Limitations of the Blom-Singer technique for voice restoration

The loss of voice following total laryngectomy is a severe blow to a patient's functional and psychological well-being. Since the first laryngectomy numerous attempts at voice restoration have been attempted with only limited success. The tracheoesophageal puncture with insertion of the Blom-Singer valve is a major development in neoglottic reconstruction. Initial reports on the use of this technique have been very encouraging. Our initial experience has not been entirely satisfactory. The difficulties encountered include: 1) inability to manage the prosthesis in the home setting; 2) anatomical problems; 3) inability to produce fluent speech. While it is our impression that this new technique is the simplest and most effective method of voice restoration, it is not appropriate for all laryngectomies. Great care should be exercised in patient selection, and this may eliminate many of the difficulties encountered.