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TEP Information and Management

Tracheoesophageal Voice Prosthesis (TEP) and Tips on TEP Management

Total Laryngectomy is a surgery involving the removal of the voice box (larynx). As part of the procedure, the surgeon creates an opening in the neck (stoma) to allow the patient to breathe. These patients are considered “total neck breathers” as the nose and the mouth are no longer pathways for breathing.

The removal of the larynx changes how a person is able to speak. The options for voicing after a total laryngectomy include:

  • Esophageal speech
  • Electrolaryngeal speech
  • AAC/Talk to Text
  • Tracheoesophageal voicing

After a Total Laryngectomy, patients work with a Speech-Language Pathologist to train and manage their chosen voice modality.

  • Total Laryngectomy Glossary
    • Larynx – The voice box, or larynx, is the part of the respiratory (breathing) tract containing the vocal cords that produce sound.
    • Total laryngectomy – The removal of the larynx and separation of the airway from the mouth, nose, and esophagus.
    • Stoma (tracheostoma) – A stoma is a hole (opening) made in the skin in front of your neck to allow you to breathe. The opening is made at the base of your neck. Air goes in and out of your windpipe (trachea) and lungs through this hole.
    • Voice box – The voice box, or larynx, is the portion of the respiratory (breathing) tract containing the vocal cords that produce sound.
  • Tracheoesophageal Voice Prosthesis (TEP or VP)
    • A tracheoesophageal puncture, or TEP, is a surgical procedure that can be done at the same time as the Total Laryngectomy surgery (primary TEP) or as a separate outpatient procedure (secondary TEP).
    • The TEP or Voice Prosthesis (VP) is a small plastic device that has two ‘flanges’ on either side to keep it in place. Between the two flanges, a small tube contains a one-way valve. This valve opens when you speak and closes when you eat or breathe.
      • The voice prosthesis does NOT talk for you.
      • The voice prosthesis is NOT permanent.
      • The voice prosthesis requires daily care and maintenance for a lifetime.
    • To learn more about TEP or for tips on TEP management, visit the Laryngectomy website.

Common Questions:

How is a Tracheoesophageal Prosthesis (TEP) managed?

  • Daily Care & Cleaning of the Stoma and Voice Prosthesis (VP)
    • Stoma Care:
      • One saline bullet, 5x/day – With or without suction
      • Remove LaryTube 3x/day to clean
    • VP Cleaning Brush & Flush
      • In the AM, after meals, and as needed
    • Consistent HME Wear: Day & Night
      • Important to achieve optimal pulmonary rehabilitation
      • 3 ways to house HME:
        • LaryTube
        • Adhesive baseplates
        • LaryButton
    • Oral care routine after meals
      • Rinse and spit, brush entire oral cavity, swallow warm (*salt) water
        • *Only if you have NO sodium restrictions
    • Daily monitoring of VP fit and function
      • Look at your voice prosthesis in a mirror when taking a drink.
      • If you notice liquid coming through or around the prosthesis, if you have frequent coughing during meals, or if you notice stained secretions after drinking liquids, it is likely time for a TEP change.

When should I return for a TEP change?

  • Daily Monitoring of Voice Prosthesis: How to know when to return to Speech for VP replacement.
    • Is the VP well-fitted?
      • Is it too long or too short?
      • Dislodgement (See Dislodgement Procedure HERE)
    • How is voicing?
      • Can baseline voicing be achieved after morning care?
    • Is the VP leaking?
      • Check with colored beverage or use food coloring in water.
      • Is the VP leaking through the center or around VP?
  • Make appointment to return to TEP clinic during next clinic day to have VP replaced.
    • Call 412-647-2100 (Option 7, Option 8)

How can I manage leaking before coming to my appointment?

  • Addressing leaking through the center of the VP
    • Use of VP cleaning brush and flush
    • Thicken liquids
      • Thickener can be found over the counter at the pharmacy or grocery stores.
      • Brands include Simply Thick, Thick It.
    • VP Plug
      • Inserted during meals or drinking liquids and remove following meals.
      • Cannot voice with VP Plug in place.
    • Use of feeding tube for liquids if it remains in place.
    • Make appointment to return to TEP clinic during next clinic day to have VP replaced.
      • Call 412-647-2100 (Option 7, Option 8)
  • Addressing leaking around the VP?
    • Thicken liquids
      • Thickener can be found over the counter at the pharmacy or grocery stores.
      • Brands include Simply Thick, Thick It.
    • Use of feeding tube for liquids if it remains in place.
    • Make appointment to return to TEP clinic during next clinic day to have VP replaced.
      • Call 412-647-2100 (Option 7, Option 8)

How can I prolong the lifespan of my device?

  • Helpful tips to prolong VP device life
    • Daily cleaning of voice prosthesis using brush/flush
    • Oral care following all meals
    • Diet modifications: Reduce foods/ beverages with high sugar and yeast content
    • Supplements: Plain Greek yogurt, probiotics
    • Reflux management

What do I do if my prosthesis falls out?

  • Emergency Dislodgement
    • Place red rubber (RR) catheter (provided at initial TEP training appointment).
    • Locate dislodged VP.
    • If VP cannot be located, you must go to the Emergency Department (ED) to have a Chest X-Ray.
    • If RR catheter is placed and VP located, you only need to call on the next clinic day to have VP replaced.
    • VP WILL NOT BE REPLACED IN ED.
    • See Dislodgement Procedure HERE.

Why do I need to return for regular appointments with a Speech-Language Pathologist and ENT?

  • Follow up with your Speech-Language Pathologist:
    • To have VP replaced immediately upon leaking, if voicing cannot be achieved or if there is a sudden/progressive change in fit.
    • TO have VP replaced at 6 months if no leaking has occurred within that time.
    • To prevent any difficult scenarios from occurring such as an enlarged TEP, development of granular tissue, TEP closure with inability to voice.
    • To consistently achieve optimal breathing, swallowing, and voicing with the guidance of a Speech-Language Pathologist.
  • Follow-up with your ENT Surgeon:
    • Yearly, to update your prescription for total laryngectomy supplies.
    • As recommended for ongoing cancer care.
  • Call 412-647-2100 (Option 7, Option 8)
    • You will be scheduled for appointments with both an SLP and ENT if you have not been seen in over 1 year.