Incidence, timing, and importance of tracheoesophageal prosthesis resizing for successful tracheoesophageal speech production.

The Blom-Singer method of tracheoesophageal (TE) speech restoration is a proven alternative to esophageal and electrolaryngeal speech in patients with total laryngectomy. This retrospective study was undertaken to determine the incidence and timing of TE prosthesis resizing, amount of change in prosthesis length, etiologies associated with resizing, and importance of long-term professional follow-up for maintenance of successful TE speech production. Participants were 26 individuals with total laryngectomy and secondary TE puncture. Results indicated that all 18 participants available for long-term follow-up required TE prosthesis resizing, and multiple resizings were required in 87% of the routinely followed participants. In 14 participants the prostheses were resized shorter (sample mean [mean] = -0.7 cm); in 3, longer (mean = +0.5 cm); and in 1, from a duckbill to a low-pressure prosthesis of the same size. The mean number of days from initial measurement and fitting to first prosthesis resizing was 26. The importance of collaboration between the speech-language pathologist and otolaryngologist and need for long-term follow-up for successful maintenance of TE speech are stressed. Cost containment of rehabilitation services using the indwelling TE prosthesis is demonstrated.