Tracheoesophageal voice prosthesis (1 of 4)
Tracheal flange beginning to embed (at arrows) because the TEP device is too short.

Tracheoesophageal voice prosthesis (2 of 4)
Esophageal flange is bowing outward because the TEP device is too short.

Tracheoesophageal voice prosthesis, corrected fitting (3 of 4)
Same patient, with normal (now flat) esophageal flange fitting.

Tracheoesophageal voice prosthesis, during voicing (4 of 4)
During TEP voicing, pulmonary air comes up the trachea, is diverted through the center of the TEP device and, when the one-way valve opens, comes into the esophagus to bring its walls into vibration.

Hypopharynx of a tracheoesophageal voice prosthesis patient (1 of 4)
Panoramic view of the hypopharynx, in a patient who has undergone total laryngectomy. The entrance to the esophagus is at the line of arrows.

Hypopharynx, as the tracheoesophageal voice prosthesis patient makes voice (2 of 4)
Air has been diverted from the trachea and through the tracheoesophageal voice prosthesis (shown in the next two images) so that the hypopharyngeal tissue here is now vibrating (thus, is blurred) and making voice.

Tracheoesophageal voice prosthesis (3 of 4)
Seen here is the inner (esophageal) flange of the tracheoesophageal prosthesis, with its central flutter valve in closed (swallowing or resting) position.

Tracheoesophageal voice prosthesis, as the patient makes voice (4 of 4)
The patient has capped his tracheostome and is diverting air into the esophagus through the now-open central flutter valve. The pharyngoesophageal tissues are now vibrating (as seen in photo 2), and this vibration is blurring the image.