Unaided speech in tube-free tracheostomy: The supplementary sling procedure.

Abstract

In some patients after tube-free tracheostomy, air escape hinders voice optimization. Our objective was to determine whether a supplementary sling procedure could reduce air escape and improve unaided speech and cough in these patients. From September 1998 through June 2001, 12 patients underwent supplementary sling procedures at the Cleveland Clinic. After surgery, stoma constriction and voice production were assessed. Fifteen procedures were performed in 12 patients. Two patients required revision procedures. All 9 patients with sufficient follow-up have markedly improved stoma constriction and speech production. Three patients with less than 3 months' follow-up already show early improvement. The supplementary sling procedure effectively reduces air escape and helps unaided speech and cough in patients with tube-free tracheostomata. As more patients undergo tube-free tracheostomy, the pool of patients who might benefit from a sling procedure will grow. Indications might extend to postlaryngectomy or post-laryngeal transplant patients.