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Prosthesis plug

Provox® Plug (top) and Blom-Singer® Valved Plug (bottom; retaining tape removed for photo)

Patients can use prosthesis plugs to close the voice prosthesis if the valve starts to leak in order to prevent aspiration until the faulty prosthesis can be replaced by a new one. The plugs are mostly specific to certain prostheses. Because of the differing inner diameters of the voice prostheses, only the manufacturer's original plug in the right shaft diameter to match the prosthesis can be used and relied upon.

The plug seals the voice prosthesis completely, which means speech is not possible when the plug is in place. However, there are plugs on the market that contain a valve that does enable speech, albeit with slightly higher pressure (because of the smaller inner diameter).

The plug is inserted by the patient, ideally in front of a mirror. This requires a little practice. If the patient presses too hard against the prosthesis, it may fall into the esophagus. It is also important to attach the plug securely, either using a plaster strip or a collar, as the little plugs can easily fall into the trachea. As a general rule, a plug is an emergency solution for a few hours to a few days. Ideally, the faulty voice prosthesis should be replaced as promptly as possible.

Plugs are not available for all prostheses.

Plugs are available for:

  • Provox®1, Provox® 2, Provox® Vega
  • Blom-Singer® Classic Indwelling 20 Fr and 16 Fr prostheses (also with valves in the plugs for prostheses from a length of 6 mm)
  • Tracoe® Voicemaster
  • Heimomed® Phonax

With all of these plugs (Provox® Plug, Blom-Singer® Valved Plug and Blom-Singer® Plug) it is extremely important that they are pushed all the way into the prosthesis, i.e. until the plug flange is right up against the tracheal flange of the prosthesis. Only then will the plug hook safely into the prosthesis and seal properly. To achieve this, both designs have lips on the plug that make sure it hooks into the prosthesis. When pushing the plugs into the prosthesis, care must be taken not to exert excess pressure on the prosthesis as otherwise it could dislodge into the esophagus. Patients must be aware of this and given the appropriate instruction.

Blom-Singer® Valved Plug

The Blom-Singer® Valved Plug is supplied with a collar to prevent the plug from dislocating into the trachea. Lots of patients replace the collar with a small plaster strip, although this is not recommended.
A valved plug is just that – a plug with a valve. The plug has a flap valve on one end that seals off the leaking prosthesis while enabling the patient to continue talking. Note that the plug valve requires a small amount of space to open. When inserting in prostheses with very short shaft lengths (4 mm), it is possible that the valve may fail to open or it could be difficult to position the plug.
The plug is positioned on the insertion aid, which is included, and securely attached to the rod.
The plug is now inserted through the tracheostoma (demonstrated here on the shunt model) into the voice prosthesis until it hooks into place.
Once the plug has hooked into the prosthesis, it is detached from the insertion aid and the collar placed around the neck for safety. A new voice prosthesis should be inserted as quickly as possible.

Provox® Plug

The Provox® Plug has a retaining tape that is attached to the neck by sticking plaster. The end of the retaining tape is wider to prevent the plug from falling into the trachea.
The Provox® Plug is placed on the handle end of the cleaning brush for insertion (the old model is shown here in the picture, although the new one is used in the same way).
This is how the plug is inserted through the tracheostoma into the prosthesis. It must hook securely into place.
Once the plug has hooked into place, the inverted brush is removed and the plug attached to the neck with its retaining tape using sticking plaster. The voice prosthesis should be changed as quickly as possible. CAVE: Atos medical recommends changing the Provox® Plug once the stretch of the retaining tape is less than 3 cm.