Leakage is the most frequent issue regarding the use of a voice prosthesis. The more comfortable you become with these simple troubleshooting techniques, you will be able to more independently manage your voice prosthesis, as well as be able to determine when to contact the SLP staff for assistance.
Before you can attempt to resolve the leakage, you must first determine if the leakage is coming through the prosthesis (through the center hole) or if it is leaking around the prosthesis (around the outside of the prosthesis, seeping between the device and the tissue). Observe in a mirror (or have someone else look) while you drink water. If it is not clear where the leakage is coming from, sometimes it’s helpful to use blue or green food coloring in the water. This can sometimes help to see when/where the leakage is occurring.
If for any reason, you are not able to resolve the leakage yourself, contact the SLP office and inform them you are experiencing leakage. These patients have a priority for scheduling and will be seen the same day or as soon as you are able to come to the office. Until your appointment, however, it is important you control the leakage to prevent material from entering your lungs (see Preventing Aspiration)
Leakage Through the Prosthesis
If you have found the leakage is coming through the center of the prosthesis, you should first be sure the prosthesis is properly aligned in the tract. Although it is normal for the voice prosthesis to spin in place an no typical concern should be given to the alignment of the prosthesis. If however, your are experiencing leakage through the device, be sure it is properly aligned. This means the bottom of the tracheal flange (the part you can see) should be at the 6 0’clock position. There will either be a number imprinted or a small silicone “stump” at the bottom of the flange. With this at the 6 o’clock position, you ensure proper alignment. Check for leakage by taking a sip of water. If the prosthesis continues to leak, proceed to the next step.
Thoroughly clean your prosthesis using the brush/flush. Following this, take a sip of water and determine if the leakage continues. If it does, and you are sure the device has been thoroughly cleaned, contact the SLP office for further assistance.
Preventing Aspiration (When the Voice Prosthesis is Leaking)
Having swallowed material enter your trachea/lungs is never a safe event. Although you may not become ill from this, it is important you try to prevent aspiration as much as possible. Once you have determined you are unable to resolve the leakage yourself, follow the following guidelines when drinking until you are seen by the SLP staff. Be sure to contact the office for an immediate appointment.
Agents can be added to liquids to make them thicker. In doing so, they thicker liquids are not so easily able to seep through the valve/around the prosthesis. Thickened liquids are helpful in preventing aspiration regardless of the source of the leakage. Thicken the liquids until they achieve a consistency that no longer leaks when you are drinking. For most patients, a thick-honey texture is sufficient.
Provox Plug/Provox Vega Plug
These are commercially available devices meant to act like “corks” when drinking. These can be inserted into the center of the prosthesis to prevent leakage. It is important to have this on hand before you experience leakage as these need to be ordered and delivered. If you decide you would like to have a plug for your prosthesis, the SLP staff will identify which plug is appropriate and instruct you on how to properly use this.
If the Plug is removed during use, you can disinfect the Provox Plug with either hydrogen peroxide 3% for 60 minutes, ethanol 70% for 10 minutes or isopropyl alcohol 70 % for 10 minutes at least once a day, according to the manufacturer.
NOTE: The Provox Plug/Provox Vega Plug will only assist in preventing leakage/aspiration when it occurs through the prosthesis. The plugs are NOT effective in preventing leakage that is occurring around the prosthesis.
For leakage through the prosthesis, if you do not have access to a plug, some patients are able to control aspiration by using a cotton swab. It is very important you do not drop the swab into the stoma! By placing the end of the swab so that it blocks the inner lumen of the prosthesis as much as possible, you may be able to prevent aspiration until you see the SLP staff for replacement. It is very important to see the SLP staff once you have persistent leakage!
Voice Prosthesis Dislodges
Although the indwelling type voice prostheses used in this practice rarely dislodge, or come out accidentally, this may occur. Should this happen, it is very important you act immediately.
First: Insert the "emergency catheter" given to you during one of your first few visits after your TEP placement. This is a red rubber tube. Insert the rounded end at least 6 inches into the tract (the "hole" left by the dislodged prosthesis). Ensure there is a knot at the other end to prevent leakage of stomach contents onto your clothes. Tape the catheter to your neck to ensure it does not fall out.
Next: Contact the office right away. If after hours, you may contact the SLP staff via this website. If needed, seek attention from the Baylor All Saints Emergency Department.
Finally: Attempt to locate the prosthesis. It is important this prosthesis not fall into the lungs. A chest x-ray will usually be ordered to ensure the prosthesis is not in the lungs if you are unable to locate this.
Since the emergency catheter is smaller in diameter than the dislodged prosthesis (so it can be easily placed by you in an emergency), it may be necessary for you to avoid drinking thin liquids for a period of time: either until a new prosthesis is placed or until the TE tract shrinks sufficiently around the catheter. Remember, the voice prosthesis acts to prevent swallowed material from entering the airway. Without this in place, you will aspirate everything you try to swallow. Placing the catheter helps to reduce this aspiration amount as much as possible while also serving to ensure the TE tract stays open and doesn't close (requiring another surgery to replace this).
Updated March 21, 2014