A Different Way of Speaking
You may be wondering how you will be able to speak after a laryngectomy. The way you speak and the sound of your voice will change, but fortunately, there are ways to regain the power of speech through voice rehabilitation.
We rely on our voices to express our thoughts and feelings. A total laryngectomy means your larynx is removed – including your vocal cords. Right after a laryngectomy, the quickest way to communicate with family, friends and healthcare professionals will be through the use of writing and gestures. It may help to practice some simple gestures and ways of communicating together with friends and family prior to your surgery. There are also apps available for smartphones that can help translate text to speech.
The good news
Losing your natural voice can initially be quite upsetting, and will have an impact on both your ability to communicate and your sense of identity. But the good news is that there are several ways to regain your voice and ability to speak after a laryngectomy. In most cases you will already have been in contact with your speech and language therapist prior to your surgery, he or she will give you advise on voicing methods that can be learned after surgery to develop your new voice.
Before a laryngectomy
Before a laryngectomy, the voice is produced by the vocal cords. The vocal cords are located in your larynx, also known as your voice box, and are the source of your natural voice.
During exhalation, the air passes the vocal cords, which produces sound through a rhythmic opening and closing.
After a laryngectomy
Having a total laryngectomy removes your larynx and vocal cords, so the way you speak after a laryngectomy is going to change. Your voice will sound different than it did before because it is no longer coming from your vocal cords.
There are 3 different methods for voice rehabilitation following a laryngectomy:
- Speaking with a voice prosthesis
- Speaking with an electrolarynx
- Oesophageal and tracheoesophageal speech
Speaking with a voice prosthesis
One of the quickest and most natural ways to regain your voice is speaking with a voice prosthesis. Your surgeon can insert this during your laryngectomy operation or later, once you’ve healed.
What is a voice prosthesis?
A voice prosthesis is a small plastic device that has two ‘flanges’ on either side to keep it in place. Between the two flanges there is a small tube which contains a one-way valve. This valve opens when you speak and closes when you eat or breathe.
How does a voice prosthesis works?
Blocking your tracheostoma with a finger will re-direct the air through your voice prosthesis and into the food pipe. As the air travels through your food pipe, it causes the air at the back of your throat to vibrate and create a sound.
Advantages of using a voice prosthesis:
- More natural voice quality than other methods
- Relatively quick and easy to learn
Challenges of using a voice prosthesis:
- Not everyone is suitable to have a voice prosthesis
- Daily cleaning is needed
- Replacement is needed regularly
How does it sounds like speaking with a voice prosthesis?
Speaking with an electrolarynx
Many people rely on an electrolarynx as a back-up speaking method for situations where speaking with a voice prosthesis is not possible. It should be noted that the voice produced with the electrolarynx has a “robotic” sound, which can be modulated to some extent.
What is an electrolarynx?
An electrolarynx is a device that has a vibrating head that you press against your neck to vocalise.
How does an electrolarynx work?
The vibrating sound created by the electrolarynx is then shaped by the tongue and lips and converted into understandable speech.
Advantages of using electrolarynx:
- Non-surgical method
- Relatively quick and easy to learn
Challenges of using electrolarynx:
- Charging required to use the device
- Hand-held for speech
- Training and practice required
How does it sounds like speaking with an electrolarynx?
Esophageal speech
This method of voicing was used before voice prosthesis was developed. Only 1 in 3 people attempting this technique will be able to do it, and often their speech is limited to short sentences.
What is esophageal speech?
This technique uses the body’s natural tissues as the new voice source and requires you to swallow small amounts of air into your esophagus before “belching” them back up.
How esophageal speech works?
A column of swallowed air causes the food pipe to vibrate, generating the sound that is further modified by the tongue and lips to create words.
Advantages of using esophageal speech:
- Non-surgical method
- Allows for hands-free speech
Challenges of using esophageal speech:
- Can be difficult to master
- Bloating can happen due to air swallowing
- Limited to short sentences
Your speech and language therapist will help train your voice and give you exercises that will make your new speaking style as clear as possible. There may be a learning curve, but most people will soon master a new voice.
Glossary
- Eesophagus – The esophagus is the food pipe that carries food and liquids from your mouth to the stomach.
- Speech and language therapist – Speech and language therapists provide treatment, support and care for those who have difficulties with communication, or with eating, drinking and swallowing.
- Stoma (tracheostoma) – A stoma is a hole (opening) made in the skin in front of your neck to allow you to breathe. The opening is made at the base of your neck. Air goes in and out of your windpipe (trachea) and lungs through this hole.
- Tracheoesophageal – Is a connection between your windpipe (trachea) and your food pipe (esophagus).
- Vocal cords – Folds of tissue in the throat that are key in creating sounds through vocalisation
- Voice rehabilitation – A specialised therapy to help patients on voice quality.
- Windpipe – The air passage from the throat to the lungs, also known as the trachea.