A total laryngectomy involves removal of the entire larynx (voice box) which includes the vocal folds that produce voice. During this surgery, the patient’s trachea, or airway, is bent into a tracheostoma, or a hole in the neck. This tracheostoma becomes the only pathway for air, and the patient no longer has a voice for speech. The Speech-Language Pathologist can explain the anatomical changes that occur, provide information about the voice restoration options, and train the individual in electrolarynx, esophageal speech, and tracheoesophageal voice prosthesis (TEP) use dependent on treatment plan established.
- Electrolarynx is a hand held device that vibrates electromagnetically. The patient holds the device up to their cheek or neck, where the vibrations transfer into the mouth allowing the facial muscles to articulate the sound into understandable speech.
- Esophageal speech is produced by forcing air into the upper esophagus, and releasing the air in a controlled manner. The muscles of the lower throat (esophageal constrictor) vibrate to create a sound the individual will use as his/her new voice. The facial muscles the form the sounds into speech. This method requires a lot of practice to learn how to produce understandable speech.
- Tracheosophageal speech is the current preferred method, as it provides improved intelligibility, duration of speech, and volume compared to other methods. It consists of a one-way valve that allows air from the trachea into the esophagus, where the air vibrates muscles of the lower throat and then exits through the mouth, much like the esophageal speech method. It is important to note that tracheoesophageal voice prosthesis (TEP) requires a surgical procedure and candidacy for this must be discussed with the patient’s head and neck surgeon. The procedure can be done at the time of the total laryngectomy or at a later time.