In their recent article "Downsizing of Voice Prosthesis Diameter in Patients With Laryngectomy," Eerenstein et al1 raise the issue of the escalating dimensions of tracheoesophageal voice prostheses and state,
Gradual dilation of the TEF [tracheoesophageal fistula] may cause bothersome leakage around voice prostheses. Prosthesis-related weight and mechanical trauma possibly exacerbate TEF dilation. If prosthesis size were to be decreased, with a concomitant decrease in prosthesis weight and diameter, dilation of the TEF would probably lessen.
Blom ED. Some Comments on the Escalation of Tracheoesophageal Voice Prosthesis Dimensions. Arch Otolaryngol Head Neck Surg. 2003;129(4):500–502. doi:10.1001/archotol.129.4.500-a
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