Individuals normally speak by exhaling air from their lung to vibrate their vocal cords. These vibration sounds are modified in the mouth by the tongue, lips, and teeth to generate the sounds that create speech. Although the vocal cords that are the source of the vibrating sounds are removed during total laryngectomy, other forms of speech can be created by using a new pathway for air and a different airway part to vibrate. Another method is to generate vibration by an artificial source placed on the outside of the throat or mouth and then using the mouth parts to form speech.
The method(s) used to speak again depend on the type of surgery. Some people may be limited to a single method, while others may have several choices. Each method has unique characteristics, advantages and disadvantages. The goal of attaining a new way to speak is to meet the communication needs of each laryngectomee.
Speech/language pathologists (SLPs) can assist and guide laryngectomees in the proper use of the methods and/or devices they use to obtain the most understandable speech. Speech improves considerably between six months and one year after . Active voice rehabilitation is associated with attaining better functional speech.
The voice prosthesisis is inserted into the puncture (called tracheoesophageal puncture or TEP) created by the surgeon in the back of the neck stoma. The hole is made at the back of the trachea (the windpipe) and goes into the esophagus (food tube). The hole between the trachea and esophagus can be done at the same time as the laryngectomy surgery (a primary puncture), or after healing from the surgery has occurred (a secondary puncture) .A small tube called a voice prosthesis, is inserted in this hole and prevents the puncture from closing. It has a one-way valve at the end on the esophagus side which allows air to go into the esophagus but prevents swallowed liquids from coming through the prosthesis and reaching the trachea and lungs.
Speaking is possible by diverting the exhaled air through the prosthesis into the esophagus by temporarily occluding the stoma. This can be done by sealing it with a finger or by pressing on a special Heat and Moisture Exchange (
After occlusion of the stoma exhaled lung air moves through the prosthesis into the esophagus causing the walls and top of the esophagus to vibrate. These vibrations are used by the mouth (tongue, lips, teeth, etc.) to create the sounds of speech.
There are two different basic types of voice prosthesis: the patient-changed type, designed to be changed by the laryngectomee or by another person, and the indwelling type, designed to be changed by a medical professional (an otolaryngologist or speech/language pathologist).
Patients who used TEP had the best results in speech intelligibility 6 months and 1 year after .
2. Esophageal speech
Of the three major types of speech following laryngectomy, esophageal speech usually takes longest to learn. However, it has several advantages, not the least of which includes freedom from dependency on devices and instrumentation. Some speech/language pathologists are familiar with esophageal speech and can and assist laryngectomees in learning this method. Self-help books and tapes can also help in learning this method of speech.
3. Electrolarynx or artificial larynx speech
It makes a buzzing vibration that reaches the throat and mouth of the user. The person then modifies the sound using his/her mouth to generate the speech sounds.
There are two main methods to deliver the vibration sounds created by an artificial larynx into the throat and mouth (intra orally). One is directly into the mouth by a straw-like tube and the other through the skin of the neck or face. In the last method, the electrolarynx (EL) is held against the face or neck.
ELs are often used by laryngectomees shortly after their laryngectomy while they are still hospitalized. Because of the neck swelling and post surgical stitches the intra oral route of delivery of vibration is preferred at that time. Many laryngectomees can learn other methods of speaking later. However, they can still use an EL as a back-up in case they encounter problems with their other speaking methods.
Other methods of speech and communication
A pneumatic artificial larynx (also called Tokyo Artificial Larynx ) is also available to generate speech. This method uses lung air to vibrate a reed or rubber material that produces a sound. The device's cup is placed over the stoma and its tube is inserted in the mouth.The sound generated is injected into the mouth through the tube. It does not use any batteries and is relatively inexpensive.
Those who are unable to use any of the above methods can use computer generated speech using either a standard laptop computer, or a single purpose speech aid. The user types what he/she wants to say onto a keyboard, and the computer speaks out loud what has been typed. Some cell phones can also operate in this manner.
Sending written messages through mobile phones (smart phones, or cell phones) can help laryngectommees communicate in noisy places or when they have other communication difficulties.
Diaphragmatic breathing and speech