inhealth Blom-Singer Instructions For Use Manual page 14

A second method for confirming gel cap dissolution and
esophageal retention flange deployment is to assess the capacity
to produce tracheoesophageal voice. If the voice prosthesis
is correctly positioned and the esophageal retention flange
deployed, airflow diverted from the trachea by digital occlusion
of the tracheostoma will open the flap valve and pass up the
esophagus to initiate fluent voice.
Proper Valve Function Confirmation of the Dual Valve
Indwelling Voice Prosthesis
Use a small wax curette or equivalent gauge instrument to
gently open the tracheal valve while the patient swallows their
saliva or water. The clinician should see the properly positioned
esophageal valve at the other end and no leakage.
If the proper deployment and positioning of the esophageal
retention flange cannot be confirmed by one or both of the
methods described above, the clinician may need to determine
gel cap dissolution and esophageal retention flange deployment
by manually opening, with gentle contact, the one-way flap valve
in the esophageal end of the voice prosthesis.
Note: The following method is not applicable to the Dual Valve
Indwelling Voice Prosthesis.
Direct a bright light into the prosthesis to visualize the flap valve
at the proximal end. Slowly and carefully advance the shaft end
(non-cotton tip) of a long cotton swab into the voice prosthesis
until you observe that gentle contact opens the flap valve. A
flap valve that does not open with gentle contact indicates that
the undeployed retention flange or an inverted flap valve is
preventing valve opening.
If the assessment methods described above fail to provide
satisfactory verification of correct esophageal retention flange
deployment, remove the voice prosthesis, dilate and re-measure
the puncture tract, and repeat the voice prosthesis insertion and
confirmation process.
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