Tracheoesophageal puncture (TEP) is a surgical procedure in which a hole is created between the trachea (windpipe) and esophagus (gullet). It is usually performed in people who undergo surgical removal of the larynx (voice-box) called a total laryngectomy (TL). This puncture restores the person’s ability to speak after the vocal cord (voice-box) has been removed.
In this procedure, the surgeon makes an opening (a hole) between the trachea (windpipe) and esophagus and places a small plastic or silicone one-way valve into it. This valve allows air to pass from the trachea to the esophagus but blocks water and food out of the trachea.
After TEP, the patient covers this opening (stoma) with the finger and swallows air into the esophagus through the valve. This forceful air vibrates the walls of the throat and remnant gullet sphincter. This vibration produces sound, which is very much like natural speech. This is called esophageal speech. Sometimes, instead of using the vocal fold vibration, pharyngeal (throat) wall vibrations are used as the sound source.
TEP is generally performed 3-6 months after the complete removal of the larynx (TL) because this provides time for the body to heal before proceeding with the prosthesis. The procedure is performed under general anesthesia. Initially, a temporary prosthesis will be placed, which will then be replaced with the voice prosthesis in approximately 1 week. A speech therapist will help patients to use this prosthesis.
Many people can achieve a certain degree of speech in this technique, but fluency remains a challenge. Regular practice sessions with a speech therapist may increase fluency and clarity in speech. This technique does not require any major prosthesis or external devices, which is a major advantage. Multiple advances have been made in the valve prosthesis design and construction (including the advent of hands-free adjuvant devices), different surgical techniques, and the timing of the procedure.
When will the doctor suggest TEP?
The doctor will only perform TEP in a person who has undergone complete removal of voice-box/vocal cord (total laryngotomy) and desires TEP phonation.
When will the doctor not suggest TEP?
The doctor may not recommend TEP if a person has:
- Partial removal of the larynx (subtotal laryngectomy).
- A TL with stomach pull-up (to avoid infection or pus-collection).
- A small laryngectomy opening (stoma).
- Poor lung function, which may decrease the ability to use the prosthesis because it requires relatively higher positive pressure in the trachea (windpipe).
- Been drinking excessive alcohol.
- Not been able to produce speech or sound.
- Inconsistent or unreliable follow-up.
- No financial support to obtain subsequent TEP care or replacement.
What are the complications of TEP?
The complications of TEP include:
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Common Medical Abbreviations & Terms
Doctors, pharmacists, and other health-care professionals use abbreviations, acronyms, and other terminology for instructions and information in regard to a patient's health condition, prescription drugs they are to take, or medical procedures that have been ordered. There is no approved this list of common medical abbreviations, acronyms, and terminology used by doctors and other health- care professionals. You can use this list of medical abbreviations and acronyms written by our doctors the next time you can't understand what is on your prescription package, blood test results, or medical procedure orders. Examples include:
- ANED: Alive no evidence of disease. The patient arrived in the ER alive with no evidence of disease.
- ARF: Acute renal (kidney) failure
- cap: Capsule.
- CPAP: Continuous positive airway pressure. A treatment for sleep apnea.
- DJD: Degenerative joint disease. Another term for osteoarthritis.
- DM: Diabetes mellitus. Type 1 and type 2 diabetes
- HA: Headache
- IBD: Inflammatory bowel disease. A name for two disorders of the gastrointestinal (BI) tract, Crohn's disease and ulcerative colitis
- JT: Joint
- N/V: Nausea or vomiting.
- p.o.: By mouth. From the Latin terminology per os.
- q.i.d.: Four times daily. As in taking a medicine four times daily.
- RA: Rheumatoid arthritis
- SOB: Shortness of breath.
- T: Temperature. Temperature is recorded as part of the physical examination. It is one of the "vital signs."
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Sore throat (throat pain) usually is described as pain or discomfort in the throat area. A sore throat may be caused by bacterial infections, viral infections, toxins, irritants, trauma, or injury to the throat area. Common symptoms of a sore throat include a fever, cough, runny nose, hoarseness, earaches, sneezing, and body aches. Home remedies for a sore throat include warm soothing liquids and throat lozenges. OTC remedies for a sore throat include OTC pain relievers such as ibuprofen or acetaminophen. Antibiotics may be necessary for some cases of sore throat.
Sore Throat Home RemediesNatural and home remedies for sore throat symptoms and pain relief include essential oils, licorice gargles, slippery elm leaves, raw garlic, Throat Coat tea, sage, and acupuncture. Typical symptoms of a sore throat include throat pain, coughing, sneezing, fever, and swollen lymph nodes. Sore throats are caused by viral (common cold, flu, mumps), bacterial (tonsillitis, some STDs), toxins, allergens, trauma or injury, or "mechanical causes" (breathing through the mouth).
Sore Throat or Strep Throat? How to Tell the DifferenceIs this a sore throat or could it be strep throat? Explore the causes of a sore throat, including strep throat, and learn how to find relief from that raw, scratchy throat pain.
Strep Throat QuizTake the Strep (Streptococcal) Throat Infection Quiz to learn about causes, symptoms, treatments, prevention methods, diagnosis, and complications of this common infectious disease.
Strep ThroatStrep throat is a bacterial infection of the throat. Signs and symptoms of strep throat include headache, nausea, vomiting, sore throat, and fever. Strep throat symptoms in infants and children are different than in adults. Strep throat is contagious and is generally passed from person to person. Treatment for strep throat symptoms includes home remedies and OTC medication; however, the only cure for strep throat is antibiotics.
Strep Throat PictureStrep infection often produces a distinct pattern of white patches in the throat and on the tonsils, as well as red swollen tonsils. See a picture of Step Throat and learn more about the health topic.