puncture

A tracheo-esophageal puncture (or tracheoesophageal puncture) is a surgically created hole between the trachea (windpipe) and the esophagus (the tubal pathway between the throat and the stomach) in a person who has had a total laryngectomy, a surgery where the larynx (voice box) is removed. The purpose of the puncture is to restore a person’s ability to speak after the vocal cords have been removed. This involves creation of a fistula between trachea and oesophagus, puncturing the short segment of tissue or “common wall” that typically separates these two structures. A voice prosthesis is inserted into this puncture. The prosthesis keeps food out of the trachea but lets air into the esophagus for oesophageal speech.
A laryngectomized person is required to breathe through a permanent breathing hole in the neck, called a tracheostoma. When a laryngectomized person occludes the tracheostoma, completely blocking exhaled air to leave the body through that pathway, exhaled air is directed through the voice prosthesis. This air enters the esophagus and escapes through the mouth. During this process, as the air passes through the upper tissues of the esophagus and lower throat, it allows for vibration of the tissues of the pharyngoesophageal segment (also called PE-segment, neoglottis or pseudoglottis). This vibration creates a sound that serves to replace the sound the vocal cords previously produced. Other methods of alaryngeal speech (speech without vocal cords) are esophageal speech, and artificial larynx speech. Studies show that tracheoesophageal speech is found to be closer to normal speech than esophageal speech and is often reported to be better, both in terms of naturalness as well as how well it is understood, when compared to esophageal speech and electrolarynx speech.
The first report on a tracheoesophageal puncture dates back to 1932 when a laryngectomized patient was said to use a hot ice pick to create a tracheoesophageal puncture in himself. This enabled him to speak by forcing air through the puncture when closing off the tracheostoma with a finger.

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