title: Prosthetic voice restoration with the tracheostomal valve: a clinical experience.
abstract: BACKGROUND
  Tracheoesophageal puncture (TEP) and use of a voice prosthesis is not a panacea for all laryngectomies. This report presents results of longitudinal treatment of 24 patients with secondary TEP followed longitudinally for 10 years in a private practice setting. Unique to this report is a focus on the use of the entire voice restoration system including both the voice prosthesis and the automatic tracheostomal valve.
  
  
  METHODS
  All patients referred for secondary TEP between 1982 and 1992 are included. Voice quality and the longevity of vocal restoration were ascertained. Clinical problems and their solutions are reported.
  
  
  RESULTS
  Immediate vocal restitution was achieved in 19 of 24 patients. Voicing was produced in two more patients within a few weeks. Four patients were not available for long-term follow-up because of death due to recurrent disease. Overall, 60% of patients were rated excellent and 5% rated fair in communication over a long-term period. Thirty-five percent were rated failure.
  
  
  CONCLUSIONS
  TEP and the use of the voice restoration system enabled both hands to be free during speaking and is achieved by many laryngectomies. Patient evaluation, training, and follow-up with team problem-solving may increase success rates using this approach.
authors.affiliation: Department of Communicative Disorders, University of Alabama, Tuscaloosa.
authors.forename: J M
authors.initials: JM
authors.lastname: Gerwin
authors.forename: G L
authors.initials: GL
authors.lastname: Culton
mesh_terms: D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000534:rehabilitation*; D007831:Larynx, Artificial / Q000009:adverse effects / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011677:Punctures; D012086:Reoperation; D012189:Retrospective Studies; D013071:Speech, Alaryngeal / Q000379:methods*; D013997:Time Factors; D014132:Trachea / Q000601:surgery; D014139:Tracheostomy; D014833:Voice Quality