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FAQ26: I just got a prosthesis but can't talk yet.  What may be wrong?
by David Blevins

Not everyone gets TEP speech right away. You need to be patient. Think of it as being like a baby first learning to talk. It won't take that long, but you should not assume that you will speak immediately. Some do...many of us do not.

(1) was an insufflation test done before you had the puncture procedure? That would indicate that you were a good candidate for the TEP. The insufflation test is described and shown in a graphic in the September issue of the "IAL News" which you can see at

(2) confirm that the prothesis is open. Squirt some water through it with a flushing pipet or pipet/syringe combination we can make

(3) some experience problems because they occlude the stoma with too much force. Use the minimum necessary to get the seal. You might find it easier to get a good seal if you wear a rubber glove. Some can also occlude more easily with a ping-pong ball or something similar (if their stoma and the area around it is regular in shape). If you happen to have an finger occluded HME some larys find it much easier to voice with one of those than using a finger or thumb.

(4) relax!!! This should require no more effort than blowing a little puff of air through a straw. The harder you try, the more tense everything is. Loosen up your shoulders and neck. This is NOT difficult.

(5) you want to just say the "ahhhhhh" sound...nothing else. Do not count or say the alphabet or anything else until you get the "ahhh" sound, and consistently when you want it.

(6) when you get the tone feel the sensation of the vibration. This is likely to be a brand new sensation to you and you may be subconsciously clamping your muscles tight to resist this strange new feeling. You need to understand that the sensation is fine...ok...is not something to be avoided like gagging. Relax!! Repeat the "ahhh" sound.

(7) As you continue with the "ahhh" sound sustain it as long as you can. Then reduce the amount of effort you are making to keep the sound going. You want to produce the sound with the minimum strain and air pressure. Again, you are "teaching" the top of your esophagus to accept this new feeling and function.

Often this "low-tech" approach will solve your problem. If you are currently seeing an SLP who has experience with larys they can lead you through the above steps if you cannot get it by yourself.

If you continue to experience problems your ENT may need to rule out circopharngeal spasm (hypertonicity, or cramping of the muscle around your esophagus).

But consider exhausting these lower tech solutions before seeking medical ones. You are more likely to need some relaxation techniques and perhaps working with an experienced SLP than a shot of Botox or a myotomy operation. Try and understand that, in all likelihood, it is you who will learn TEP speech through working at it and not someone else "giving" it to you on a platter. I could well have made the mistake implied above myself, and it could have delayed my getting TEP speech.

: )o

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