There are several kinds of speech rehabilitation available to the patient after a removal of the voice box (total laryngectomy). The selection of the best speech technique for the individual patient will depend on a number of factors including the person's age and personal preferences. The goal of all rehabilitation for laryngectomees is to learn to speak by whatever way is best for that person.
Since the lungs can no longer expel air into the mouth, a person who has had a
laryngectomy breathes through an opening in the lower neck called
a stoma. The laryngectomee must also learn an entirely new method of
The patient is taught to take air into the mouth and swallow or force the air into
the esophagus by locking the tongue to the roof of the mouth. When the air is
forced back up into the mouth, it causes the walls of the esophagus and pharynx,
as well as the returning air, to vibrate, causing a low-pitched sound. This sound
is further changed in the mouth and becomes the laryngectomee's voice.
The whole process is similar to a controlled belch or burp. The patient then
forms this sound into words with the tongue, lips, teeth and palate, as do
Esophageal speech costs less because laryngectomees don't need equipment to help them speak. Esophageal speech can also produce a more "normal" sounding voice but it can be sometimes harder to understand. A downside is that it is more difficult to learn than speech produced with special devices.
Tracheo-esophageal speech is similar to esophageal speech, but it uses a device to re-direct air from the trachea (windpipe) into the esophagus. This is often done through the use of a small shunt placed through an opening made
between the trachea and esophagus called a tracheoesophageal puncture (TEP). TEP is done either at the time of the first surgery
or at a later time.
This procedure creates an opening between the
windpipe and food pipe through a small puncture at the stoma site. A small
one-way valve placed into this opening allows the patient to force air from their
lungs into the mouth.
There are two types of devices to help laryngectomees speak or speak better. If the laryngectomee is unable to be understood using esophageal speech, then an electronic larynx can be used to creates a clearer voice. The electronic amplifier is used to increase the volume of a person who uses esophageal speech.
The extra-oral type of larynx looks like a flashlight with batteries in the handle and has a vibrating disc on the end. This is pressed against the outside of the upper neck. When a button is pressed, the disc vibrates, causing a sound to be made which travels through the soft tissues of the neck into the mouth. This sound becomes the laryngectomee's voice.
- The intra-oral type of larynx is a shirt pocket sized battery pack connected to a sound emitter by a small wire. The sound emitter is the size of a silver half dollar and about a half inch in thickness. It is held in the palm of the hand, and when a button is pressed, it makes a vibrating sound that is sent directly into the mouth through a small hollow plastic tube attached to the sound emitter. The sound becomes the laryngectomee's voice.
- A number of amplifiers are on the market to help laryngectomees with weak or soft voices to increase their volume. Some amplifiers are small enough to be carried in the shirt pocket or purse.
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