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08 February 2022
Speaking after a total laryngectomy
Speaking after a total laryngectomy.
Is it possible to speak after a total laryngectomy? Usually, it is. There are three main options to speak after a total laryngectomy: Using tracheoesophageal (TE) speech, speaking with an electrolarynx, or using esophageal speech. We will explain these three alternatives here in this text.
Voice is an important part of your identity. It is how you express your thoughts, feelings, and ideas. A total laryngectomy will change how you speak, but not what you want to express. Most people can regain their voice but in different ways.
Before your total laryngectomy, your voice is produced by vocal cords that located in your larynx/voice box. Your vocal cords generate sound so you can speak. When you breathe out, air passes through the vocal cords making them vibrate to produce sound. The sound moves into your mouth and is shaped into speech with your lips, teeth, and tongue.
Ways to communicate after surgery
A total laryngectomy is removal of the larynx/voice box which includes the vocal cords. After surgery, your medical team will try to find a way to replace the sound source. Thankfully, there are several ways to do this. There are three main options for replacing the sound source.
- Using tracheoesophageal (TE) speech with a voice prosthesis
- Speaking with an electrolarynx (EL)/artificial larynx
- Using esophageal speech
Tracheoesophageal speech using a voice prosthesis and esophageal speech uses the upper part of your esophagus/food tube to produce sound for speech. The Electronic Larynx is a device that electronically produces sound. You and your medical team will determine which method(s) is best for you. The method you choose will sound different than before surgery. However, most speak without much effort after undergoing training and with practice.
Tracheoesophageal speech using a voice prosthesis is the most common and natural sounding speech method used today. It is also considered the most successful method as it creates a more natural sounding, effortless voice. Your surgeon will create a tracheoesophageal puncture (TEP) between your trachea/windpipe and your esophagus/food tube and places a small silicone device called a voice prosthesis. This can be done during your laryngectomy or later once you are healed. The voice prosthesis does not make the sound but allows air to travel from your lungs into your esophagus/food tube to produce sound. When you cover your stoma to speak, the air goes from your lungs through the voice prosthesis into your esophagus/food tube. The esophagus/food tube then vibrates and produces sound. That sound then travels to the mouth to shape it into speech. The voice prosthesis is a one-way valve that opens when you are speaking and closes when you are eating/drinking. The voice prosthesis will need to be changed on average every 2-3 months by either your doctor or your speech pathologist in their office. Learning to use your voice prosthesis is quick and easy. You may be able to communicate well with little effort the first time you try.
Most learn to use an electrolarynx/artificial larynx right after surgery in the hospital. It is an electronic device that produces sound that can be shaped into speech. The sound goes into your mouth either by placing the device up to your neck or cheek or by putting a small straw into your mouth. Once the sound is in your mouth, you then move your lips, teeth, and tongue to shape that sound into speech to communicate. Some use this as their main way of speaking and others use it as a back-up device or to be heard in a noisy environment. It may take some time for others to understand you. However, with practice and training from your clinician, most can be understood.
Another way to speak after surgery is using esophageal speech. Esophageal speech uses the upper part of your esophagus/food tube to make the sound. The way it works is that you push the air that is in your mouth into your esophagus/food tube with your lips and tongue. Your esophagus/food tube then vibrates producing sound. That sound then travels into your mouth, and you move your lips, teeth, and tongue to shape that sound into speech. Esophageal speech does not require a device or prosthesis. However, it can take time and patience to learn and has a lower success rate compared to other ways of communication.
Many people have trouble swallowing prior to having a total laryngectomy as the larynx/voice box is important in preventing food/liquid from entering your airway. Many times, the tumor and/or other treatment side effects may change the function of the larynx/voice box and one chokes when eating or drinking. After your laryngectomy, your airway is separate from your esophagus/food tube. As a result, you will no longer breathe through your nose and mouth, and you cannot choke while eating or drinking. You will only breathe through a small opening at the base of your neck called your stoma. Your stoma directly communicates with your lungs, and it is important to keep it covered. You will cover your stoma with a heat and moisture exchanger (HME)