Below are some frequently asked questions, tips and techniques for using Provox Voice Prosthesis. If you have a question that is not listed here, please contact our Customer Service Team at 800.217.0025. We are here to help!
My patient’s voice prosthesis starts to leak very short after insertion. When I take it out, there is no Candida visible and the valve flap seems intact. What is the problem?
Leakage directly or shortly after insertion may have several causes.
- The inserter tube hasn’t been loaded properly. The esophageal flange has not been folded correctly forwards in the loading tube and thus, it has not been fully unfolded in esophagus, leading to leakage. Re-insert the prosthesis according to the manual if the safety strap is intact.
- Incorrect insertion. The loading tube has not been fully brought through the fistula and thus, the esophageal flange has been unfolded in the fistula instead of esophagus, also leading to leakage. Check the position by slightly pulling and rotating the prosthesis. Re-insert the prosthesis according to the manual if the safety strap is intact.
- Your patient might have ‘underpressure’ in the esophagus when breathing in and/or swallowing. This is often visible and/or audible. While closely observing the voice prosthesis, ask the patient to swallow (dry) and inhale deeply and look for movements of the flap and listen clicking/whistling sounds from the valve flap. If the prosthesis is situated such that you cannot see the valve flap, the use of a flexible scope can help for visualization. If the patient usually has this problem, which is often combined with a very short device life, a change to Provox ActiValve will in most cases solve the problem.
- A too short prosthesis has been inserted. This will stretch the prosthesis and may cause leakage. If the prosthesis is correctly inserted but still leaks, due to being too short, this is an indication that a longer prosthesis should be inserted. You can check if the length is correct, by rotating and slightly pulling the prosthesis after insertion. If the prosthesis is too short it is quite hard to rotate it and the tracheal flange is pulled slightly towards the mucous membrane. If it is too long you will notice a gap between the tracheal flange and the tracheal wall. You can also inspect the tracheal part of the prosthesis. If the prosthesis is too short, the central part of the prosthesis is slightly extruded into the fistula.
Does a leaking voice prosthesis need immediate replacement?
First you should always check that the prosthesis has been thoroughly cleaned, cleaning the prosthesis might in some cases solve the problem with leakage.
When a voice prosthesis is leaking, the patient is aspirating. Therefore, it is important that it is replaced as soon as possible. A Provox Plug is available that temporarily blocks the prosthesis and prevents leakage. It is a good idea to provide each patient with a Plug and teach them how to use it.
Do you have tips or techniques designed to help assist patients and their family members?
Yes! We have developed several CareTip Information Sheets as an educational resource for both patients healthcare professionals. View our Atos CareTips here.