In addition to the above, counselling should also include detailed information about the various options for voice production. These are oesophageal speech, the articial larynx and surgical voice restoration (SVR). The latter involves the creation of a tracheo-oesophageal puncture (TEP) at the time of primary surgery or at a later date. The TEP is a stula through the posterior tracheal wall into the oesophagus. This TEP is stented open with a Foley catheter or a one-way valve made of medical grade silicone. Air can pass into the oesophagus for voice production when the stomal exit is temporarily covered, but food and uid are not aspirated (Figure 15.3).