Tracheoesophageal Prosthesis Malfunction - A Case Report

Tracheoesophageal prosthesis (TEP) is an artificial connection between the trachea and esophagus allowing air into the upper esophagus from the trachea thereby vibrating it. TEPs give patients who lose their vocal cords to laryngectomies a tracheoesophageal voice. A potential complication of this is silent aspiration of gastric content. We present a case of a 69-year-old female with a TEP placed after a laryngectomy for laryngeal cancer who presented to the hospital with shortness of breath and hypoxia. She was initially treated for a presumed diagnosis of chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) exacerbations but continued to be hypoxic despite aggressive medical management. Further evaluation revealed silent aspirations as a consequence of TEP malfunction. Through our case report we urge clinicians to consider this differential diagnosis, as the clinical presentation of silent aspiration among patients with a TEP can be easily mistaken for a COPD exacerbation. A large number of patients with TEPs are smokers with underlying COPD. LEARNING POINTS: TEPs give patients who lose their vocal cords to laryngectomies a tracheoesophageal voice. A potential complication of TEPs is silent aspiration around or through the TEP, causing coughing and even recurrent aspiration pneumonitis or pneumonia. Patients with TEPs typically have extensive smoking histories and underlying COPD or CHF which can have exacerbations that are similar in presentation.