Booklet: What You Need to Know about Laryngeal Cancer

Learning To Speak Again

It's natural to be fearful and upset if the voice box must be removed. Talking is part of nearly everything we do, and losing the ability to talk--even temporarily--can be frightening. Patients and their families and friends need understanding and support during this very difficult time.

Until patients learn to talk again, it is important for them to be able to communicate in other ways. In the beginning, everyone who has had a laryngectomy has to communicate by writing, gesturing, or pointing to pictures, words, or letters. Some people like to use a "magic slate" for writing notes. Others use pads of paper and pens or pencils. It's handy to have a supply of pads that fit easily in a pocket or purse. In addition, some patients use a typewriter or computer. Others carry a small dictionary or a picture book (sometimes called a picture dictionary) and point to the words they need. Patients may want to select some of these items before the operation.

Within a week or so after a partial laryngectomy, most people can talk in the usual way. After a total laryngectomy, patients must learn to speak in a new way. A speech pathologist usually meets with the patient before surgery to explain the methods that can be used. In many cases, speech lessons can begin before the person leaves the hospital.

Patients may try out various new ways of talking. One way is to use air forced into the esophagus to produce the new voice (esophageal speech). Or the voice can come from some type of mechanical larynx. Some people rely on a mechanical larynx only until they learn esophageal speech, some decide to use this device instead of esophageal speech, and some use both.

Even though esophageal speech may sound low-pitched and gruff, many people want to use this method instead of a mechanical larynx because it sounds more like regular speech. Also, there's nothing to carry around, and the person's hands are free. A speech pathologist teaches the laryngectomee how to force air into the top of the esophagus and then push it out again. The puff of air is like a burp. It vibrates the walls of the throat, producing sound for the new voice. The tongue, lips, and teeth form words as the sound passes through the mouth.

For some laryngectomees, air for esophageal speech comes through a tracheoesophageal puncture. The surgeon creates a small opening between the trachea and the esophagus. A plastic or silicone valve is inserted into this opening through the stoma. The valve keeps food out of the trachea. When the stoma is covered, air from the lungs is forced into the esophagus through the valve. The air produces sound by making the walls of the throat vibrate. Words are formed in the mouth.

It takes practice and patience to learn esophageal speech, and not everyone is successful. How quickly a person learns, how natural the new voice sounds, and how understandable the speech is depend partly on the type and extent of the surgery. Other important factors are the patient's desire to learn and the help that's available. Patience and support from loved ones are important, too.

A mechanical larynx may be used until the person learns esophageal speech or if esophageal speech is too difficult. The device may be powered by batteries (electrolarynx) or by air (pneumatic larynx). The speech pathologist can help the patient choose a device and learn to use it.

One kind of electrolarynx looks like a small flashlight. It has a disk that makes a humming sound. The device is held against the neck, and the sound travels through the neck to the mouth. (This device may not be suitable for people who have had radiation therapy.) Another type of electrolarynx has a flexible plastic tube that carries sound to the person's mouth from a hand-held device.

A pneumatic larynx is held over the stoma and uses air from the lungs instead of batteries to make it vibrate. The sound it makes travels to the mouth through a plastic tube.

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