Experience with Barton button and peristomal breathing valve attachments for hands-free tracheoesophageal speech

Background. Tracheostoma breathing valves permit hands-free tracheoesophageal (TE) speech production; however, few laryngectomees routinely use them because of problems with attachment. Methods. We retrospectively reviewed the charts of 45 TE speakers to determine the success rate and factors associated with successful breathing valve use based on attachment. All patients attempted to use a tracheostoma breathing valve with either a standard or customized peristomal housing, or a standard or customized Barton button. Device selection was based on inspection of the patient's neck and peristomal contour. Six to eight consecutive hours of attachment defined success. Results. Overall, 9% of subjects succeeded with any peristomal attachment as compared to 68% with either a standard (57%) or customized (85%) Barton button. Smooth stomal contour, a contiguous stomal lip, and correct button length were important for successful Barton button use. Conclusions. Standard or customized Barton buttons offer excellent alternatives to peristomal housing attachments for hands-free TE speech in select patients. (C) 2000 John Wiley and Sons, Inc.