Methods of speaking after laryngectomy

Although total laryngectomy removes the entire larynx (vocal cords/voice box). However, most laryngectomees can acquire a new way of speaking. About 85-90% learn to speak using one of the three main methods of speaking described below. About 10% do not communicate by speaking but can use computer-based or other methods to communicate.


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 total laryngectomy.  Active voice rehabilitation is associated with attaining better functional speech.

The three main methods of speaking after laryngectomy are:

1. Tracheoesophageal speech

In tracheoesophageal speech pulmonary air is exhaled from the trachea into the esophagus through a small silicone prosthesis that connects the two, and the vibrations are generated by the lower pharynx.

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 (HME) filter that is worn over the stoma. An HME partially restores the lost nasal functions. Some use a" hands free" HME (automatic speaking valve) that is activated by speaking. 


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). 

The HME or automatic speaking valve can be attached in front of the tracheostoma in different ways: by means of an adhesive housing that is taped or glued to the skin, or by means of a laryngectomy tube or stoma button that is placed inside the stoma. 

Patients who used TEP had the best results in speech intelligibility 6 months and 1 year after total laryngectomy.

2. Esophageal speech

In esophageal speech the vibrations are generated by air that is “belched” out from the esophagus. This method does not require any instrumentation. 

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

The vibrations in this speech method are generated by an external battery operated vibrator (called electrolarynx or artificial - larynx) which is usually placed on the cheek or under the chin. 

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.

Types of electrolarynx

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.

Pneumatic artificial larynx

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

Diaphragmatic breathing ( also called abdominal breathing ) is the act of breathing  slowly and deeply by using the diaphragm muscle rather than by using one's rib cage muscles. When breathing using the diaphragm, the abdomen, rather than the chest expands. This method of breathing allows for greater utilization of the lung capacity to obtain oxygen and dispose of bicarbonate gasses. Neck breathers are often shallow breathers who use a relatively smaller portion of their lung capacity. Becoming accustomed to inhaling by using the diaphragm can increase one’s stamina and also improve esophageal and tracheoesophageal speech.

Diaphragmatic breathing

Increasing the voice volume using a voice amplifier

One of the problems encountered when using tracheoesophageal or esophageal speech is the weakness of the volume. Using a waistband voice amplifier enables one to speak with less effort and can allow one to be heard even in noisy places. It also prevents breakage of the stoma's housing seal because the laryngectomee who uses tracheoesophageal speech does not need to generate a strong expiratory air pressure to exhale air though the voice prosthesis.

 A voice amplifier 

Speaking over the phone

Speaking over the phone is often difficult for laryngectomees. Their voice is sometimes hard to understand and some individuals may even hang up the phone when they hear them.  

It is best to inform the other party about the speaking difficulties of the laryngectomee by first asking them "can you hear me?". This may enable the larynngectomee to inform and explain to their party about their speaking difficulties.

There are phones available that can amplify the outgoing voice, making it easier for the laryngectomee to be heard and understood. 

There is a nationwide phone service that allows a person whose speech may be difficult to understand to communicate over the telephone with the help of a specially trained Communications Assistant.  No special telephone is needed for this calling option. The three digit number 711 can be used as a shortcut to access Telecommunications Relay Services (TRS) anywhere in the U.S. TRS facilitates telephone conversations by one or more people who have speech and hearing disabilities. All telecommunications carriers in the U.S., including wire-line, wireless and pay phone providers must provide 711 service.

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.