If a decision is to be made regarding the secondary insertion of a voice prosthesis but there is some doubt as to whether an adequate myotomy was made during the laryngectomy, then an insufflation test may help. A thin silicone tube, similar to a stomach tube, is inserted through the nose and into the upper esophagus. By closing the tracheostoma for expiration, air is introduced into the upper esophagus at about the level of a future voice prosthesis.
If the air flows gently upwards and out of the mouth and the patient is able to speak, then it is highly probable that he will also be able to talk with a voice prosthesis. Fig. A. The insufflation test is no longer as important as it used to be, since the ability to speak is almost always achieved, even without an adequate myotomy, if an EMG-controlled injection of Botulinum Toxin A is performed.