FAQ17: Suggestions for Beginning to Vocalize with a TEP/prosthesis.
by David Blevins

1. Those who get TEP speech right away are lucky. Many of us take much longer. I took more than a year to get it. I am among those who take the longest.

2. The advice to relax is important. Also to not push too hard on your stoma with your finger or thumb. If you happen to have ready access to an HME such as the InHealth or ATOS cassette, it is easier to occlude your stoma with those than your thumb. Something else which has been used to get a good seal with minimum pressure is a clean ping pong ball or large spoon. Again, the idea is to get a complete seal with a minimum of pressure.

3. Just try and get the "ahhhhh" sound. For some reason it is much harder to try and count or say the alphabet. And do this in an atmosphere of minimum pressure. Ex. It is easier to get the sound at home than when in the possibly tense atmosphere of your ENT's office

4. If you have someone around, have them check your shoulders and neck as you try this to make sure you are not getting tense. We have a natural tendency when experiencing a problem to "try harder," and this often makes it more difficult because of the tension. Remember...this is not a hard thing to do which requires great effort on your part. It should require no more pressure than blowing air through a straw used to be.

5. When you get the "ahhhh" sound gradually reduce the amount of pressure you are using to sustain it until the sound stops. Repeat this. You just want to get the "ahhhhh" sound with as little pressure as possible. Once you get the tone, try and lower the tone or pitch too, along with the volume. What you are doing is "teaching" the top of your esophagus that it is ok for it to vibrate, and to do so with the minimum airflow possible. You are not trying for a loud sound...just a sound. For some larys the feeling of the vibrating top of the esophagus comes close to the feeling of regurgitation (vomiting,) so they react by clinching the top of the esophagus to stop the "leakage", in this case, of air.

These things are "low tech" and should almost certainly be done before looking for other solutions which are more expensive and carry risks such as medical procedures. And if you have an SLP you can work with who has experience with larys this may be more workable than the ENT who will tend towards higher "tech" solutions which are more part of his/her training. But ENTs differ in how they use SLPs. Those in clinical settings may tend to use them more often.

6. Was an insufflation test done prior to the TEP surgery? It should have been done to see if you were a candidate for the TEP, although many ENTs have little or no experience with us "problem TEP cases" and may not think to do it. This is one of the major problems with primary TEPs. They probably ought never be done without a positive insufflation test first. My ENT had never had a lary who had a problem with the TEP. There is an article in the September 2002 issue of the "IAL News" by Dr. Carla Gress on this issue of determining if a person is a good candidate for the TEP (PDF version has now been posted at http://www.larynxlink.com/Main/newslett.htm).

If the "low tech" solutions do not work, then this should be considered:

7. Your ENT should consider doing one of the following:
a. injecting zylocaine or similar numbing medication into the muscle surrounding the esophagus. This will temporarily relax the muscle if your problem is hypertonicity of the muscle around the esophagus. If you get voice, then we know the source of the problem...hypertonicity or spasm.
b. injecting Botox. This does the same as the zylocaine, but is longer lasting.

8. if that fails, you may be a candidate for a myotemy...a fairly simple surgical procedure which separates the esophageal muscle to permanently relax it

It is more likely that one of the first 5 ideas will do the trick, but understand that these other options exist.

One question every lary who experiences problems in getting TEP voice must ask and answer is: How much do I need and want TEP speech? How much money, effort, and risk am I willing to put up with for the chance to get TEP speech? For me and my situation, I wanted and needed TEP speech, so I went to lots of trouble to get it. Your situation may be different.

Regards,
David