title: [Tracheostomy valve with integrated cough flap for improving hands-free speech in laryngectomized patients--development and clinical applications].
abstract: BACKGROUND
  Following successful voice restoration after laryngectomy either by a voice prosthesis, a surgical shunt or microvascular laryngoplasty, a further goal in rehabilitation is the insertion of a tracheostoma valve, which enables the patient to speak without using his fingers for closure of the tracheostoma. One important disadvantage of the tracheostoma valves, which are available today, is the necessity of removal of the valve in case of coughing, because the valve could be thrown from the stoma by the strong air flow during coughing. As many laryngectomies suffer from chronic bronchitis, this coughing problem is one of the reasons why only few patients could be provided with this useful aid.
  
  
  METHODS
  At the department of biomedical engineering of the faculty of medicine at the university of Groningen, the Netherlands, 1994 two prototypes of a tracheostoma valve with an integrated cough lid were developed. These devices contain two separate valve systems: the normal speaking valve and a special coughing valve, which opens at a certain air flow and closes automatically after the coughing attack. Thus no manipulations are necessary during coughing, the patient can speak undisturbed. The ADEVA company (Lübeck, Germany) undertook the industrial production of this new type of tracheostoma valve creating different modifications of the prototype #2.
  
  
  METHODS
  In four series with 6-8 patients per group the modified tracheostoma valves were tested clinically and the occurring faults or lack of correct function eliminated by small changes in the production.
  
  
  RESULTS
  Meanwhile a suitable model for routine use is available, which was tested in 30 patients so far. This suitability was achieved by improvements in the valve mechanism, the valve seal and the adjustment mechanisms for the individual pressure level of the speaking and the coughing valve.
  
  
  CONCLUSIONS
  The newly developed tracheostoma valve with integrated coughing lid (Window, ADEVA-medical Company, Lübeck, Germany) provides further improvement in speech rehabilitation of laryngectomies. The low acceptance of tracheostoma valves, which enable the patient to speak without using his fingers for closure of the tracheostoma, possibly may be raised by this new aid.
authors.affiliation: Klinik für Hals-Nasen-Ohrenkrankheiten, Plastische Operationen, Katharinenhospital Stuttgart. hagen.hno@katharinenhospital.de
authors.forename: R
authors.initials: R
authors.lastname: Hagen
authors.forename: C
authors.initials: C
authors.lastname: Schwarz
authors.forename: K
authors.initials: K
authors.lastname: Berning
authors.forename: A A
authors.initials: AA
authors.lastname: Geertsema
authors.forename: G J
authors.initials: GJ
authors.lastname: Verkerke
mesh_terms: D001991:Bronchitis / Q000503:physiopathology / Q000534:rehabilitation*; D003371:Cough / Q000503:physiopathology*; D006801:Humans; D007825:Laryngectomy / Q000295:instrumentation*; D011183:Postoperative Complications / Q000503:physiopathology / Q000534:rehabilitation*; D011474:Prosthesis Design; D012123:Pulmonary Ventilation / Q000502:physiology; D013071:Speech, Alaryngeal / Q000295:instrumentation*; D014139:Tracheostomy / Q000295:instrumentation*