Speech After Total Laryngectomy

Li Liu, MD
Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
I was recently diagnosed with throat cancer and scheduled for a total laryngectomy. Will I be able to speak again after my voice box is removed?
J.

Li Liu, MD, OncoLink Editorial Assistant, responds:

Dear J,
Thank you for your interest and question.

Total laryngectomy (TL) involves a complete removal of the larynx (voice box) including the vocal cords that normally produce speech sounds. In order to communicate, you'll have to learn an entire new type of speech. Currently there are three types of speech for patients who have TL, electrolarynx, esophageal speech, and tracheoesophageal speech.

The electrolarynx is a hand-held device about the size of a small electric shaver that has a vibrating plastic diaphragm on the top and a small button on the side. When you speak, you place the diaphragm against the neck and push the button. The vibration from tongue, palate, and throat will transmit to the diaphragm and produce a "voice." With some practice, the speech from an electrolarynx can be very clear and easily understood.

In esophageal speech, the sound is produced by vibrations in the esophagus and pharynx. The individual swallows air and then allows it to escape in a controlled fashion. As the air escapes it causes the walls of the esophagus to vibrate. This produces a sound, which can then be articulated by the mouth and lips to produce speech.

In tracheoesophageal speech, a small opening called a fistula is created between the trachea and the esophagus. A small valved tube is placed into the opening or fistula to produce sound and to prevent aspiration of food and liquid into the trachea. In order to talk, the stoma must be covered with one's thumb during exhalation.

You should discuss speech rehabilitation after TL with your surgeon and perhaps a speech pathologist.