Stomach Gas and Acid Reflux in Laryngectomees
by Carla DeLassus Gress, ScD

     Two conditions which may develop or worsen following the removal of the larynx are increased stomach gas, which can produce uncomfortable pressure and belching; and an increase in stomach acid reflux, which causes the sensation of “heartburn” or acid taste, and may be severe enough to require medical attention.  Patients who are fitted with the TEP prosthesis often develop more problems with stomach gas than those who use the artificial larynx for several reasons:

(1) If you are able to look into the opening of the prosthesis while it is in place, sometimes you can see the valve opening inadvertently during quiet breathing. You may also be able to hear a "click" with each breath when the prosthesis valve opens and shuts. Small amounts of air may be entering the esophagus with each breath and move downward into the stomach, coming back up later as a belch. The solution to this problem is to go to a higher resistance prosthesis that isn't as susceptible to the changing air pressures. 

     Because of design differences, the Provox prosthesis does not cause this problem to the same degree as the standard InHealth and Bivona low pressure/low resistance prostheses and the InHealth Indwelling devices. A duckbill style prosthesis will frequently correct the problem, but the increased resistance of this design can be too great to get a very good voice for some individuals. The 20 French duckbill made by Bivona can in some instances provide a good balance, offering extra airflow for speech because of the larger diameter, but increased resistance of the valve to prevent inadvertent opening during quiet breathing. So, one approach to reducing air moving down into the stomach of laryngectomees who use the TEP prosthesis is changing the type of prosthesis.

(2) Another problem that can cause stomach gas is related to the surgery itself and how the throat was reconstructed after the larynx was removed. Prior to surgery, there is a more or less concentric valve (sphincter) at the junction of the lower pharynx with the esophagus that helps to keep the entrance of the esophagus closed. The sphincter relaxes during the swallow to open the esophagus for the passage of food or liquid. 

     The fact that it is ordinarily closed helps prevent stomach acid from gurgling back up into the esophagus and throat. If the surgery left this area without much of a protective sphincter then the laryngectomee may not only suffer from acid gurgling back up into the esophagus and throat (known as “gastroesophageal reflux disease” or GERD), but also swallow a considerable amount of air. Try eating slowly so as not to swallow so much air. 

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