Voice Prosthesis Leakage: Tips for Effective Management & Care

How to check if your voice prosthesis is leaking and how to reduce and prevent leakage.

Introduction

A voice prosthesis is a device that needs proper care and maintenance in order to perform correctly. We’ve put together this helpful guide so you can quickly and easily identify leakage and take the necessary steps to resolve and prevent the issue.

A voice prosthesis at a glance

A voice prosthesis is a small device made of medical grade silicone. The prosthesis is placed between the food pipe (esophagus) and windpipe (trachea) and has two ‘collars’ on either side to keep it in place. Between these collars, there is a smaller tube that contains a one-way valve. This valve opens while speaking and is closed when eating or breathing to prevent anything from entering the windpipe that shouldn’t – such as saliva, food or drink.

Provox voice prostheses are manufactured with high precision at the Atos Medical production plant in Sweden. Each voice prosthesis is thoroughly inspected by specially trained personnel before being approved and delivered to you.

Why does a voice prosthesis leak?

In time, all voice prostheses will start to leak due to a variety of reasons. The most common reason is fungus, yeast and bacteria (biofilm) from the mouth and throat accumulating on the voice prosthesis, preventing the valve from closing properly ^(1,2). Bacteria and fungi are naturally present in the mouths and throats of all people, and the accumulation will in time happen on all prostheses ^(1,2). Leaking can also be caused by food that has been caught in the voice prosthesis and is preventing the valve from closing properly.

Types of voice prosthesis leakage

Leakage of fluids or food into the windpipe is the most common problem related to the use of a voice prosthesis (3). The leakage can come through the small opening in the centre of the voice prosthesis, or around the outside of the prosthesis, seeping between the collars and the tissue. Leakage through and leakage around the prosthesis are solved in different ways, so it is important to determine how the prosthesis is leaking ^(4,5).

On very rare occasions, a voice prosthesis can dislodge or come out accidentally. If this happens, contact your clinician immediately.

Typical signs of voice prosthesis leakage are:

• Coughing during, or after, eating and drinking
• Fluid-stained mucus
• Food-stained mucus
• Increased mucus
• Recurrent chest infections

DID YOU KNOW?

Leakage can, if not solved, cause chest infections. Fluids or food could enter the trachea (windpipe) and lungs, leading to increased mucus production and coughing, and may also lead to infections and, in rare cases, pneumonia ^(5,7,8).

 Voice Prosthesis Leakage Test

We’ve put together a helpful guide to help you test if your voice prosthesis is leaking and steps that you can take at home to stop or alleviate leakage. We recommend you test for leakage at least once a month. You can download of copy of the guide by clicking here.

• Stand in front of a mirror with good light and clean your Provox Voice Prosthesis with a Provox Brush and Flush.
• Take a sip of coloured liquid (e.g., milk, coffee or juice, as they are easier to see).
• See if anything leaks through or around your voice prosthesis. If you need help, ask someone to look for you. You may need to take another sip to check again.
• If you are not sure if it is leaking through or around the voice prosthesis, insert the Plug into the voice prosthesis and take another sip. If it still leaks, it is most likely leakage around the voice prosthesis. If there are no more signs of leakage, it is most likely leakage through.
• If you are experiencing leakage, don’t hesitate to contact your clinician.

Tips for Managing a Leaking Voice Prosthesis

Consider thickening your liquids to decrease or eliminate leakage or try to avoid thin liquids such as water and coffee. Commercially available thickeners can be added to most liquids to make them thicker. Contact your clinician for advice on what thickeners may be right for you ⁽⁹⁾.

Clean your voice prosthesis at least two times per day, in the morning and in the evening, and after each meal ⁽⁹⁾.

When you have a Provox plug in place you will not be able to speak with your voice prosthesis. You could consider an electrolarynx like Provox TruTone Emote or Provox SolaTone Plus during those times. Your clinician can advise you about this ⁽⁹⁾.

Always read the Instructions for use before starting to use any of the products. For Instructions for use, please visit www.atosmedical.com.

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References:

¹ Spalek J, Deptula P, Ciesluk M, Strzelecka A, Lysik D, Mystkowska J, et al. Biofilm Growth Causes Damage to Silicone Voice Prostheses in Patients after Surgical Treatment of Locally Advanced Laryngeal Cancer. Pathogens. 2020;9(10).
² Leonhard M, Zatorska B, Tan Y, Moser D, Schneider-Stickler B. In vitro biofilm growth on modern voice prostheses. Head Neck. 2017;40(4):763-9.
³ Graville DJ, Palmer AD, Andersen PE, Cohen JI. Determining the efficacy and cost-effectiveness of the ActiValve: results of a long-term prospective trial. Laryngoscope. 2011;121(4):769-76.
⁴ Parrilla C, Longobardi Y, Galli J, Rigante M, Paludetti G, Bussu F, et al. Periprosthetic Leakage in Tracheoesophageal Prosthesis: Proposal of a Standardized Therapeutic Algorithm. Otolaryngol Head Neck Surg. 2021:194599820983343.
⁵ Lorenz KJ. The development and treatment of periprosthetic leakage after prosthetic voice restoration. A literature review and personal experience part I: the development of periprosthetic leakage. Eur Arch Otorhinolaryngol. 2015;272(3):641-59.
⁶ Acton LM, Ross DA, Sasaki CT, Leder SB. Investigation of tracheoesophageal voice prosthesis leakage patterns: patient's self-report versus clinician's confirmation. Head Neck. 2008;30(5):618-21.
⁷ Kummer P, Chahoud M, Schuster M, Eysholdt U, Rosanowski F. [Prosthetic voice rehabilitation after laryngectomy. Failures and complications after previous radiation therapy] in German. HNO. 2006;54(4):315-22.
⁸ Scherl C, Kauffels J, Schutzenberger A, Dollinger M, Bohr C, Durr S, et al. Secondary Tracheoesophageal Puncture After Laryngectomy Increases Complications With Shunt and Voice Prosthesis. Laryngoscope. 2020.
⁹ Atos Medical. What to do if your voice prosthesis is leaking?; 2024 [cited 2024.04.24]. Available from: https://www.atosmedical.com/news/what-to-do-if-your-voice-prosthesis-is-leaking