Voice prosthesis

A voice prosthesis (plural prostheses) is an artificial device, usually made of silicone that is used to help laryngectomized patients to speak. During a total laryngectomy, the entire voice box (larynx) is removed and the windpipe (trachea) and food pipe (esophagus) are separated from each other. During this operation an opening between the food pipe and the windpipe can be created (primary puncture). This opening can also be created at a later time (secondary puncture). This opening is called a tracheo-esophageal puncture (TE puncture). The voice prosthesis is placed in this opening. Then, it becomes possible to speak by occluding the stoma and blowing the air from the lungs through the inside of the voice prosthesis and through the throat, creating a voice sound, which is called tracheo-esophageal speech. The back end of the prosthesis sits at the food pipe. To avoid food, drinks, or saliva from coming through the prosthesis and into the lungs, the prosthesis has a small flap at the back. There are two ways of inserting the voice prosthesis: through the mouth and throat (retrograde manner) with the help of a guide wire, or directly through the tracheostoma (anterograde) manner. Nowadays, most voice prosthesis are placed anterograde, through the stoma.

There are two lines of development on behalf of giving a voice to patients being laryngectomized.

In 1869 the first artificial voice box (larynx) was built by Czermak. In 1873 Theodor Billroth made a total laryngectomy (in steps) and implanted an artificial voice box. A new development, using modern materials, took place in France by Debry.

In 1972 the very first voice prosthesis for voice rehabilitation after total laryngectomy was described in an article in Polish by Mozolewski. Since then, many efforts have taken place in this area of rehabilitation. There are several manufacturers that have voice prosthesis in their product portfolio, e.g. Adeva®, Eska®, MediTop®, Heimomed®. The internationally most widely used are devices made by InHealth and Atos Medical. In 1980, the first commercially available prosthesis was introduced by Singer and Blom: the ‘Blom-Singer® Duckbill’, a 16 French diameter, non-flanged device that the patient could remove, clean and replace him- or herself (non-indwelling). The first indwelling voice prosthesis (Groningen) was described in 1984. And in 1990, the first Provox® voice prosthesis, manufactured by Atos Medical, was introduced to the market, followed by the Provox®2 in 1997, the Provox® ActiValve™ in 2003, and the non-indwelling Provox® NID™ in 2005. 1994, the Blom-Singer® Classic™ Indwelling Voice Prostheses was introduced to the market. Like the Blom-Singer® Advantage® Indwelling Voice Prosthesis it is only inserted or replaced by medical professionals, such as speech pathologists or physicians. In 2009 the third generation Provox® Vega with SmartInserter™ was introduced.

...
Wikipedia