Unaided speech in tube-free tracheostomy: The supplementary sling procedure

OBJECTIVE: In some patients after tube-free tracheostomy, air escape hinders voice optimization. Our objective was to determine whether a supplementary sling procedure could reduce air escape and improve unaided speech and cough in these patients. STUDY DESIGN AND SETTING: From September 1998 through June 2001, 12 patients underwent supplementary sling procedures at the Cleveland Clinic. After surgery, stoma constriction and voice production were assessed. RESULTS: Fifteen procedures were performed in 12 patients. Two patients required revision procedures. All 9 patients with sufficient follow-up have markedly improved stoma constriction and speech production. Three patients with less than 3 months' follow-up already show early improvement. CONCLUSION: The supplementary sling procedure effectively reduces air escape and helps unaided speech and cough in patients with tube-free tracheostomata. SIGNIFICANCE: As more patients undergo tube-free tracheostomy, the pool of patients who might benefit from a sling procedure will grow. Indications might extend to postlaryngectomy or post-laryngeal transplant patients.