[Speech rehabilitation following total laryngectomy with tracheo-esophageal puncture]

Speech rehabilitation after total laryngectomy has often been neglected, and traditional methods of esophageal voice production are frequently unsuccessful or disappointing. The development of the tracheoesophageal puncture (TEP) technique and the valved voice prosthesis by Singer and Blom in 1979 offered patients an alternative method for laryngeal speech rehabilitation. This technique is now used successfully in an increasing number of patients after total laryngectomy. We present our experience with TEP since 1988 in 8 men and 1 woman, aged 50-86 years, who had adequate follow-up. In 5, primary TEP was performed at the same time as the total laryngectomy; in 4, secondary puncture was performed 12-18 months after primary surgery. 1 had serious operative complications, 2 had minor complications, 1 had long-term problems which necessitated discontinuing use of the prosthesis, while 8 achieved satisfactory voice use and could communicate effectively. We hope that further experience with TEP in Israel will confirm its effectiveness for speech rehabilitation after total laryngectomy.