Vocal Rehabilitation in the Laryngectomized Patient with a Tracheoesophageal Shunt

A tracheoesophageal shunt was used for vocal rehabilitation in 29 laryngectomized patients. Twenty-three patients had the shunt constructed at the time of laryngectomy. Radiation therapy or radical neck dissection did not limit the usefulness of the shunt. Twenty of the 29 patients acquired useful speech (69%). T-E shunt speech equals or exceeds other forms of alaryngeal speech when measured against the parameters of rate, duration, and intelligence. Failure to acquire useful speech occurred in nine patients because of either stenosis of the shunt (10%), aspiration (7%), or wound probems (14%). Stenosis of the shunt was primarily a problem in patients who received postoperative radiation therapy without a stent in the shunt. Wound problems were related to either our previous use of a lateral based flap or diabetes mellitus. Since January 1973 there has only been one failure in fourteen shunts constructed. The technique as now used is simple, applicable in a wide variety of clinical situations and associated with a low incidence of complications.