Proof of Concept of a Tracheoesophageal Voice Prosthesis Insufflator for Speech Production After Total Laryngectomy

Importance. There may have a variety of reasons why patients are unable to produce tracheoesophageal speech after total laryngectomy (TL) including poor pulmonary reserve or other comorbidities that prevent adequate stoma occlusion and intratracheal pressure to voice. Other patients find it difficult, uncomfortable, or socially awkward to manually occlude the stoma with the finger or thumb. Objective. The study aimed to assess the feasibility of achieving TE speech with a prototype TE voice prosthesis insufflator (TEVPI). Design, Setting, and Participants. We prospectively assessed the feasibility of achieving TE speech with a commercially available continuous positive airway pressure device in six TL patients. Intervention. The intervention is the use of a prototype TEVPI. Main Outcomes and Measures. A battery of acoustic and perceptual metrics were obtained and compared between TEVPI speech and standard tracheoesophageal voice prosthesis (TEVP) speech. Results. Voicing was accomplished with the TEVPI in five of six participants. On average, the duration of phonation with TEVPI was shorter, not as loud, and perceived to be more difficult to produce compared to TEVP speech. Conclusions and Relevance. The TEVPI is a feasible, hands-free solution for restoring speech after TL. Although the current model produced inferior acoustic metrics compared with standard TEVP speech, further modification and refinement of the device has the potential to produce much improved speech.