Voice Rehabilitation Following Total Laryngectomy

Nearly 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) — provides the best option for cure.

UPMC's speech-language pathologists help people restore their voices and improve their quality of life following total laryngectomy surgery. We use state-of-the-art diagnostics and treatments to provide the best level of care.

About Total Laryngectomy

During total laryngectomy, surgeons:

• Remove the entire larynx
• Completely separate the trachea (airway) from the nose and mouth
• Redirect the trachea through a permanent hole in the neck, called a stoma

The disconnection of the nose and mouth from the lungs results in a number of anatomical changes.

Following surgery, you will be unable to talk or breathe through your nose and mouth. Instead, you will exhale and inhale through the stoma.

You won't be able to sniff or blow your nose, which may decrease your sense of smell. When you sneeze or cough, the air and mucous will come out of your stoma rather than your mouth.

Our Laryngectomy Rehabilitation Services

The speech-language pathology team at UPMC has expert training in laryngectomy rehabilitation.

We offer the following services after laryngectomy surgery:

• Evaluation for a communication method
• Placement of voice prostheses
• Management of leaking around voice prostheses
• Advanced care of tracheoesophageal puncture
• Assessment and treatment of cricopharyngeal dysfunction

We also offer education and training in:

• Electrolaryngeal, tracheoesophageal, or esophageal voice
• Self-placement of voice prostheses
• Hands-free voice devices
• Stoma care and maintenance

Restoring Speech after Surgery

There are three methods of restoring your voice after total laryngectomy surgery:

• Electrolaryngeal voice
• Tracheoesophageal voice
• Esophageal voice

Speech-language pathologists at UPMC's voice rehabilitation program will recommend the best method for you. We'll provide training and work with you to restore your voice as soon as possible.

Electrolaryngeal Voice Device

An electrolarynx is a battery-operated electronic device that provides an artificial vibration to replace vibration of the vocal cords.

When you place the device against the skin or in the mouth, it vibrates the tissue and creates an artificial voice while you mouth the words to create speech.

Disadvantages:

• Sounds more mechanical than one's natural voice
• Has occasional mechanical difficulties

Advantages:

• You can use your voice right away
• Low maintenance; you can care for it independently

Tracheoesophageal Voice Prosthesis

A tracheoesophageal puncture is a procedure that surgeons can complete during total laryngectomy or any time after surgery.

The procedure involves:

• Making a surgical puncture between the airway (trachea) and the food pipe (esophagus)
• Placing a voice prosthesis in the puncture tract — the prosthesis allows air from the trachea to move into the esophagus and vibrate a muscle to create voice

To talk, you take a breath and put your finger or thumb over your stoma.

Disadvantages:

• Involves more maintenance than electrolaryngeal voice devices
• Requires you to change it on a routine basis

Advantages:

• Most people can use their voice right away
• Sounds more natural than the electrolaryngeal voice

Esophageal Voice

Esophageal voice involves you injecting or swallowing air into the esophagus. Once you force the air into your esophagus, the air vibrates a muscle and creates esophageal voice.

Disadvantages:

• Can be hard to learn
• Often, you can only speak short phrases in a quiet voice

Advantages:

• Sounds more natural than the electrolaryngeal voice
• Does not require you to purchase and maintain a device

Make an Appointment with a Speech-Language Pathologist

To make an appointment or learn more about speech-language pathology services at UPMC:

• Call University Ear, Nose, & Throat Specialists (Oakland) at 412-647-6461
• Email the UPMC Division of Speech-Language Pathology at divisionofspeech@upmc.edu