• Reference Number: HEY-735/2023
• Departments: ENT, Speech and Language
• Last Updated: 30 November 2023

Introduction

This leaflet has been produced to give you general information about your voice valve. Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your Healthcare Professional, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

This information leaflet describes how to look after your stoma and voice valve.  It also lists some of the problems that you may experience and how to deal with them.

Stoma Protection

The stoma should always be covered with either a bib protector, base-plate or stud/tube filter system. The stoma is not able to perform the four essential functions of resistance, filtering, warming and moistening of the air that you breathe. Long term breathing with the stoma uncovered will lead to irritation of the lungs which then results in increased mucus production, coughing and chestiness. As well as assisting with breathing, stoma protection also improves appearance and protects your clothes.

There is a wide range of stoma protection supplies on prescription. Your ENT Nurse Practitioner and/or Speech and Language Therapist will be happy to advise on the products most suitable for you.

Orders are generally made through the home delivery company, Countrywide Supplies. They provide a very prompt and reliable service. You will be able to reorder as you need to using the freephone number that will be provided with your first order. You may also make your order on-line.

There are a number of items that are not currently on prescription such as decorative cravats. Please ask your ENT Nurse Practitioner and/or Speech and Language Therapist for more details or current brochures.

Cleaning your Stoma and Voice Valve

For stoma cleaning you will need:

• Water spray bottle
• Tissues
• Cotton buds (long stem)
• Tweezers
• Stoma protection
• Mirror
• Good light

Procedure:

1. Wash your hands thoroughly.
2. Sit in front of the mirror with a good light shining at your stoma.
3. Spray into your stoma 2 to 3 times. Wipe away any mucus with a tissue/cotton bud.
4. Ease mucus away with tweezers, using a damp tissue to loosen stubborn pieces.
5. Clean your stoma button in hot, soapy water and dry.
6. Place the button in the stoma. Use a small amount of Aquagel if needed.
7. Spray the bib cover and place over your stoma.

Check your stoma regularly throughout the day. It is recommended that you clean your stoma at least four times daily.

For voice valve cleaning you will need:

• Blom-Singer pipettes
• Voice prosthesis brushes (if advised)
• Water
• Plus the equipment listed above for stoma cleaning

Procedure:

1. Dip cotton bud in water and remove secretions from around the voice prosthesis.
2. Carefully remove dry pieces of mucus from the edge of the valve with tweezers.
3. Fill approximately one third of the stem of the pipette with clean water.
4. Gently insert the tip of the pipette into the valve until it fits snugly.
5. Briskly squeeze the bulb of the pipette to flush water through the valve.
6. If water does not squirt through the valve, it may need to be cleaned with a brush.
7. Place a finger on the valve strap and carefully insert the brush.
8. Twist in a clockwise direction before gently removing.
9. Pipettes and brushes can be cleaned in warm, soapy water and allowed to air dry.

Problems that may occur and suggested solutions

The valve may come out on cleaning or coughing

• Place a catheter in the tract where the valve normally sits and secure appropriately. Retain the valve and bring it with you to your next appointment (we need to know that it is not in your chest).
• Make contact via the telephone numbers given and book an appointment to have a new valve placed.

Please do not come to the hospital without first arranging an appointment as we need to allocate an appropriate amount of time to see you. Please bring your valve changing kit with you.

The valve may fall down your windpipe

• If this happens do not panic.  The valve will not stop you from breathing.
• Place a catheter in the tract where the valve normally sits and secure appropriately.
• Bend over with your head as low as you can manage and try to cough the valve out. Try this up to 3 times, observing to see if the valve has come out of the stoma (please retain if it does).
• If you are unable to cough the valve out, please make an appointment to see the ENT Nurse Practitioner or Speech and Language Therapist.

It may be difficult to place a catheter

• Try to place your dilator as an interim measure and tape securely to your neck. Do not eat or drink with the dilator in place.
• You may wish to try placing the catheter after the dilator has been in for 5 -10 minutes. You may eat and drink if the catheter is securely positioned.
• If you are experiencing difficulty placing a dilator or catheter, please contact the ENT Nurse Practitioner or Speech and Language Therapist during working hours or the ENT Ward outside working hours.
• Please note that the tract may close quickly, so you need to act promptly.
• If the tract closes fully, a further surgical procedure will be required before the valve can be re-fitted.
• Remember at all times that you must not eat or drink if the valve has come out and you have not placed anything in the tract.

The valve may leak through the middle

• Leakage through the middle of the valve will tend to cause coughing and possibly staining on clothing. Do not ignore this as you may develop a chest infection if it continues.
• Take a drink of milk or blackcurrant juice and look at your valve in the mirror with a good light.
• If you notice milk or blackcurrant juice coming through the middle of the valve, clean it thoroughly with the pipette and/or brush. Food or phlegm may be stuck at the end of the valve and simple cleaning will solve the problem.
• Try drinking milk or blackcurrant again. If you still have leakage, the valve may need to be changed. This can only be done within working hours currently

The valve may leak around the outside

• Leakage around the outside of the valve will tend to cause coughing and possibly staining on clothing. Do not ignore this as you may develop a chest infection if it continues.
• Take a drink of milk or blackcurrant juice and look at your valve in the mirror with a good light.
• If you notice milk or blackcurrant juice leaking around the valve, you will need to make an appointment to see the ENT Nurse Practitioner or Speech and Language Therapist. It will not be possible for you to solve this problem at home.

The valve may develop candida deposits causing leakage

• Candida is a type of fungus which may grow in the mouth and neck. For the valve wearer, it may stick to the valve, causing it to change shape and leak prematurely.
• If you wear dentures, ensure that these are cleaned thoroughly and regularly with a recommended denture cleaning agent.
• Natural anti-fungals that control the growth of candida are bio-yoghurts (with a live culture), Turkish or Greek yoghurt and buttermilk. One of these products each day is advised unless contra-indicated by your diet.
• If candida deposits are significantly reducing the life-span of the voice valve on a regular basis, Nystatin liquid or an alternative may be recommended. These are available via your GP on prescription.

The valve can dislodge and may result in effortful voice or no voice

• If the valve is protruding forward and you can still talk without effort, the prosthesis may be too long. Contact the ENT Nurse Practitioner or Speech and Language Therapist to make an appointment for assessment.
• If the valve is protruding forward and you are having difficulty in talking or you do not have any voice, you need to act promptly as the tract may be closing at the back. Contact the ENT Nurse Practitioner or Speech and Language Therapist to make an appointment.
• If the valve is embedded in the tissue, it may have dislodged on cleaning. Secure with tape and contact the ENT Nurse Practitioner or Speech and Language Therapist to make an appointment.

If you have any questions, please contact:

ENT Department, Centenary Building, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ. Tel: (01482) 624703

or

Speech and Language Therapy Department, Therapies Centre, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ. Tel: (01482) 604331

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.