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Guidance for reinsertion of TEP voice prostheses

Proposed guidance for reinsertion of trachea-oesophageal puncture (TEP) voice prostheses

during the COVID-19 pandemic


Issued : 25 March 2020


To: UK head and neck multidisciplinary teams


BAHNO recognises that the management of many patients with cancer will have to be modified during the current COVID-19 crisis.  One particular group that may cause management dilemmas are those with voice prostheses.


Reinsertion of tracheooesophageal puncture (TEP) voice prostheses

  • Attendance at hospital out-patient and Emergency Departments should be avoided


  • Contact patients by telephone/video call/email now with advice on altered service


  • Functioning voice prostheses should not be replaced however old


  • Central leakage should be managed by thickened fluids or plug first


  • If TEP fistula closing a new prosthesis should not be inserted


  • Prostheses may be reinserted to prevent aspiration but not for voice


  • If prosthesis requires changing consider a dummy valve which will avoid the risk of further central leakage until safe services are resumed.



Cyrus Kerawala

President BAHNO