Management techniques in the use of the Blom-Singer valve

The use of a valve to restore functional speech following a total laryngectomy has been well described. We have encountered problems in both the formation of the tracheo-oesophageal fistula and stenosis of the tracheostome if the valve is used by itself for long periods. A simple technique to establish the fistula is described, and a modification of the valve with a stoma button is suggested.