Learning to Speak Again After Laryngeal Surgery
Laryngeal cancer is cancer of the larynx, or voice box. Treatment may include a full
laryngectomy. This means the larynx is surgically removed. This surgery takes away
your ability to speak using your vocal cords.
Modern advances in surgery, radiation, and chemotherapy treatment can often save the
larynx or part of it. Keeping the larynx saves the voice, even if its quality is changed.
If the cancer is very advanced (a large tumor), removing the larynx may still be the
What is the larynx?
The larynx, also known as the voice box, opens to help you to breathe. When you swallow,
it keeps food out of the trachea, which is the windpipe. Air passing through the larynx
causes the vocal cords to vibrate, producing sound. With the help of your mouth, teeth,
tongue, and lips, that sound becomes your voice.
What happens when the larynx is removed?
When the larynx is removed, the surgeon trims and turns the trachea to create an opening
in the front of the neck. This opening, called a stoma, is the new passage for breathing.
It bypasses the nose and mouth. During the operation, the surgeon puts a tracheostomy
(trach) tube in the stoma to hold it open. A few weeks later, the healthcare provider
may replace the tube with a tracheostomy button, often called a stoma button. Some
people without a larynx leave the trach tube in. Others, after some time, don't use
either the tube or the button.
Preparing for surgery
A speech-language pathologist (SLP) or speech therapist will meet with you before
your surgery. The SLP will evaluate your speech and explain your communication options
SLPs counsel people before surgery to put them at ease and to let them know that they'll
be able to communicate right after surgery.
You need to know that even if only a part of your larynx is removed, your voice won't
sound the same as it did before the operation. It will have a lower pitch. It may
be hard to be heard in loud places. You'll need to practice each type of speech, try
to relax when speaking, and be patient. Remember, learning how to speak as a child
wasn't easy, either.
Your sense of smell and taste may also be affected. This is because air doesn't travel
through your nose, You can be taught how to recover some sense of smell, and that
can help your sense of taste. This treatment might be called olfactory rehabilitation.
Talk with your healthcare team to learn more about it.
For a few days after surgery, you won't be allowed to speak. This is so you don't
move your tongue around and pull apart the sutures. To help you heal, you'll be fed
through a feeding tube for a week or so. The type of feeding tube and length of time
you'll need it depend on the type of surgery you've had. A humidifier in your hospital
room will moisten the air to help keep your stoma from drying out. You may also be
taught how to use a suction machine to remove excess mucus at the stoma.
Before learning to speak again, you can communicate by writing. You might want to
bring a computer, tablet, or phone with you to the hospital so that you can write
notes to caregivers and send emails to family and friends.
Speech therapy usually starts before you leave the hospital. Once your healthcare
provider gives approval, the SLP will begin speech lessons with you. Learning to talk
again may involve things like esophageal speech, an artificial larynx, or a tracheo-esophageal
puncture (TEP). Each is described below.
Esophageal speech is when you take air into your esophagus and let it out. The top
of your esophagus then vibrates and produces sound. It's kind of like a belch, but
different—the air isn't coming from the stomach. Air is pulled in (inhaled or taken
in using the lips or the tongue) right below that vibrating segment, and then it comes
out. It's a more controlled way to produce sound. You'll learn how to use your lips,
tongue, and teeth to form words from the released air.
Esophageal speech is difficult and takes time to learn—often up to 6 months.
After you leave the hospital, you'll continue to learn esophageal speech with the
SLP, probably about once a week. You may also have a home health speech therapist
visit a few times a week. Some hospitals offer intensive laryngectomee workshops to
teach esophageal speech. Learning to speak this way may be hard. But you won't need
any tools or more surgery.
You can learn to use an artificial larynx (AL) while you're still in the hospital.
With a little practice, you can communicate with an AL and can even use it to speak
on the telephone.
There are 2 types of artificial larynxes—neck type and intraoral:
The neck type is placed on your skin on the side of your neck, under your chin, or
on your cheek. It may take some practice to find the position on your neck or near
your mouth that makes the best-sounding voice.
The intraoral type of AL is a small tube that goes in your mouth. It's best to use
your non-dominant hand to hold the AL so that your dominant hand is free to write
or shake hands.
Some people stick with the AL as their form of speech because they can communicate
right away and don't need another operation to use it.
Although communication is immediate with ALs and the devices are easy to use, some
people don't like the mechanical quality it gives their voice.
Tracheoesophageal puncture (TEP)
A TEP prosthesis is put into a small hole or puncture that the surgeon makes between
your windpipe and your esophagus. You may need another operation for this. Some healthcare
providers perform a TEP at the same time as the laryngectomy. Usually, you can decide
if you want a TEP. Or the healthcare provider and the SLP may suggest it if esophageal
speech isn't working.
To speak with a TEP, you take a deep breath and then cover the stoma so that when
you exhale, the air that would normally come out of the stoma is shunted through a
little prosthesis (a TEP valve). The air goes through the one-way valve of the prosthesis,
then up your esophagus, where muscle vibrations help to produce voice. You can either
cover your stoma with your finger when speaking, or you can get a "hands-free" tracheostoma
valve. A TEP lets you develop a natural-sounding voice and good sound quality within
a few weeks after surgery.
Learn from others
When the larynx is removed, the usual method of producing voice is also lost. It's
important to remember that laryngectomees (someone who has had cancer and laryngectomy
surgery) can speak again. You just have to learn a new way to speak.
A laryngectomee is sometimes called a "lary." You can find a lary to talk to through
laryngectomee clubs, such as "Lost Chord" or "New Voice.". You'll find lists of clubs,
and other resources, on the International Association of Laryngectomees website.