The recommendations for diet modification, head of the bed elevation, etc., can alleviate mild gastric reflux. A chronic or severe acid reflux condition requires medications (prescription brand names include Prilosec, Propulsid, Prevacid) for effective control.
(3) An additional problem can be related to almost the opposite extreme, where the reconstructed throat offers too much resistance to the air column moving upwards as it exits the prosthesis for speech production. As a consequence of the operation, scar tissue formation, or radiation, the pharynx or upper esophagus can be too narrow or constricted, in some cases to the extent that solid food is not easily swallowed.
In some instances the muscles have too much tone (rigidity, tightness, or “hypertonicity”), or go into spasm (cramping). If there is increased tone or spasm, the voice is strained and requires extra effort, or there may be intermittent breaks in the voice where no sound comes out at all. As the air exits the prosthesis into the pharyngoesophagus, it can't easily exit upwards through the mouth (because of the narrowed area or the hypertonicity) and instead moves down to the stomach. If the patient is pushing to make the TEP speech louder, it can exacerbate the problem. For this reason it is important to try to speak effortlessly and use gentle pressure of the finger for stoma occlusion. The pressure for occlusion should eliminate stoma air leakage around your finger or heat-and-moisture exchange device (InHealth Humidifilter, Provox stomafilter, StomVent), but not so tight that the entrance to the prosthesis is blocked or that the esophagus is kinked.
Determining the cause of the problem often takes some detective work. The sound of the voice can give some clues. If the voice is weak and breathy, almost a whisper, it may be related to a “loose throat” (#2 above). But if the voice sounds tight or strained or high pitched, it may be due to a “tight throat” (#3).
Laryngectomees who are in the beginning stages of learning esophageal speech may also experience excess stomach gas and frequent belching as they learn to trap air and release it with the muscles of the throat. This is particularly true if the laryngectomee develops a “double pump” to initiate the intake of air into the esophagus. As speech proficiency develops, this problem decreases significantly.
While excessive stomach gas and acid reflux are not uncommon conditions for many laryngectomees, help in addressing these problems is available from your physician and speech/language pathologist.
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