Learning to Speak Again After Laryngeal Surgery
Laryngeal cancer is cancer of the larynx, or voice box. Treatment may include a full
laryngectomy, meaning the larynx is surgically removed. This takes away your ability
to speak using the vocal cords.
Modern advances in surgery, radiation, and chemotherapy treatment, however, 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, though, removing the larynx may still
be the best choice.
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 inserts a tracheostomy
tube in the stoma to hold it open. A few weeks later, the healthcare provider may
replace the tube with a tracheostomy button, commonly 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) will meet with you before your surgery. The SLP
will evaluate your speech and explain your communication options after surgery.
SLPs counsel patients 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. Talking
to be heard in loud situations may be difficult. 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.
For a few days after surgery, you won't be allowed to speak. This is because healthcare
providers don't want you to 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 the stoma
from drying out. You may also be taught how to use a suction machine to remove excess
Before learning to speak again, you can communicate by writing. You might want to
bring a laptop computer with you to the hospital so that you can write notes to caregivers
and send emails to family and friends.
Speech therapy usually begins before you leave the hospital. Once the 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 transesophageal
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 a challenge, but you won't
need any apparatus or additional surgery.
Artificial larynx (AL)
You can learn to use an artificial larynx while you're still in the hospital. With
a little practice, you can communicate immediately with an AL and can even use it
to speak on the telephone.
There are two 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 experimenting 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 nondominant hand to hold the AL so that your dominant hand is free to write or
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 of the resulting voice.
Tracheoesophageal puncture (TEP)
A TEP prosthesis is inserted 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 voice is not 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, often called "Lost Cord" or "Nu-Voice" clubs. You'll find a list
of clubs on the International Association of Laryngectomees website.