The TEP, Another View Point
by Jack Henslee
So you think you might want to try a tracheoesophageal puncture (TEP) for speech. A nice simple operation, and you may even be talking the first day. Then again you may not. Before you make this important decision there are a few things that you should be aware of.
The first is that although some people are able to obtain sound, or even speech almost immediately, this is not always the case. A significant number of people require several speech therapy sessions as a minimum, plus hours of practice to become really proficient. They may also have to try several different prosthesis sizes and types before they find the one that’s best suited for them. In other cases the puncture itself may have to be re-oriented (inserting a catheter through the puncture down toward the stomach, or up into the mouth/nose, and leaving it in for several days, or up to a week) to obtain the optimum angle for sound production, or, to resolve difficulty in swallowing.
Another consideration may be “who you want to do it.” All doctors do not do it the same way, and sometimes the differences are based on personal preferences (the doctors not yours) rather than a medical necessity. For example, some doctors will do the puncture and insert the prosthesis on the same day, with some speech therapy given immediately, or within a day or two. The more common practice is to do the puncture, insert a catheter that either runs down toward the stomach, or up through the nose, and leave it there for 2-3 days. The catheter is then removed and you are fitted with the prosthesis if you have sufficiently healed. At the extreme end of this spectrum of methods is the doctor that runs the catheter through the mouth (you look like a fish on a stringer because the rubber catheter forms a connected loop through the stoma puncture and out the mouth) for 7-10 days, then its reoriented down towards the stomach for another 7-10 days before you are even fitted. A very uncomfortable procedure at best. The doctor will naturally perform the procedure that he thinks is best for you. However, one day may be too soon for some people and they will have difficulties. On the other hand a two week wait may be totally unnecessary for someone else. If the method used makes a difference to you (it is your body you know) then be sure to ask your doctor exactly how he plans on doing it. If you don’t like what he proposes, or the reason he gives, then you are always entitled to a second opinion.
The puncture itself is a very simple and painless procedure in most cases. Its almost always done on a outpatient basis and there are few if any after effects. In most cases there is a total lack of pain associated with the procedure and you are released without any prescribed medications. In fact, the only after effect may be some difficulty swallowing with that catheter in your throat.