Voice Restoration

 

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    Services are provided to restore verbal communication due to loss of voice from total laryngectomy surgery or tracheostomy. 

    Total Laryngectomy
    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 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.

    Frequently asked questions:

    Q: How long will it take me to learn to speak after my total laryngectomy?
    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 sessions/weeks.   Esophageal 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

    Tracheostomy Patients
    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.