Tracheal-esophageal Prothesis!

By -
About a month ago I had the opportunity to travel to Indiana for the Blom-Singer Tracheal-esophageal Prothesis course! First, I just have to say WOW! This was such a fantastic course, and to have the opportunity to learn from Dr. Blom and his colleagues was nothing short of awesome! I am amazed with the creativity and inginuity in the makings of the various prothesis.

When I first started in this field my knowledge base of a laryngectomy was limited. When I started working at my outpatient facility I was inspired to continue expanding my knowledge base due to our population. To understand the tracheal-esophageal prothesis (TEP) we first must ask, what is it? Why does a person need it? How is it used? 

Why would someone need a TEP?
After a person is diagnosed with a laryngeal cancer they are typically offered one, more or all of the following options:

1. Surgery to remove tumor
2. Radiation
3. Chemo
4. Partial laryngectomy
5. Full laryngectomy

When a person has a laryngectomy there larynx is removed. When the larynx is removed this means that the vocal folds are removed. A stoma is created into the enterance of the trachea so the patient now has a new airway.




Now without vocal folds it is pretty difficult to communicate but there are options such as...

1. Esophageal speech
2. Electrolarynx
3. Tracheal esophageal prothesis
4. Other AAC options


What is it?/How does it work?
A TEP is placed above the stoma site (see below). This in essence is a fistula created through the tracheal wall into the esophgeal wall (a shared wall). A prothesis is placed that has a valve. The patient now can take a breath, digitally occlude (finger occlude) their stoma and the air will now be directed through the prothesis in order to then create a voice through the new vibratory source, the esophagus.

Stoma with no TEP

Stoma with TEP


Lateral view of tracheal-esophageal shared wall.


Now you might be thinking, why the need for a valve? You need the valve in order to eat. If you do not have a prothesis in (or a prothesis that is just open - no valve) and a patient drinks or eats the food/drink will then fall through the fistula and then into the airway. Food into the airway equals an increased chance of choking and pneumonia. The above image is fantastic for the new airway flow when the stoma is covered.

Learning how to correctly place a TEP.
There are several important factors in placing a TEP but the two I wanted to share is in regards to size and are so very critical for appropriate placement. First you will hear the terms "16 French" "20 French" and possibily even a "23.5 French." This is in regards to the diameter of the prothesis. A concept that was emphasized at the conference was "bigger is not always better." You must respect the fistula that has been placed. This is tissue that has been through trauma and the least amount of bother one is to the tissue the better. Many place a larger TEP - 20 French and up thinking that the receiver will then have a better vocal quality. This is not always the case. I was so fortunate to meet a woman at this conference who volunteered for us to practice TEP placements with. She had a 16 French placement and had a very clear AND feminine voice! 

The next size concern is the depth of tracheal-esophageal wall tissue. How long does the TEP need to be? It is important not to have it too tight and especially not too lose (leakage). You use a measuring tool/dialator (below) in order to determine the correct size.

The dilator looks something like this...


Keep in mind that patient's that are just post laryngectomy and TEP/fistula placement, they will be sore and swollen. It will take time for this tissue heal.  Dr. Blom recommends for a secondary TEP patient (a patient that had a laryngectomy and then decided they wanted a TEP and when back later for their surgery) could be placed with the TEP 2-3 days post surgery. They would then be able to start vocalizing as soon as the TEP was placed. They may need to come back in 2-3 weeks for a new prothesis due to recovery of tissue. 

There are also two major types of TEP's - indwelling and non-indwelling. An indwelling must be replaced by a medical professional, a non-indwelling can be replaced by the patient. Just because a patient has a non-indwelling that doesn't mean they do not need to continue to work with a medical professional. The TEP site can change and so does the needs of the patient.

Problem solving is a big part of placing TEP's. I highly recommend going to a TEP course and that being said this blog post should not be considered enough education to go and do a TEP placement - going to a course first is recommended.

What is your experience with TEP's? What courses do you recommend?


Comments

Post a Comment

Popular posts from this blog

Sharing Research: A Behind the Scenes Look

By -
Image
This past year has been such an exciting adventure in professional growth and development. When 2019 was nearing, I took the time to reflect on my professional aspirations. One of my goals was to start sharing my research findings from my dissertation. My dissertation chair encouraged me to submit my research to the Dysphagia Research Society (DRS) for their 2019 conference. That was goal #1. Goal #2 was submitting for an oral presentation at my annual state organization conference. I completed both applications and I was thrilled when my presentations were accepted at both conferences! My goal for this blog post is to talk about my personal experience in preparing and presenting research. The process of sharing your research can be intensive but it is truly an invaluable experience. There are two main types of presentations out there. An oral presentation which can last for a variety of times, 30 minutes, 1 hr, 2 hrs, 3 hrs, or full day institutes. Then there is a poster pr...
Read more

Shaving Cream Fun!

By -
Image
This Week in Speech ~ Shaving Cream Fun! This week in speech we decided to get a little messy! With shaving cream, a lunchroom tray, lots of towels, and various treatment plans we were able to have a lot of fun!   My department orders these tiny shaving cream canisters. Simply spray onto a surface that can be wiped off and you are set for fun!   There are so many options that you can use this in therapy! Here are just a few ideas! Articulation – you or your student draw out target words to practice Reading sight words Spelling Visual memory – write it down, draw it out, and then wipe it off – recall later Story telling Receptive language – identifying drawings Vocabulary – Learning about the vocabulary terms of “soft” “messy” “fluffy” and “white.” Drawing/writing synonyms and antonyms. Expanding vocabulary knowledge by letting the child draw or try to explain the feature that you drew. Receptive language – following directions through d...
Read more

"Swing Thoughts"

By -
Image
Once upon a time, I wasn’t a Speech-Language Pathologist. Crazy right? My identify for so many years, has been that I am an SLP. But yes, before I went into the field I was actually a golfer. That was my identify for the majority of my life. My dad, Charlie Mahon, is a Class A PGA Golf Professional. My older brother, Charlie Mahon Jr., ran golf courses for most of his career and played for UMKC in college. My older sister, Courtney Mahon, she is now an LPGA Teaching Instructor and played for the University of Arkansas in college. My mom, our biggest cheerleader! I guess you can say I was born into a golfing family and it appeared that golf would be my destiny. I played golf throughout high school and then moved onto earning a scholarship to play for Missouri State University. I learned so many life lessons from playing golf. I learned how to be patient with myself and patient with others. I learned about ethics, being a good teammate, and how to work incredibly hard. I lea...
Read more