A laryngectomy is a surgical procedure involving the complete or partial removal of the larynx (voice box), most often performed to treat laryngeal cancer. Since the larynx houses the vocal cords, its removal fundamentally changes how a person produces sound and breathes. While patients no longer speak using their natural voice mechanism, verbal communication is not lost. New methods for voice production must be learned, but communication remains possible through specialized techniques and devices.
How Laryngectomy Changes Voice Production
Normal speech relies on a precise system where the lungs act as the air generator, forcing air up through the trachea and past the vocal cords in the larynx. The vocal cords then vibrate to create the primary sound source, which is finally shaped into recognizable words by the tongue, lips, and mouth. A total laryngectomy disrupts this entire process by removing the larynx and the vocal cords, eliminating the body’s natural vibrating mechanism.
To ensure safe breathing after the surgery, the trachea is separated from the esophagus and brought to an opening in the neck, creating a permanent stoma. Air from the lungs now bypasses the nose and mouth entirely, exiting and entering the body through the stoma. Because the lungs’ airflow is permanently rerouted, it can no longer be used for traditional speech production. The separation of the airway from the upper digestive tract also prevents aspiration, but the patient must adapt to breathing through the neck.
Primary Methods for Speaking After Surgery
Post-laryngectomy voice restoration requires finding a new source of vibration to replace the lost vocal cords. Three primary methods are available, each utilizing a different mechanism to generate sound that can be articulated into speech. The patient’s anatomy, lifestyle, and rehabilitation goals influence the most appropriate method.
Tracheoesophageal Puncture (TEP) Speech
TEP speech is a surgical method that often yields the most natural-sounding voice. The procedure involves creating a small passage (fistula) between the trachea and the esophagus, either during the laryngectomy or later. A small, one-way silicone valve, called a voice prosthesis, is placed into this puncture.
To speak, the patient covers the stoma, redirecting air from the lungs through the prosthesis into the esophagus. This pulmonary air causes the tissue in the upper esophagus (the pharyngoesophageal segment) to vibrate, creating a sound. This sound is then shaped into words using the mouth, tongue, and lips.
The voice prosthesis requires regular maintenance and replacement, as the valve may fail or the puncture site may enlarge. While many patients manually cover their stoma, specialized hands-free devices are available to automatically direct the air toward the prosthesis. The high success rate and superior voice quality make TEP the most widely used method for voice restoration.
Electrolarynx
The electrolarynx is a non-surgical, external device that provides an immediate option for verbal communication. This battery-powered device is held against the neck or cheek, producing a constant mechanical vibration when activated. The sound waves are transmitted through the skin into the oral cavity, which acts as a resonance chamber.
The patient moves their mouth and tongue to shape this mechanical sound into speech. The voice produced is often described as having a “robotic” or monotone quality because the device generates sound at a constant frequency. Despite the mechanical sound, the electrolarynx is easy to learn and can be used as a primary or backup communication method.
Esophageal Speech
Esophageal speech is a non-surgical technique relying entirely on the body’s modified anatomy, requiring no devices or additional surgery. The method involves the patient learning to “inject” or swallow a small volume of air (typically 40 to 80 cubic centimeters) into the upper esophagus. The air is then expelled, causing the walls of the esophagus to vibrate to create a sound, similar to a controlled burp.
This vibratory source, known as the neoglottis, acts as the new sound generator and is articulated into words by the tongue and lips. Esophageal speech requires significant training and practice to master; only 50 to 60% of patients who train for it achieve functional communication. However, its major advantage is complete independence from external devices or surgical procedures.
Rehabilitation and Adjusting to New Communication
The process of learning to speak again after a laryngectomy is an intensive rehabilitation journey guided by a specialized Speech-Language Pathologist (SLP). Therapy often begins even before the surgery, with the SLP discussing the upcoming anatomical changes and potential communication methods. This pre-operative counseling is important for emotional adjustment and setting realistic expectations.
Post-surgery, the SLP provides hands-on training for the chosen method, such as teaching stoma occlusion for TEP speech or the air injection method for esophageal speech. Mastering a new voice takes time, coordination, and dedicated practice, especially for esophageal speech, which is the most challenging method to learn. The SLP also assists with managing the voice prosthesis, including troubleshooting leaks or helping with replacement procedures.
Beyond the mechanics of sound production, rehabilitation addresses the practical challenges of communication in daily life. Patients learn strategies for speaking in noisy environments and managing conversations with people unfamiliar with their new voice. Support groups and psychological counseling are often integrated to help patients and their families navigate the social and emotional changes. The goal of this multidisciplinary approach is to restore communication, helping the individual reintegrate into social and professional life.