The Singer-Blom voice restoration procedure.

The Singer-Blom tracheoesophageal puncture (TEP) technique is an effective and safe surgical method for speech rehabilitation of the alaryngeal patient. The silicone prosthesis, which is fitted in the TEP tract, allows pulmonary air to be used for voice production but prevents aspiration. In a series of 63 patients, 56 (89%) were able to develop fluent speech, but only 45 patients (71%) currently use tracheoesophageal speech as their prime mode of communication. Of the 18 patients (29%) who no longer use tracheoesophageal speech, 11 experienced either inadvertent dislodgement of the prosthesis or were noncompliant, five patients failed to develop fluent speech after adequate trial, and two patients failed because of aspiration. Almost all of the successful patients have voice quality and fluency that are as good or better than accomplished esophageal speakers, despite the fact that most of these patients were unable to learn esophageal speech. Since the Singer-Blom technique has eliminated most of the problems associated with other forms of surgical speech rehabilitation, it is considered to be the best surgical technique presently available for restoring speech in the alaryngeal patient.