Mr. Jones is a patient who underwent a total laryngectomy…
Mr. Jones is a patient who underwent a total laryngectomy (no flaps) and bilateral neck dissections at an outside hospital and then had postoperative radiation tx and secondary TE puncture. His treatment was completed about 1 year ago. He is now establishing care at your facility. When seen, he reports that he’s always had trouble with his indwelling voice prosthesis leaking after about 4-6 weeks. He was frustrated with this and considering trying to have it removed. He also complains that talking is difficult at times and he often has to go through 3-4 peristomal adhesives per day because he “blows the seal”. His voice is somewhat tight and effortful, with a max TE phonation time of about 4-5 seconds. He does not initially complain of swallowing problems, but upon further questioning does admit that meats and breads are difficult to eat and he avoids them. He has to drink a lot of liquid to wash his food down and does not like to go out to eat too often. He has a lot of difficulty talking during and foe a while after eating a meal. Occasionally, when he drinks liquids too fast, they come back up or might come through his nose. 1. What are some potential causes of this patient’s voice prosthesis difficulty? 2. What further testing would you want to complete and why? 3. How could this patient’s swallowing and voice prosthesis difficulty be related? Explain. 4. What could be some potential interventions that might be helpful, based on further testing?