Services are provided to restore verbal communication due to
loss of voice from total laryngectomy surgery or tracheostomy.
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
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.
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 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 then vibrates 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 a short time after.
Q: How long will it take me to learn to speak after my total
A: It is
important to begin to restore communication immediately following surgery to
improve quality of life for the patient.
The electrolarynx is usually learned by most individuals within several
speech requires training over several months while TEP speech is often successful
immediately after placement of the first prosthesis.
Q: Will I be understood on the phone?
A: Dependent on the
voice restoration method chosen and clarity of speech produced, being
understood on the phone will vary.
Most patients are successful communicating on the phone. There are certain techniques the
individual can use to improve speech on the phone:
- Pacing- focusing on each word
- Open Mouth Posture- increasing loudness
- Overarticulation- exaggerating speech sounds to
help clarify words
- Phrasing- pausing between phrases to give your listener
time to process what he/she has heard
The Passy-Muir Speaking Valve is available for adults and
children with tracheostomy tubes in place, intact vocal folds and an
unobstructed airway. This allows the
individual to inhale through their tracheostomy tube and exhale through their
larynx, setting the vocal folds into vibration, and creating voice. The Speech- Language Pathologist will
evaluate if the individual can tolerate and benefit from speaking valve use.
The individual and/or family will be trained in valve use and care if voicing
can be obtained and respiratory status remains stable during evaluation.