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Objectives: We performed in vitro evaluation of a novel, disposable, automatic hands-free tracheostoma speech valve for laryngectomy patients based upon the principle of inhalation. The commercially available automatic speech valves close upon strong exhalation and open again when the pressure drops. This method makes long sentences or pauses difficult. The novel iValve is designed to allow almost natural speech, with mid-sentence pausing and whispering., Methods: The inhalation closing flows and exhalation opening pressures of 6 iValve prototype versions at different settings were compared with physiological values. The airflow resistance at inhalation was compared to physiological values and to commercial valve values., Results: The iValve prototypes showed flow and pressure ranges in concordance with the physiological values in the literature. The airflow resistance in the breathing mode was within the physiological airflow resistance range, yet above the values from the two commercial valves. The resistance in the speaking mode was above the physiological airflow resistance range., Conclusions: In vitro tests show that the iValve versions can be selected and adjusted to operate within the physiological range. The airflow resistance in the breathing mode is good. In speaking mode, inhalation should, and can, be decreased. The iValve should offer the patient a more intuitively useable alternative with more dynamic speech. Its low cost allows disposability and wider use.

Tracheoesophageal speakers can achieve speech without digital occlusion by using a tracheostoma valve. Laryngectomized patients who are successful with this device can regain considerable freedom. However, little is known about which valve suits the patient best. Valve aerodynamics may give a guideline for its use. Three major tracheostoma valves, each divided into four subtypes, were repeatedly measured in this study. Dynamic pressure and airflow rate signals were sampled through an analog-digital interface into a computer. Considerable aerodynamic differences were observed between the tested valves. The maximum airflow rates, closing pressures, and resistances at low velocities were compared. The presented data may help increase the successful use of tracheostoma valves in tracheoesophageal speakers. Patient factors and additional valve factors should always be taken into account. Further clinical study to validate the clinical relevance of the data is needed.

Forty laryngectomy patients in Iowa have received a tracheoesophageal fistula and voice button prosthesis. The fistula was successfully completed in all patients using local anesthesia. Delayed insertion of the voice prosthesis, approximately a month after the fistula is created, appears to be helpful in establishing the respiratory muscle control needed to achieve tracheoesophageal speech. In addition, delayed insertion allows for longer fistula maturation, recognition by the patient that speech is formed by vibrations within the pharyngoesophageal segment, and improved ability to manage the fistula site by proper insertion of the stent. The tracheoesophageal fistula-voice button prosthesis technique has proved to be a relatively simple, uncomplicated, reproducible and inexpensive method of achieving effective speech in a majority of laryngectomy patients.

The loss of voice following total laryngectomy is a severe blow to a patient's functional and psychological well-being. Since the first laryngectomy numerous attempts at voice restoration have been attempted with only limited success. The tracheoesophageal puncture with insertion of the Blom-Singer valve is a major development in neoglottic reconstruction. Initial reports on the use of this technique have been very encouraging. Our initial experience has not been entirely satisfactory. The difficulties encountered include: 1) inability to manage the prosthesis in the home setting; 2) anatomical problems; 3) inability to produce fluent speech. While it is our impression that this new technique is the simplest and most effective method of voice restoration, it is not appropriate for all laryngectomies. Great care should be exercised in patient selection, and this may eliminate many of the difficulties encountered.

Thirty-two tracheoesophageal punctures (TEP) were performed on 30 patients by The Cleveland Clinic Foundation Department of Otolaryngology and Communicative Disorders. In all cases, the Blom-Singer duckbill prosthesis was utilized for alaryngeal voice restoration. Ninety-three percent were able to produce significantly better voice following TEP when compared to their preoperative mode of communication, The preoperative orientation/evaluation format, surgical technique, success-failure ratios, and possible factors affecting successful TEP voice restoration are examined.

Newer surgical techniques for postlaryngectomy voice rehabilitation provide a simple, effective method of communication but require manual occlusion of the tracheostoma during speech. We report the development of a unique tracheostoma valve that avoids the necessity for covering the stoma. This airflow-sensitive valve closes during speech and remains open with normal respiration. Results of a clinical trial with 50 patients over a ten-month period are encouraging. Our experience suggests that excessive vocal tract resistance to airflow is the principal limitation to effective valve use. Approaches to decreasing airflow resistance through the vocal tract to improve both voice production and tracheostoma valve use are discussed.