Voice Rehabilitation Following Total Laryngectomy
UPMC’s dedicated team of speech-language pathologists is certified and highly trained in laryngectomy rehabilitation . Our experts utilize state-of-the-art diagnostics and treatment procedures to provide patients with the best level of care. The goal of this program is to provide high quality care and education to restore verbal communication and improve quality of life for patients who received a total laryngectomy.
What is a Total Laryngectomy?
Approximately 12,500 new cases of laryngeal cancer are diagnosed every year, making it the most common site for head and neck cancer. Often times with advanced cancers, a total laryngectomy, or surgical removal of the entire larynx (voice box), is required to provide the best option for cure. During the surgery, the entire larynx is removed and the trachea (airway) is completely separated from the nose and mouth and re-directed through a permanent hole in the neck called a stoma.
Anatomical and Physiologic Changes after Total Laryngectomy
The disconnection of the nose and mouth from the lungs results in a number of changes. The following is a list of some of these changes:
- patients will no longer breathe through their noses and mouths and will exhale and inhale air through a hole in the neck.
- patients will not be able to sniff and blow their noses after the procedure
- because the patients cannot sniff, their senses of smell may be diminished
- when the patients sneeze or cough, the air and mucous will come out of their stoma rather than their mouth
- after the removal of the larynx the patient will be unable to talk
Restoring Communication after Surgery:
There are three methods of restoring voice after a total laryngectomy surgery.
1. Electrolaryngeal Voice
An electrolarynx (EL) is a battery-operated electronic device that provides an artificial vibration to replace vibration of the vocal cords. When the device is placed against the skin or in the mouth, it vibrates the tissue and creates an artificial voice while the patient mouths the words to create speech. Electrolaryngeal voice tends to sound more mechanical than a natural voice and there can be occasional mechanical difficulties with the devices. However, the advantages of an electrolarynx are that patients can achieve immediate voice and the devices are low maintenance and can be independently cared for by the patients.
2. Tracheoesophageal Voice
A tracheoesophageal puncture is a surgical procedure that can be completed at the time of the total laryngectomy or anytime after the surgery. The procedure involves a surgical puncture between the airway (trachea) and the food pipe (esophagus). Once the procedure is completed, a voice prosthesis is placed in the puncture tract which allows air from the trachea to move into the esophagus to vibrate a muscle to create voice. To talk, the patient takes a breath, and puts their finger or thumb over their stoma. The sound of the voice is more natural than the electrolaryngeal voice and patients are generally able to use their voice immediately. The voice prostheses needs to be changed on a routine basis and can be maintained by the patient.
3. Esophageal Voice
Esophageal voice involves the patient injecting or swallowing air into the esophagus. Once the patient has forced the air into their esophagus, the air vibrates a muscle and creates esophageal voice. Esophageal voice tends to be difficult to learn and patients are often only able to talk in short phrases with a quiet voice. However, the sound of the voice is more natural compared to the electrolarynx and it does not require purchasing of any devices.
Our speech-language pathology team provides services following a laryngectomy procedures:
Evaluation for a communication method after surgery
- training in electrolaryngeal voice
- training in esophageal voice
- placement of voice prostheses, training in tracheoesophageal voice, training in self-placement of voice prostheses
- advanced management of tracheoesophageal puncture – customizing voice prostheses, management of leaking around voice prostheses, assessment and treatment of cricopharyngeal dysfunction
- training in hands-free devices
- training in stoma care and maintenance
Local support groups
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