Tracheal-Esophogeal Puncture


Improve communication abilities with a tracheal-esophageal puncture.

Treatment for throat cancer sometimes involves the removal of the voice box, a procedure called a laryngectomy. One of the more noticeable side effects of having the larynx removed is an inability to communicate effectively without electronic assistance.

A procedure called a tracheal-esophageal puncture (TEP) may be able to improve a patient’s daily life and vocal capabilities following surgical treatment for throat cancer.


Why TEP Is Performed

During a laryngectomy, the removal of the larynx results in a hole that’s left behind in the neck called a stoma. This hole allows patients to breathe. However, a patient normally has to find new ways to communicate since the structures that produce the vibrations necessary for speech are no longer in place. The primary purpose of a TEP procedure is restore the ability to communicate without the need to use an electronic voice box, also referred to as an electrolarynx.

How It Works

A tracheal-esophageal puncture involves the placement of a silicone valve between the esophagus and trachea. It’s one-way valve that allows air to flow from the trachea into the adjacent esophagus that connects the throat to the stomach. Food is blocked. However, liquids and saliva can still get into the airway. Air entering this canal produces vibrations that can be used to vocalize. The valve is meant to remain in place permanently.

Learning to Communicate with TEP

In order to prepare for communication following a tracheal-esophageal puncture, patients are typically encouraged to work with a speech therapist to learn how to use the one-way valve correctly. Training involves learning how to over-emote or enunciate to improve clarity. Training usually takes places over several sessions until a patient is comfortable with the vocal quality being produced with the valve. The voice that’s produced is often very similar in tone and sound to the pre-surgery voice.

Benefits for Patients

With TEP, patients can communicate without the monotonous and robotic speech that’s produced by an electronic voice box. While TEP will require some patient education, it’s often less challenging than learning how to use esophageal speech to communicate. There’s also no need to carry an electrolarynx around just to be able to vocalize.

Ongoing Care After Valve Placement

The valve is convenient and easy to use after a period of initial patient education. Yet it will need to be kept clean to minimize the risk of infection, illness, or clogs from food blockage. A lack of care may also cause the valve to leak saliva or water, which may lead to respiratory ailments such as pneumonia. It’s also important for patients to report any unusual discomfort, although many patients reach a point where the device functions well enough to significantly improve communication.

Tracheal-esophageal punctures have been performed since the early 1980s. Advances in technology have made the technique more accessible, so much so that an ear, nose, and throat specialist is often able to do a TEP as an outpatient procedure. Usually taking about an hour to perform, TEP may be done at the same time a laryngectomy is performed. It can also be done as a second surgery.