title: Unaided speech in tube-free tracheostomy: The supplementary sling procedure.
abstract: OBJECTIVE
  In some patients after tube-free tracheostomy, air escape hinders voice optimization. Our objective was to determine whether a supplementary sling procedure could reduce air escape and improve unaided speech and cough in these patients.
  
  
  METHODS
  From September 1998 through June 2001, 12 patients underwent supplementary sling procedures at the Cleveland Clinic. After surgery, stoma constriction and voice production were assessed.
  
  
  RESULTS
  Fifteen procedures were performed in 12 patients. Two patients required revision procedures. All 9 patients with sufficient follow-up have markedly improved stoma constriction and speech production. Three patients with less than 3 months' follow-up already show early improvement.
  
  
  CONCLUSIONS
  The supplementary sling procedure effectively reduces air escape and helps unaided speech and cough in patients with tube-free tracheostomata.
  
  
  CONCLUSIONS
  As more patients undergo tube-free tracheostomy, the pool of patients who might benefit from a sling procedure will grow. Indications might extend to postlaryngectomy or post-laryngeal transplant patients.
authors.affiliation: Department of Otolaryngology, The Cleveland Clinic Foundation, Ohio 44195, USA. eliachi@ccf.org
authors.forename: Isaac
authors.initials: I
authors.lastname: Eliachar
authors.forename: Lee M
authors.initials: LM
authors.lastname: Akst
authors.forename: Ron
authors.initials: R
authors.lastname: Eliashar
mesh_terms: D000328:Adult; D000368:Aged; D000403:Airway Resistance; D000714:Anastomosis, Surgical / Q000379:methods; D003371:Cough; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007829:Laryngostenosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000601:surgery*; D018579:Patient Selection; D012086:Reoperation / Q000706:statistics & numerical data; D020181:Sleep Apnea, Obstructive / Q000601:surgery; D013060:Speech; D014139:Tracheostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000601:surgery