Tracheostoma valve with integrated cough lid for improvement of hands-freespeech in laryngectomees - Development and clinical use.

Background: Following successful voice restoration after laryngectomy eithe r by a voice prosthesis, a surgical shunt or microvascular laryngoplasty, a further goal in rehabilitation is the insertion of a tracheostoma valve, w hich enables the patient to speak without using his fingers for closure of the tracheostoma. One important disadvantage of the tracheostoma valves, wh ich are available today, is the necessity of removal of the valve in case o f coughing, because the valve could be thrown from the stoma by the strong air flow during coughing. As many laryngectomees suffer from chronic bronch itis, this coughing problem is one of the reasons why only few patients cou ld be provided with this useful aid. Method: At the department of biomedica l engineering of the faculty of medicine at the university of Groningen, th e Netherlands, 1994 two prototypes of a tracheostoma Valve with an integrat ed cough lid were developed. These devices contain two separate valve syste ms: the normal speaking valve and a special coughing valve, which opens at a certain air flow and closes automatically after the coughing attack. Thus no manipulations are necessary during coughing, the patient can speak undi sturbed. The ADEVA company (Lubeck, Germany) undertook the industrial produ ction of this new type of tracheostoma valve creating different modificatio ns of the prototype #2. Patients:ln four series with 6-8 patients per group the modified tracheostoma valves were tested clinically and the occurring faults or lack of correct function eliminated by small changes in the produ ction. Results: Meanwhile a suitable model for routine use is available, wh ich was tested in 30 patients so far. This suitability was achieved by impr ovements in the valve mechanism, the valve seal and the adjustment mechanis ms for the individual pressure level of the speaking and the coughing valve . Conclusion: The newly developed tracheostoma valve with integrated coughi ng lid (Window((R)), ADEVA((R))-medical Company, Lubeck, Germany) provides further improvement in speech rehabilitation of laryngectomees. The low acc eptance of tracheostoma valves, which enable the patient to speak without u sing his fingers for closure of the tracheostoma, possibly may be raised by this new aid.