Role of computed tomography and bronchoscopy in speech prosthesis aspiration

Tracheoesophageal puncture prostheses (TEPPs) are an integral aspect of speech rehabilitation for many patients who have undergone total laryngectomy. Because one flange of the prosthesis sits in the trachea and the other in the esophagus, these devices can be aspirated or swallowed if dislodged. Five cases of prosthesis aspiration that occurred in 4 veterans within a 16-month period are described. The 5 aspirated TEPPs resulted in highly variable clinical presentations ranging from complaints of "lost" TEPPs in asymptomatic patients to near-asphyxiation. Furthermore, the aspirated TEPPs were not reliably demonstrated on chest radiographs, often leading to delayed diagnosis. Aspiration of TEPPs may be more common than formerly recognized, and chest computed tomography or bronchoscopy is indicated in cases of missing TEPPs not demonstrated on plain films.