Blom-Singer prostheses--an 11 year experience of primary and secondary procedures.

Over the past 11 years, 25 primary and 29 secondary tracheo-oesophageal punctures have been performed in 51 laryngectomees. Pre-operative assessment is required for the secondary procedure. Both primary and secondary procedures require intensive speech therapy after fitting of the prosthesis. Fifty-four per cent of the primary and 37% of the secondary patients attained long-term speech, the latter figure rising to 58% with newer valves and increasing experience. Failures were commonly due to psychological or prosthesis-related problems. Complications were relatively minor, none being life threatening. Seventy per cent of the long-term users were self caring. Adequate rehabilitation counselling and support is necessary to ensure long-term use of the prosthesis.