Voice ProsthesisThe Laryngectomee Guide

Dr Mawaddah AzmanAssociate Professor Dr Marina Mat Baki

Department of OtorhinolaryngologyUniversiti Kebangsaan Malaysia Medical Centre

Laryngectomy (Removal of voice box)Total laryngectomy is an operation performed for

advanced cancer of the larynx (voice box)

Patients with cancer of voice box normally presents withHoarsenessNoisy breathingShortness of breath

Carcinoma of the larynx (Voice Box Cancer)

(UKM experience)1981 to 1988

137 cases76 (55.5%) required total laryngectomy

1998 to 200793 cases18 (19.4%) required total laryngectomy

cancerIn the circle- voice box

Main effect of total laryngectomyNO VOICE

However communication after the operation is still possible

One of the ways is by using Voice Prosthesis

Majority of who had laryngectomy used voice prosthesis compared with other ways of voice rehabiltation

Voice Prosthesis

Esophageal speech

None02468

101214161820 18

2

6

Voice Rehabilitation 1998-2011

No. of cases

Voice Prosthesis

A voice prosthesis is a one-way valve that allows passage of air towards the throat and food passage, and that prevents leak of fluid and food into the airway

Prosthesis

Hands free speechOne of the example of a voice prosthesis,

latest product in the market

Advantages80% success rateRelatively easier to learnBest results in speech intelligibility six

months and one year after total laryngectomy

DisadvantagesNeeds maintenance

Cleaning the prosthesisNeed stable hands to do this

Local side effectsLeaking causing choking (aspiration)

Unable to vocalise or talk (25%)Dislodgement of prosthesis

How to make sure the voice prosthesis last longer Before using the brush provided by the manufacturer, dip it in a cup of hot

water and leave it there for a few seconds.

Insert the brush into the prosthesis (not too deep) and twist it around a few times to clean the inside of the device. 

Take the brush out and rinse it with hot water and repeat the process 2-3 times until no material is brought out by the brush.

Because the brush is dipped in hot water one should be careful not to insert it beyond the voice prosthesis inner valve to avoid traumatizing the esophagus with excessive heat.

Flush the voice prosthesis twice using the bulb provided by the manufacturer using warm (not hot!) potable water or air.

To avoid damage to the esophagus, sip the water first to make sure that the water temperature is not too high.

How to prevent fungus infection

Reduce the consumption of sugars in food and drinks.

Brush your teeth well after every meal.

Diabetics should maintain adequate blood sugar levels.

Take antibiotics only if they are needed.

Dip the voice prosthesis brush in a small amount of mycostatin

Brush the inner voice prosthesis before going to sleep.

How to prevent fungus infection

Consume probiotics by eating active-culture yogurt and/or a probiotic preparation

Gently brush the tongue if it is coated with yeast (white plaques)

Replace the toothbrush after overcoming a yeast problem to prevent re colonizing with yeasts

Keep the prosthesis brush clean