Article courtesy of Inhealth Technologies.
The following recommendations are provided by Eric D. Blom, Ph.D.
Leakage through Prosthesis |
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| Causes | Solutions | |
| Duckbill tip contact against posterior esophageal wall |
Replace with low pressure type prosthesis | |
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| Valve deterioration | Replace prosthesis | |
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| Candida deposits on/in valve mechanism | Nystatin Suspension swish and swallow 1 tspn. b.i.d. | |
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Leakage around Prosthesis |
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| Causes | Solutions | |
| Prosthesis is too long resulting in piston movement/track dilation | Resize to a shorter prosthesis | |
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| Insufficient tracheoesophageal party wall thickness | Reconstruct tracheoesophageal party wall with muscle flap |
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| Irridiated tissue | Flap reconstruction | |
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Microstoma |
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| Causes | Solutions | |
| Stenosis | a. Fenestrated silicone tracheostoma vent b. Surgical revision of tracheostoma (enlargement) |
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Macrostoma |
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| Causes | Solutions | |
| Natural trachea size/tracheomalacia | Surgical revision of tracheostoma (reduction) | |
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Granulation Tissue Formation |
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| Causes | Solutions | |
| Irritation, inflammation, tissue thickness (circumferential "donut") associated with presence of foreign body | Surgical removal of tissue (circumferential "donut") |
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Immediate post-fitting aphonia/dysphonia |
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| Causes | Solutions | |
| Prosthesis valved tip is stuck due to increased saliva viscosity | Flush prosthesis in situ with water filled pipet. | |
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| Forceful stoma occlusion | Light finger contact |
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| Pharyngeal constrictor spasm | a. Assess voicing through open *Pharyngeal constrictor myotomy if fluent voicing can't be achieved |
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Delayed post-fitting aphonia/dysphonia |
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| Causes | Solutions | |
| Prosthesis valved tip is stuck | Remove prosthesis and inspect valve | |
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| Puncture tract closure due to inadequate prosthesis length | Dilate and re-insert longer prosthesis |
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| Failure to fully insert prosthesis | Dilate and re-insert prosthesis |
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Insufficient Tracheostoma Valve Tape Seal Duration |
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| Causes | Solutions | |
| Excessive system "backpressure" | a. Assess intertracheal pressure during connected speech with pressure meter b. Alter prosthesis type/diameter c. Increase prosthesis diameter to 20FR. d. Reduce speech loudness |
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| Failure to cleanse skin prior to valve placement | Cleanse skin oil and/or adhesive solvent from skin surface with alcohol |
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| Failure to allow adhesive to dry | Wait 3-4 minutes before applying tape housing to adhesive coated skin |
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| Careless application, use | a. Reinstruct in method of application |
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