LARYNGECTOMY REHABILITATION

Early stage cancers of the larynx, or “voicebox”, are typically treated through surgery, radiation therapy, chemotherapy, or a combination of the above.  Advanced cancers may result in removal of the entire larynx, also known as total laryngectomy.  Removal of the larynx can alter respiration/breathing, voice, and swallowing with profound functional and psychosocial impact on the patient.  It is critical that voice restoration be established quickly after surgery.  Options for restoration of voice following laryngectomy include use of an electrolarynx (an electronic speech aid), esophageal speech, and tracheoesophageal speech.

• Electrolarynx – An electrolarynx or “artificial” larynx usually consists of a hand-held electronic or pneumatic device.  Sound is produced by the device, which transmits the sound to the vocal tract by introducing a small tube into the mouth or by placing the device on the side of the throat.  A limitation of the electrolarynx is the mechanical quality of the sound that is produced. 
• Esophageal speech – Air is injected into the upper esophagus, and then released in a way to create sound.  Although still occasionally used, one of the limitations of esophageal speech is the effort required to learn this method, along with the number of air injections required to produce fluent speech.    
• Tracheoesophageal speech – The current “state of the art” method of voice restoration following laryngectomy is through the tracheoesophageal puncture procedure.  A small hole is created surgically between the trachea (breathing tube) and esophagus (stomach tube). Following creation of the hole, a small plastic tube, the tracheoesophageal voice prosthesis, is placed into the puncture.  This one-way valve allows for air to flow from the trachea into the throat, which creates sound through the vibration of muscles.  This sound is then modified into a speaking voice.