Dilators perform several functions. On the one hand, they are used to stretch the esophagotracheal fistula slightly before a new voice prosthesis is inserted to make the process easier. It is rarely necessary to dilate the shunt for a routine voice prosthesis replacement. A second function is to temporarily close the shunt while the voice prosthesis is replaced (see fig. 1). When the dilator is in place and secured using sticking plaster, the "operator" has both hands free and the patient can swallow without aspirating. As the patient can usually tolerate this state for up to several hours, this removes the dynamics from the process of changing the voice prosthesis. In line with the management of complications, a dilator can stabilize a freshly recanalised shunt for up to several hours after a voice prosthesis dislocation before a new prosthesis is inserted. The insertion of a dilator in the shunt also provides information on the openness or closure of the shunt, and not rarely prevents the insertion of a voice prosthesis in a via falsa.

Dilators are made by various manufacturers and in various shapes and styles. We are showing some of them here, although this selection is by no means exhaustive.

Provox® dilator: the nubs on the dilator indicate the increasing diameters from 18 Fr (6.0 mm) to 24 Fr (8 mm) in 2 Fr (0.67 mm) intervals.
The dilator is made of medical grade silicone, and can be sterilized and reused.
Tracoe® VoiceMaster fistula dilator: the dilator has an increasing diameter to 16fr (5.7 mm) to 22fr (7.3 mm).
The dilator is made of medical grade silicone, and can be sterilized and reused.
Blom-Singer® Tracheoesophageal Puncture Dilators are available in two versions: 18 Fr. (6 mm) and 22 Fr. (7.3 mm). The diameter of the dilators increases to 18 Fr. or 22 Fr. The 90° bend enables the dilator to be safely attached to the neck using sticking plaster.

The dilator is made of soft medical-grade silicone, and can be sterilized and reused