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, or voice box, to manage laryngeal cancer.
These options include a voice prosthesis, esophageal voicing, and an artificial larynx, also known as an electrolarynx. Voice restoration is usually provided after all treatments for laryngeal cancer are complete.
These procedures typically aren’t necessary in people with early laryngeal cancer.
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 compared to other voice restoration methods.
At the time of laryngectomy or during a separate surgery, surgeons insert a prosthesis, a small valve-like device, into the upper part of the trachea and connect it to the adjacent esophagus, the muscular tube that carries food from the mouth to the stomach.
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. The voice produced has a generally rough, hoarse quality.
This method of voice production cannot begin until the surgical incisions are well healed.
Speech therapists can help you 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. This small, battery-operated device is placed directly on the neck, under the chin, when you want to speak.
When you push a button on the device, the electrolarynx produces a vibration that is transferred through the skin to the throat. You shape this sound into words with the mouth, tongue, lips, and teeth.
The sound created by an electrolarynx has an electronic quality, but it can be well understood. 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 is shaped into words by the mouth, lips, tongue, and teeth.
Esophageal speech usually creates a rough, hoarse sound. This method does not require additional surgery or devices, but learning how to produce esophageal speech takes practice. NYU Langone speech therapists can teach you how to speak using this method.
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