Loss of speech and voice restoration after a laryngectomy
Not being able to speak is a great loss for anyone who has had a laryngectomy. It can take time for you, your family and your friends to adjust to this change.
There are several methods to help you to produce sound and learn to speak again. At least two-thirds of people who have a laryngectomy are able to use a voice prosthesis or oesophageal speech. Some people can go back to jobs that involve a lot of talking - for example, telephone operators and salespeople.
A speech and language therapist will usually visit you before your operation to discuss the different ways of communicating. You may be able to meet someone who has had similar surgery or watch videos of people talking after they’ve had a laryngectomy. Some people find this very helpful, while others prefer to have written information.
The method of speech you can use will depend on:
the type of surgery you have
your individual circumstances
what you prefer.
During the laryngectomy operation, a channel (tract) is made through the wall between the windpipe and the gullet (oesophagus). This tract can be used after your operation for enteral feeding.
After a few days, a voice prosthesis is inserted into the channel. When you breathe out and cover the laryngectomy stoma with a thumb or finger, air from the lungs passes through the prosthesis and vibrates in your gullet to produce a voice. As with normal speech, movements of your lips, cheeks and tongue shape the sound into words.
The voice prosthesis has a valve that prevents food and fluids from passing into the windpipe. It may take a while to learn how to speak with a voice prosthesis. The voice can sound quite natural, although in women it’s usually a lower pitch than before the operation.
There are several types of valve including Blom-Singer®, Groningen® and Provox® valves. Some types are completely within the laryngectomy stoma and are known as in-dwelling valves. They need to be changed by a doctor, speech and language therapist or nurse. Others (ex-dwelling) have a strap outside the stoma and can be changed by you or your carer.
There are advantages and disadvantages of each type, and your doctor, specialist nurse or speech and language therapist should discuss these with you.
Another method is a technique known as oesophageal speech. As soon as you have recovered from a laryngectomy, you can be taught this technique. Air is squeezed into the gullet from the mouth. As the air moves up from the gullet, it vibrates and can be used to produce a voice. Movements of the lips, cheeks and tongue shape the sound into words.
Some people find it easy to make oesophageal speech or use a voice prosthesis, but others find it more difficult. It’s usually best to practise little and often. A speech and language therapist can help you have the best speech as comfortably as possible. They will also help you to use your new way of talking for social situations and on the telephone.
Several types of electronic aids are available to help produce a voice. While you are in hospital you may be given one to use while you practise developing your new voice. You may choose to use it as your main way of communicating. The electronic devices are held next to the neck under the chin and make sound vibrations that can be formed into speech. Your speech and language therapist will help you choose the type that suits you best. They will show you how to use it and look after it.
To use an aid properly, or to have good oesophageal speech, you’ll need training from a speech and language therapist. It takes plenty of practise, but it’s well worth the effort.
Most people with a laryngectomy can learn to speak effectively using one of the techniques above. Some people also like to use electronic keyboards (like small typewriters) to communicate. Mini-laptops or text messaging on your mobile phone can be another good method. Several different types of writing device are available. Your speech and language therapist can show you these.