A 60-year-old man undergoes total laryngectomy for T4a glottic carcinoma. Six months post-surgery he develops tracheoesophageal voice using a Blom-Singer prosthesis but notes aspiration. The most likely cause is:
- A Stenosis of the tracheoesophageal puncture site
- B Formation of pharyngocutaneous fistula
- C Prosthesis failure with leakage through the device (central leakage) ✓
- D Radiation-induced pharyngeal stricture
Correct answer: C. Prosthesis failure with leakage through the device (central leakage)
Explanation
Aspiration in a tracheoesophageal prosthesis (TEP) user is most commonly due to central leakage — failure of the prosthesis valve, allowing saliva/liquid to pass through the device into the trachea. Periprosthetic leakage (around the prosthesis) is the other type. Central leakage requires prosthesis replacement. Stenosis of the TE puncture would cause loss of voice rather than aspiration.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.