NYU Langone doctors and speech and swallowing therapists provide several options for restoring the voice after a laryngectomy, which is the full removal of the larynx to manage hypopharyngeal cancer.
These options include placement of a voice prosthesis, esophageal voicing, and an artificial larynx, also known as an electrolarynx.
Tracheoesophageal Voice Prosthesis
To restore speaking ability in people who have had a laryngectomy, NYU Langone doctors may use a tracheoesophageal voice prosthesis. This usually provides the best voice quality when compared to other voice restoration methods.
Either during the laryngectomy or in a separate surgery, surgeons insert a prosthesis, a small valve-like device, into the upper part of the trachea and connect it to the esophagus, which is alongside the trachea.
To speak, a person takes a breath, covers a stoma—a small, surgically created opening from the trachea that leads to the outside of the neck—with a finger or a small plastic valve, and exhales. This causes air to flow through the prosthesis into the esophagus. This airflow makes the top of the esophagus vibrate, creating sound that the mouth shapes into words.
This method of voice production can begin only after all the surgical incisions are well healed.
The sound a voice prosthesis produces can be somewhat hoarse. NYU Langone speech therapists help people learn how to speak using a voice prosthesis. They can also teach you how to care for it.
Another voice restoration option is an artificial larynx, also known as an electrolarynx. To use it, a person holds the small, portable, battery-operated device directly on the neck, under the chin, when he or she wants to speak.
When you push a button on the device, the electrolarynx produces a vibration that is transferred through the skin into the throat. You shape this sound into words with the mouth, tongue, lips, and teeth.
The sound an electrolarynx produces has an electronic quality, but it is generally easy for others to understand. Speech therapists can teach you how to use the device as a primary means of communication or as a backup to one of the other options.
Esophageal speech involves learning to push air with the mouth into the esophagus and then back out again, causing the upper esophagus to vibrate and make a sound. This sound gets shaped into words by the mouth, lips, tongue, and teeth. Esophageal speech usually creates a rough, hoarse sound.
This technique does not require additional surgery or devices, but learning how to produce esophageal speech takes practice. Speech therapists can help you learn how to speak using this method.
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