A patient undergoes total laryngectomy for T4a glottic carcinoma. Six months later, he presents with successful tracheoesophageal voice via a Blom-Singer prosthesis. The underlying mechanism of this voice production is:

• A Vibration of the epiglottis by pulmonary air
• B Electronic amplification via an electrolarynx placed on the neck
• C Pulmonary air directed through a one-way valve into the esophagus, causing pharyngo-esophageal segment vibration ✓
• D Esophageal air trapping and eructation producing esophageal speech

Explanation

Tracheoesophageal (TE) voice prosthesis (e.g., Blom-Singer) uses a surgically created tracheoesophageal puncture (TEP). The one-way silicone valve allows pulmonary air to pass from the trachea into the esophagus when the stoma is occluded; this air causes the pharyngo-esophageal (PE) segment muscle to vibrate, producing a voice. This is the standard voice rehabilitation after total laryngectomy with superior outcomes compared to esophageal speech or the electrolarynx.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.