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Blom-Singer Advantage Voice Prostheses - InHealth

Blom-Singer® Advantage Indwelling ..

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The ADVANTAGE indwelling voice prosthesis is the newest advancement in Blom-Singer voice restoration. Silver oxide has been incorporated into the prosthesis as a material preservative. The ADVANTAGE is placed by the clinician in the tracheoesophageal puncture so that routine changing of a voice prosthesis is unnecessary. It is ideal for laryngectomees who are unable or resistant to changing a removable voice prosthesis, such as the Duckbill or Low Pressure styles. The ADVANTAGE is inserted and replaced on an as needed basis by a speech pathologist or physician only.

Blom Singer - Advantage Indwelling Voice Prosthesis - Rx

Heat/Moisture Exchange (HME) filters are a type of stoma cover which help laryngectomees partially restore functions previously performed by our noses and upper airways. They might be thought of as "artificial noses." As the name implies, an ?exchange? of heat and moisture occurs in the HME filter as a laryngectomee inhales and exhales. During exhalation, warmth and humidity are conveyed from the lungs and deposited into the filter. During inhalation, the warmth and moisture are picked back up by incoming air and returned to the lungs.

HMEs are receiving more attention in the U.S. as the results of research which has been conducted in several European countries becomes more widely known, and certainly because they are now covered by Medicare.

Before the laryngectomy, the upper half of the breathing system filtered, humidified and warmed incoming air. It also provided resistance so that the lungs fully inflated. This helped maintain lung capacity, and facilitated an efficient exchange of gasses in the lungs (oxygen added to the blood stream and carbon dioxide removed). Prior to the laryngectomy, by the time the inhaled air reached the lungs it was saturated with moisture and its temperature was close to the body temperature of 98 degrees Fahrenheit (37 Celsius). Air at 100% relative humidity and 98 degrees is ideal for oxygen/carbon dioxide gas exchange. After the laryngectomy, the incoming air was dirtier, drier and cooler.

The resistance function of the nose and upper airway might be a little more difficult to understand than dirtier, drier and cooler air and the problems those produce for laryngectomees.

Prior to the laryngectomy, the nose provided 80% of the resistance to breathing; with the mouth, larynx and trachea providing the rest. By providing resistance the lungs had to move air a further distance, and past curved and sticky mucus covered surfaces which resisted the air flow. This consequently made us "work" harder to breathe. We had to breathe more deeply to move the amount of air we needed. This helped maintain lung capacity (the volume of air our lungs could hold), and the efficiency of the gas exchange in the lungs where oxygen is added to the blood stream and carbon dioxide is removed. The quantity of oxygen in the blood of laryngectomees is measurably reduced if they do not compensate for the loss of resistance. And our breathing efficiency typically declines, particularly in the months immediately following the surgery.

All laryngectomees can use an HME regardless of their method of speech. There are basically two different types of HMEs, and two major ways to attach them to the stoma. One HME type is designed for TEP prosthesis speakers who cover their stomas (occlude) with a finger or thumb in order to speak. This same type filter can be used by traditional esophageal speakers or those who use ALs (artificial larynges). It consists of a housing and a filter.

A second type of HME is for TEP prosthesis speakers. It combines the HME filter with a hands-free valve. The hands-free valve closes when the TEP prosthesis user exhales, and air is redirected into the prosthesis without having to cover the stoma with a finger or thumb (hence the term ?hands-free?).

There are two basic ways to attach an HME or HME/hands-free valve combination. In one, the housing is glued to the skin around the stoma, and the HME snaps into the circular hole in middle of the housing.

Some systems have reusable housings and the user applies the glue in liquid form to the housing and then lets it dry. Other housings are pre-glued and are disposable after using them for a day or two.

In either case, the skin surface around the stoma is first cleaned in order to get good adhesion. Many use rubbing alcohol for this purpose. Some of those with sensitive skin also use a product such as ?Skin Prep? or ?Skin Shield? as a barrier between their skin and the housing glue. Several suppliers have pre-glued disposable housings which use special formula glue for those with sensitive skin.

A second method for using an HME filter is to combine it with a laryngectomee tube (vent, button). Two laryngectomee tubes/vents/buttons which are designed to accommodate an HME filter are the Lary Tube from ATOS, and the Barton-Mayo Button from Bivona and InHealth. The Trachi-Naze Plus system combines a lary tube with a finger occluded HME. Both the ATOS Provox filter cassette HME and the InHealth Blom-Singer HME fit into these tubes. (See "Hands-Free/Glue-Free" article in the for more details about using the hands-free valve with the Lary Tube or the Barton-Mayo Button.

In addition to helping maintain the cleanliness, temperature, humidity and resistance to the air we breathe, HMEs have other benefits. In addition to mucus reduction, another of the most important of these is that many laryngectomees who speak via the TEP (tracheo-esophageal puncture) prosthesis report that their voicing is improved through the use of the finger occluded HME or the hands-free valve/HME combination. In the case of the finger occluded ones, it takes less pressure to get a good seal around the stoma to get a good and loud enough voice, and less pressure is applied to the entire area. This often results in speech being easier to produce as well as more clear to your listener.

Heat/moisture exchange filters (MHEs) need to be tried for a period of time. Using them continuously for at least one week is the minimum time they should be tried. The reason is that unless you just had your laryngectomy, you have gotten used to the lack of resistance to air moving in and out of your stoma. You may find the initial experience a little unpleasant and feel that the HME is restricting airflow. It is, but in beneficial ways. It takes time to get past this sensation and for you to adjust to it.

But in addition to this feeling, it also takes time for the HMEs to demonstrate some of their most important benefits such as reduced coughing and mucus production. And these benefits are unlikely to become obvious to you for a week, or even longer. A major mistake would be to try them for a day or less and conclude that they restrict your airflow. Research has shown that laryngectomees are more likely to stick with the use of HMEs if they are introduced right after the laryngectomy. The longer we go without using anything which provides resistance the more difficult it becomes to stick with them. We have simply gotten used to less restricted airflow and the sensation of having to work harder to get air is felt by many to be uncomfortable until they have adjusted to it.

Those with breathing problems such as COPD (Chronic Obstructive Pulmonary Disease), emphysema, asthma, etc., should not try an HME without approval from your MD. But trying them has been made easy since the major HME producers will send you a free sample kit of their HMEs (but not the hands-free valve/HME combinations) upon request.

If you wish to try them, you might consider trying those which have the least resistance first, and then move to those with greater resistance. This would suggest trying the Blom-Singer (or ATOS HiFlo cassette) first, and then to the ATOS Regular cassette, and finally to the Kapitex filters. The Kapitex nighttime filter provides the greatest resistance, so it should probably be tried last after you have gotten used to the feeling of added resistance to air flow, and it should only be used during sleep.

HMEs cannot completely restore the functions of the nose and upper airway in conditioning the air we breathe to the standards we enjoyed prior to becoming laryngectomees. They can, however, make a significant different in reducing coughing and excessive mucus production, and deliver a better quality of air to our lungs than the alternative stoma covers. They can also make a noticeable improvement in voicing for many, and they can help maintain lung function. While some laryngectomees will decide that they are not worth the additional hassle of using them or their cost, every laryngectomee should at least consider giving them a fair trial.

Blom-Singer Advantage Indwelling Voice Prosthesis Kit

#15791 - Blom-Singer Advantage Indwelling Voice Prosthesis Kit

In total, 749 voice prostheses were included, used by 102 patients; 108 Blom-Singer Classic Indwelling, 62 Blom-Singer Dual Valve, 424 Provox2, 117 Provox Vega, and 38 Provox ActiValve. Per device, the mean and median were, respectively: Blom-Singer Classic 86/69 days, Blom-Singer Dual Valve 104/75 days, Provox2 98/66 days, Provox Vega 107/92 days and Provox ActiValve 298/291 days (See Fig. ).

When comparing the medians within the groups, Provox ActiValve had significantly longer lifetimes compared to all other prostheses (p p = 0.006) and compared to Blom-Singer Classic (p = 0.004). There was no significant difference between the device life of Blom-Singer Classic versus Provox2 (p = 0.604), Blom-Singer Dual Valve versus Provox2 (p = 0.233) and versus Provox Vega (p = 0.159). (See table accompanying Fig. ).

Stimmprothese » Blom-Singer Advantage

The valve of the Blom-Singer® Advantage prosthesis is made of silver oxide silicone

You can establish your initial IVR system without as well much hassle by choosing an open source provider. Usually, these firms call these services held IVR packages which generally suggest that they handle all the technological upgrades for you. On top of that, these held services tend to be very personalized and could be customized specifically to your personal company’s requirements and services. Functions that are commonly consisted of in commercial IVR bundles are fundamental Rapid Response Indwelling Voice Prostheses acknowledgment, consumer service alternatives, phone menu navigating, and also call routing. First, brainstorm the kinds of attributes you would love to see in the item. Also if you currently have an unclear suggestion of exactly what you are seeking, making the effort to work generate a harsh draft of your objectives as well as assumptions will certainly do a whole lot to clarify what you should do in order to earn those things take place. It will certainly additionally assist you when you are talking with an IVR supplier. You would be shocked how easy it is to lose sight of your objectives when you listen to the vast variety of attributes readily available with IVRs.

Next off, ensure the supplier recognizes you desire organized or open source . A lot of vendors want to market their items as complete service IVRs, yet what they are truly supplying are a system with great deals of bells and whistles not hands off upkeep. Ten’s dealt with; choose what type of speech recognition you desire. All speech IVRs has some level of Rapid Response Indwelling Voice Prostheses acknowledgment; whether the system could only comprehend really certain as well as minimal phrases or is powered by extremely advanced expert system is up to you. Regardless of your decision, this option needs to be made before you go deal with the system as well as will certainly assist establish how you deal with establishing in the following couple of steps. This is where your IVR is going to truly beam if you made the effort to detail your purposes.

Blom and Singer were the first to use TE voice prosthesis for voice rehabilitation following ..
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All voice prostheses were used in accordance with the manufacturer’s recommended use of the device and the manufacturer’s recommended insertion method. The following algorithm of prosthesis choice is generally accepted and applied in our institution: Provox 2, Provox Vega and Blom-Singer Classic are used as standard devices by choice of the doctor using the device based on his experience and patients requirements (e.g. stoma size, place of TE puncture, preferred insertion method, need for overshooting, speaking problems). If a standard device shows a reduced device life

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In our centre a variety of voice prostheses from different manufacturers is being used to meet each patient’s individual needs. Since device life is an important factor in clinical and economical decision making, the aim of our prospective study was to investigate and compare the device life of five different indwelling devices used at our institute with a special focus to compare the newer devices (Provox Vega and Blom-Singer Dual Valve) to standard prostheses used in our institution.

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