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.