too wide to hold a voice prosthesis, surgery not an option

Problem: the TE fistula is too wide to hold a voice prosthesis and surgery is not an option anymore

A rare example of such a situation is shown in the top figure. The patient was in an end stage of a second primary cancer (non-small lung carcinoma) and severely cachectic. The solution was blocking the TE fistula with a nasal septal button, which was cut into shape (top left figure). In the next figure the situation after anterograde insertion of the nasal septal button is shown. In this way the intractable aspiration was stopped and the patient could tolerate liquids again.