Medical Oncologist
CION Cancer Clinics
Tracheo-oesophageal puncture and the voice prosthesis | CION Cancer Clinics
A voice prosthesis is a small silicone one-way valve placed in a tiny hole between the windpipe and the food pipe. Cover the stoma, breathe out, and air passes through the valve so the throat vibrates and your mouth forms words. It is the most natural sounding way to speak after a laryngectomy. This page explains how it works, what is decided about it, what it asks of you daily, and who it does not suit. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is a TEP voice prosthesis, and how does it give you a voice?
- What actually happens when you speak with the valve?
- What choices are made about the puncture and the valve?
- Words you will hear, in plain language
- Four things families tell us, and what is actually true
- Who a voice prosthesis does not suit, and what this page cannot tell you
- Common questions about the voice prosthesis
The short answer
What is a TEP voice prosthesis, and how does it give you a voice?
A voice prosthesis is a small silicone valve, about the size of a shirt button, that sits in a tiny hole made between your windpipe and your food pipe. When you cover the stoma and breathe out, air passes through the valve into the throat, the top of the food pipe vibrates, and your mouth shapes that sound into words. It is the most natural sounding of the three ways to speak after a laryngectomy.
What the valve is and is not
It is a one-way door. Air goes forward into the throat for speech. Food and drink cannot come back the other way into the windpipe, as long as the valve is working. It has no battery, no electronics and makes no sound of its own. The voice is yours, made with your own breath.
Why it needs a surgeon
The hole, called a tracheo-oesophageal puncture or TEP, is made either during the laryngectomy itself or at a short later procedure. The valve is then fitted into it. Once in place it stays, and is swapped for a new one when it starts to leak, usually every few months.
This is not a tracheostomy tube and not an implant in the sense of a pacemaker. It can be removed, and the puncture will close on its own if it is left empty.Each word
What actually happens when you speak with the valve?
Breathe in through the stoma
A normal breath, through the neck. The lungs fill as they always did.
Cover the stoma
Press a thumb or finger over the cassette or the opening, so air cannot escape through the neck. A hands-free valve does this for you when you breathe out firmly.
Push air through the valve
As you breathe out against the closed stoma, air takes the only route left: through the prosthesis into the top of the food pipe.
The throat vibrates and the mouth speaks
The muscle at the top of the food pipe vibrates with the airflow, making a low sound. Lips, tongue and teeth turn it into words, exactly as before.
Not sure whether this applies to you?
Ask an oncologistThe decisions
What choices are made about the puncture and the valve?
Your surgeon and speech therapist make these with you. Knowing the names helps you follow the conversation.
Primary puncture
The hole is made during the laryngectomy and the valve or a feeding tube placed at once. Voice training starts early. Not always chosen if the throat is being rebuilt or healing is expected to be slow.
Secondary puncture
The hole is made at a short second procedure, months later, once the throat has healed and any radiotherapy is finished. A safe route for people who were not suitable at the first operation.
Indwelling or patient-changed
An indwelling valve stays in and is changed by a trained clinician. A patient-changed valve is removed and replaced at home. Most Indian centres use indwelling valves.
Ask about
- Who does the change and where
- How far you would travel for it
Hands-free valve
A cassette holder that closes on a firm breath out, so you can speak without a finger on the stoma. Needs a good seal on the skin and some practice. Not everyone gets on with it.
At the clinic
Words you will hear, in plain language
- TEP
- Tracheo-oesophageal puncture. The small hole between the windpipe and the food pipe that holds the valve.
- Leak through
- Liquid coming through the middle of the valve into the windpipe when you drink. The usual sign that the valve has worn and needs changing.
- Leak around
- Liquid coming around the outside of the valve, because the puncture has widened. Needs a clinic visit; a different size or a short rest may be needed.
- Candida
- A yeast that grows on the silicone and stops the valve closing. The commonest reason a valve wears out early.
- Occlusion
- Covering the stoma with a finger to speak.
- Brush and flush
- The small brush and syringe used to clean the valve in place, usually after meals.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Commonly believed
Four things families tell us, and what is actually true
"It is fitted once and lasts for life."
A valve is a consumable. Silicone wears, yeast grows on it, and it starts to leak. It is changed at a clinic visit, usually every few months, though the interval varies a lot between people. Budget for that from the start.
"It is leaking, so the operation has failed."
Leaking is the normal way a valve tells you it is worn. It is fixed by a change, which takes minutes and needs no anaesthetic. Leaking around the valve rather than through it is a different matter and needs a visit, but is still usually manageable.
"He must keep his finger on his neck to say anything."
A finger over the stoma is the usual way, and most people do it without thinking within weeks. A hands-free valve removes the need for some people. It is not for everyone, and using a finger is not a failure.
"Only rich families can afford the valve."
It is an ongoing cost, and that is a real concern for many families. Prices vary widely between types and suppliers, and some schemes and insurers cover part of it. Ask for written figures and about cheaper options before deciding it is out of reach.
!
Two things that need same-day care
If the valve comes out, or you cannot see it in the puncture, and you had a sudden coughing fit, it may have gone into the windpipe. Go to the nearest emergency department and say so. Separately, if the puncture is empty, it starts closing within hours; a soft catheter needs to be placed in it the same day to keep it open, so call your centre at once even if you feel well.
Being straight with you
Who a voice prosthesis does not suit, and what this page cannot tell you
A valve does not suit someone who cannot clean it, because of poor eyesight, shaky hands or memory problems, and who has nobody at home to do it for them. It does not suit someone who cannot get to a centre when it leaks. And it is sometimes not possible when the throat has been rebuilt with tissue from elsewhere, or when the muscle at the top of the food pipe is too tight to vibrate.
What it asks of you every day
Cleaning with the brush after meals. Watching for coughing when you drink. Keeping a cassette over the stoma, because dry air shortens the valve's life. Keeping a spare plug and a catheter at home in case it leaks or comes out. None of it is hard, but it is daily, and it is easier if the family learns it too.
What this page cannot tell you
It cannot tell you how clear your voice will be, how long each valve will last for you, or what it will cost against your own cover. Those depend on the operation you had, radiotherapy, the shape of your puncture and the supplier your centre uses. Ask for these three answers in writing before you decide.
If your centre does not fit valves, ask for a referral for that part alone. The rest of your care can stay where it is.Questions we are asked
Common questions about the voice prosthesis
How soon after surgery can he speak with it?
If the puncture was made during the laryngectomy, voice work usually starts once the wound has healed and swallowing is safe, often a few weeks in. The first sounds come at the speech therapist's session. Clear conversation takes practice over the following weeks and months.
Does changing the valve hurt?
It is uncomfortable for a moment rather than painful. The old valve is pulled out and the new one pushed into the same hole, at a clinic visit with no anaesthetic. Most people describe a brief pressure and a cough. You can speak, eat and drink straight afterwards.
Why does he cough when he drinks water?
Because a little liquid is getting through or around the valve into the windpipe. Through the valve usually means it is worn and needs changing. Around it needs a look at the puncture. Until you are seen, thicken drinks and sip slowly; do not just push through it.
How often does it need changing?
It varies a great deal between people. Some go many months, others need a change much sooner, particularly where yeast grows fast or reflux from the stomach is a problem. Your team will learn your pattern over the first year. Ask what shortens the life of a valve and what you can do about it.
Can he eat normally with it in?
Yes. The valve sits out of the way of swallowed food. Clean it with the brush after meals so nothing sticks and stops it closing. Some people find sticky foods and dry rice catch a little at first, and chewing well and sipping water with meals helps.
Can it be fitted if he has had radiotherapy?
Often, yes. Radiotherapy makes the tissues heal more slowly and can make the puncture widen over time, so the surgeon may prefer a secondary puncture after treatment has settled. It is a judgement for your team, made on your own scans and how the neck has healed.
What happens if he decides he does not want it any more?
The valve is removed and the puncture is left to close, which it usually does on its own. Some people need a small procedure to close it. You can still use an electrolarynx or learn oesophageal speech afterwards. Nothing about the choice is permanent.
Is the valve covered by Aarogyasri or insurance?
The puncture itself, as part of the cancer operation, is often covered. The replacement valves over the years are less consistently covered. Aarogyasri, CGHS, ECHS and EHS are accepted at CION, and most cashless insurers are empanelled. Call the helpline with your card details and ask specifically about replacement valves.
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Sources
- Macmillan Cancer Support — Laryngectomy
- Cancer Research UK — Laryngeal cancer
- American Cancer Society — Surgery for laryngeal and hypopharyngeal cancer
- National Cancer Institute — Laryngeal cancer treatment (PDQ), patient version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Speaking After Laryngectomy: The Three OptionsHow the valve compares with the other two methodsOesophageal Speech: Learning ItThe no-device alternativeElectrolarynx: How It Works and What It CostsA backup for days when the valve is leakingHumidification and Why It MattersMoist air makes valves last longerSwallowing and Eating After LaryngectomyEating with a valve in place
Talk to us
Leaking valve, or wondering whether one is possible for you?
Call the helpline. A head and neck surgeon or speech therapist will tell you whether a leak needs a visit today, or talk through whether a puncture is an option after your operation. One helpline serves every CION centre.