A laryngectomy is a surgical procedure that involves removing the larynx, commonly referred to as the voice box. The larynx houses the vocal cords, which produce the sound for speech. Because this structure is removed, the ability to communicate in the traditional manner is lost. However, modern medical and rehabilitation techniques ensure communication remains possible. Most individuals who undergo a total laryngectomy learn a new, effective method of speaking, requiring dedicated training and adaptation.
How the Laryngectomy Changes Speech
The removal of the larynx permanently redirects the body’s airflow and eliminates the natural source of sound. The surgery creates a permanent opening in the lower front of the neck, known as a stoma, through which breathing now occurs. Air is no longer drawn in through the nose and mouth to reach the lungs, and the trachea (windpipe) and the esophagus (food pipe) are surgically separated.
This anatomical change means air from the lungs can no longer travel past the vocal cords to create vibration, requiring a substitute sound source. The separation of the respiratory and digestive tracts also means air no longer passes through the nasal cavity, which can significantly reduce the sense of smell. The absence of the larynx means coughing or sneezing will expel air and mucus directly from the stoma.
The Three Primary Methods of Voice Restoration
Voice restoration post-laryngectomy is achieved through one of three primary methods, each utilizing a different mechanism to create sound.
Tracheoesophageal Puncture (TEP)
The most successful and natural-sounding option is the tracheoesophageal puncture (TEP) with a voice prosthesis. This involves a surgeon creating a small puncture between the trachea and the esophagus, into which a one-way silicone valve is placed. To speak, the individual covers the stoma, directing air from the lungs through the valve into the esophagus, causing the upper esophageal tissue to vibrate and produce sound. The prosthesis requires periodic replacement, typically every two to three months, often performed by a speech-language pathologist.
Electrolarynx
The Electrolarynx is a battery-operated device that produces a mechanical sound vibration. The user places the device against the neck or cheek, or uses a small tube placed in the mouth, while articulating words with the lips and tongue. The Electrolarynx is often taught immediately post-surgery as it is easy to learn and provides an immediate means of communication. However, the resulting voice quality is electronic or mechanical.
Esophageal Speech
Esophageal Speech does not require any external device or surgical placement. This technique involves the user learning to intake air into the upper esophagus and then releasing it in a controlled manner. The resulting vibration of the esophageal wall creates a sound that is then shaped into words. Esophageal speech requires the most intensive training and practice, and it has a lower success rate compared to the other two methods.
Speech Rehabilitation and Training
The process of learning to speak again is primarily managed by a Speech-Language Pathologist (SLP) who specializes in alaryngeal (without a larynx) communication. Immediately following surgery, communication relies on non-verbal means like writing or gestures. The SLP guides the patient in selecting and mastering the voice restoration method that best suits their physical and lifestyle needs.
Training Focus
For those using the Electrolarynx, training focuses on proper placement and coordinating device activation with clear articulation. Individuals pursuing the TEP voice must learn to coordinate their breathing and the precise timing of covering the stoma to direct air through the prosthesis. They also receive training on the daily care and cleaning of the voice prosthesis, including leak testing.
Esophageal speech training is the most challenging, requiring dedicated practice to master the technique of air ingestion and controlled release. The SLP helps the individual eliminate secondary behaviors, such as audible air noise at the stoma or facial grimacing, which can interfere with clear speech. Functional speech clarity typically improves substantially between six months and one year after the laryngectomy procedure.
Communicating Effectively in Daily Life
Integrating a new voice method into everyday life presents practical challenges that require adaptation from both the speaker and conversational partners. One difficulty is being understood in noisy environments, as the volume of alaryngeal speech is often less robust than a natural voice. This limitation may require the use of supplementary aids, such as writing or text-to-speech applications on a smartphone, in busy settings.
For TEP speakers, the act of speaking requires manual dexterity to cover the stoma, which is necessary to divert lung air into the prosthesis. Some individuals opt for hands-free systems, such as a Heat and Moisture Exchanger (HME) with a specialized valve, to manage the stoma while speaking. The Electrolarynx voice is recognized as sounding mechanical, which can sometimes lead to misinterpretations or require the speaker to anticipate the need for clarification. Learning to use non-verbal cues, maintaining eye contact, and instructing partners on how to listen to the new voice are techniques that contribute to successful social integration.