A Basic Explanation
Laryngectomy (surgery to remove the larynx (voice box)) changes
the structures of the head and neck area permanently.
Following surgery a laryngectomee (a person who has undergone a
laryngectomy) will probably have a tracheostomy tube in place to
make breathing easier.
The may have a feeding tube in place together with some drains
in the neck area.
Immediately following surgery there will be no voice and patients
generally ‘mouth’ words or write down what they wish
to say – so pen and paper or a ‘magic slate’ (e.g.
magna doodle) are important things you should take into hospital
“Ok for me but not everyone
could understand and I was repeating myself”
“I never actually used mouthing,
I was more comfortable writing down although this was very inconvenient”
“Find it easy and people understand
what I say.”
“Can only use silent articulation
when quiet unless people can lip read”
“Got frustrated at times as
you can’t argue”
“This was my preferred method
for the first two weeks until I was able to use oesophageal speech”
“Found I couldn’t write
as quick as I thought and ended up missing out words and spelling
Once healing is complete, eating and drinking should be unaffected.
However smell and taste may be affected as will coughing and sneezing.
Post operative radiotherapy may be necessary where disease is extensive,
or where there is disease recurrence.
Time permitting, most patients are offered the opportunity to meet
with a laryngectomee prior to surgery or at a later time if that
suits them better.
Breathing occurs by inhaling air through the
mouth and/or nose which then passes down into the lungs via
pharynx. The pharynx is found at the back of the mouth and
this area is also used when eating and drinking i.e. food
and liquid passes from the mouth into the pharynx and into
the oesophagus (food pipe) before entering the stomach.
In normal speech inhaled air then leaves the lungs, travels
along the trachea (windpipe) up through the larynx (voice
box) and vocal folds which vibrate and produce voice.
This picture shows that the larynx has now
been removed and there is a tracheostoma “stoma”
(hole) which is developed during surgery. Basically, this
consists of a small opening in the neck which is formed when
the trachea (windpipe) is stitched to the neck during the
operation. At this point you can see that there is no longer
a connection between your mouth and nose and the lungs. The
pharynx is no longer a shared area and at this stage is used
primarily when eating or drinking. You will now breathe in
and out through the stoma located in your neck and because
air is no longer breathed in, warmed and filtered through
the nose you will have to permanently protect this area by
This speech aid can be used very soon after surgery. Mouth
pieces can be attached and be placed near a patient’s
lips or the device can be held firmly and directly against
a cheek or the neck. It looks very simple to use but requires
a great deal of practice in the first instance. Placement
of the device, on-off co-ordination of buttons, pausing, articulation
and the rate and loudness of speech all have to be considered.
“Found it easy, but had
to get used to taking my finger off the button so people cold
“Unable to use due to
being unable to find a place to place it on my neck to make
“Could not get it in
the right place to talk – my son put me off by calling
me Darth Vader”
“Works quite well”
The air supplied for oesophageal voice may be taken in by
one of two techniques: injection or inhalation. The residue
of air in the mouth is passed backwards through the muscle
fibres at upper part of the oesophagus (food pipe) and is
returned back passed these muscle fibres causing them to vibrate
and produce noise which is then shaped into specific sounds
by the teeth, lips and tongue. This is often referred to as
talking on burps and although it is not the same as a burp
the sensation of air moving up the oesophagus is similar.
This sound is then worked on and ‘shaped’ to become
more refined but this does take practice. Care should be taken
that there isn’t an increase in air from the stoma.
A speech and language therapist will be available to guide
you through this technique.
“This is my method of
communication. I find it very easyto use and have no problem
other than occasionally it fails for short periods”
“In my opinion this is
the best method to use if possible”
“I’m just getting
used to doing it when with the family”
Surgical Voice Restoration
This involves further surgery. A small puncture allows a prosthesis
to be fitted at the back of the stoma and allows air expired
from the lungs to be shunted back into the oesophagus up through
the pharynx and out through the mouth. To achieve this, an
airtight seal must be made and the stoma has to be occluded
(covered over). This can be by the thumb or with the use of
manufactured devices e.g. HME (heat and moisture exchange
system). Again a speech and language therapist will be on
hand to guide you through this process.
“Not been fitted yet”
“Unable to have one fitted
due to my neck being too short.”
“It’s great. Feels
back to normal.”
“Just cannot shout which
is yuk – like to make myself heard”
– don’t want one”
All images supplied courtesy and copyright of InHealth Technologies