The most common surgery used for the treatment of throat cancer is a total laryngectomy. In this operation, the larynx (and with it the vocal chords etc.) is removed completely. After this, the end of the trachea is sewn onto the edge of an opening cut out at the lower part of the neck, creating a breathing hole similar to that used by a whale. This hole is called tracheostoma and permits the patient to breathe through it after the operation.
The air goes from outside through the tracheostoma directly to the lungs without passing the upper respiratory organs of nose, mouth and throat. Because of that, speech is seriously impaired and the development of an oesophageal voice is thereby necessary.
The oesophageal voice is thus produced without an artificial larynx and achieved by learning to pump air from the mouth into the upper oesophagus. The oesophagus is slightly expanded. Then the air is released in a regulated manner and goes back to the mouth with simultaneous articulation of words.
The oesophageal speech is quieter and more strenuous than ‘normal speech’. Not so many words can be produced successively. Good oesophageal speakers can produce an average of 5 words per breath and 120 words per minute.
Because of the large, vibrating pharyngo-oesophageal segment, the pitch of oesophageal speech is very low; between 50 and 100 Hz. In oesophageal speech, pitch and intensity correlate: a low-pitched voice is produced with low intensity and a high-pitched voice is produced with high intensity. The production of the latter is more exhausting.
The voice of a speaker without a larynx sounds as if he or she has a cold.
Another option for restoring speech to the laryngectomy is the tracheoesophageal puncture or TEP. In this simple surgical procedure, a small puncture is made between the trachea and the esophagus, and a one-way air valve is inserted. This air supply can be used to cause vibrations in a similar manner to oesophageal speech. This surigical procedure may occur during the laryngectomy (primary TEP) or after a period of time (secondary TEP). The prosthesis is placed approximately 10-14 days post operation by a certified speech language pathologist (SLP) who specializes in ENT work. During the placement of a prosthesis, the SLP measures the depth of the puncture, choses the correct prosthesis and inserts it with a loading device (the entire process can occur in 30-45 minutes pending complications). Patients return to be resized every few months after surgery. When the puncture site stops changing sizes, then a more permanent prosthesis can be placed that will last approximatley 6-12 months (indwelling prosthesis). Patients may choose this route, in which case they will return to the SLP for placement every 6-12 months, or may choose a low pressure, or duckbill prosthesis that they can change independently at home every few months. This option has become increasingly populary in the past 10 years as in many cases intelligible voicing may be achieved within minutes of placement of the prosthesis. Esophageal and electrolaryngeal speech (speech with an electrolarynx) may take weeks or months of training to achieve functional voicing).
An electrolarynx is a handheld device which is held against the throat, and provides vibrations to allow speech. Electrolarynges may be used immediately post surgery with an oral adapter (the neck being too tender immediately post surgery).