Roles and Responsibilities of Speech-Language Pathologists With Respect to Evaluation and Treatment for Tracheoesophageal Puncture and Prosthesis

ASHA Special Interest Division 3, Working Group on Voice and Voice Disorders

It is the position of the American Speech-Language-Hearing Association (ASHA) that speech-language pathologists (SLPs) play a critical and direct role in the delivery and management of services to speakers using tracheoesophageal (TE) speech. As a prerequisite to TE speech, an opening or puncture is made through the wall between the trachea and esophagus. A prosthesis is placed in the puncture at the time of surgery by an otolaryngologist, or at a later time, by either an SLP or an otolaryngologist. When the tracheostoma is occluded manually or with a tracheostoma valve, the prosthesis shunts pulmonary air into the esophagus where the tissue vibrates to generate the sound source for speaking.

Ideally, the surgeon and the SLP work as a team when a TE prosthesis is used, beginning with the preoperative patient selection and assessment of the capacity for the patient to generate fluent voicing via the pharyngoesophageal segment. It is primarily the responsibility of the SLP to participate in the selection and fitting of the TE prosthesis, to teach the care and use of the TE prosthesis, and to identify and facilitate resolution of problems related to sound generation, the effective use of the prosthesis for speaking, and the TE puncture site. The SLP is also primarily responsible for evaluating and training the patient to use a tracheostomal valve for hands-free speech.

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