Page 91 - Prosthetic voice rehabilitation-5th edition

5.6.6 Voicing blocked during stoma occlusion If the VP is too long, the patient might press the device during stoma occlusion into the back wall of the esophagus, thereby partly or even completely blocking the flow of air (as discussed under 5.2; see animation right). Aside from causing a voicing problem, this ultimately might lead to damage and/or necrosis of the back wall of the esophagus, which potentially is a serious complication. This problem can be encountered e.g. after an infectious episode, for which a longer device was inserted. After subsiding of the edema, the VP will be too long. If this does not result in periprosthetic leakage, this too long VP might stay in situ for a prolonged period of time, ultimately causing the problem discussed here. Another cause might be the constant pressure of a cannula onto the VP, pushing the device into the back wall of the esophagus. In the first case, the obvious solution is replacement of the VP with one of the proper size. In the second case, if insertion of a shorter VP is not an option, it should be tried to lower the pressure onto the device by decreasing the diameter of the cannula or try to avoid the use of a cannula completely, e.g. carrying out a stoma plasty: see Surgery chapter 3.5 Stoma revision. Also, the use of an automatic speaking valve can solve this problem, because that takes off the digital pressure onto the VP. 91