To the Editor.—As originators of three of the four prostheses that were the subject of Weinberg and Moon's1 recent article, we feel obligated to point out at least one important observation the authors failed to make. They correctly identify that the "duckbill" portion of the prosthesis may be pushed inward against the posterior esophageal wall by finger occlusion of the tracheostoma during speech, thus restricting valve opening. This, in fact, was one of the considerations that prompted our development of a circular hinge-type valve, protected within the tip of the prosthesis, that avoids tissue contact.2
What Weinberg and Moon failed to recognize in this and previous reports on prosthesis-airflow resistance is that finger pressure exerted against the tracheostoma may also embed the prosthesis airflow port in tracheal tissue, thus potentially altering (increasing) airflow entrance resistance. Additionally, clinical observations frequently show that the airflow port is commonly the
BLOM ED, SINGER MI. Tracheoesophageal Puncture Prostheses. Arch Otolaryngol. 1985;111(3):208–209. doi:10.1001/archotol.1985.00800050102019
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