LARYNGECTOMY FAQ'S

Why do I get "stomach gas" when using my TEP/prosthesis?
(Dr. Eric Blom, Ph.D.  - Inhealth Technologies)

Flatulence, or excessive stomach gas, is a disturbing problem experienced by a small number of tracheoesophageal voice prosthesis users. It is usually attributable to one of four possible causes including: 1) inhaling air through the prosthesis to the esophagus, 2) inhaling air through the mouth and nose to the esophagus, 3) pharyngeal constrictor muscle spasm, and 4) pharyngoesophageal stricture. 

During the inhalation cycle of respiration the pressure within the esophagus becomes more negative and creates a pseudo-vacuum that in some tracheoesophageal speakers actually pulls the valve in the voice prosthesis to the slightly opened position and air enters the esophagus. Sometimes this is accompanied by a simultaneous "click" sound caused by the flap of the valve opening. The solution to this problem is to refit the patient with a higher resistance voice prosthesis, i.e., a "duckbill" type prosthesis that opens less easily. 

A second circumstance under which flatulence may occur is when the pharyngoesophageal segment (esophageal inlet) is hypotonic. Air is unintentionally exchanged in and out of the esophagus simultaneously with each respiratory cycle. Esophageal speech is spontaneously produced and tracheoesophageal voice is effortless to the point of being weak and breathy. An elastic band worn "comfortably tight" around the neck directly above the stoma to slight constrict the pharyngoesophageal mucosa may improve voice quality and decrease air ingestion. 

Both pharyngeal constrictor muscle hypertonicity and scar formation (stricture) may also be factors responsible for flatulence, but by different mechanisms. Active contraction of the pharyngeal constrictor muscles elicited by speech airflow distention of the esophagus during tracheoesophageal voice production results in airflow resistance and air being driven in the reverse direction the stomach. Successful surgical (myotomy) or chemical (Botox) treatment of the pharyngeal constrictor muscles can eliminate hypertonicity, i.e., vocal effort and associated flatulence. 

Stricture formation severe enough to significantly decrease deglutition may also restrict the egress of tracheoesophageal speech airflow. Consequently, air is forced to the stomach. Treatment for severe stricture is either mechanical dilation or surgical reconstruction.