Alaryngeal voice rehabilitation therapy provides functional means of communicating verbally following complete removal of the larynx (voice box). Each year, 10,000-12,000 individuals in the United States are diagnosed with cancer of the larynx. Cases that are detected early are usually treated successfully with radiation therapy, or a combination of radiation and chemotherapy. Those that are more advanced, however, often require complete removal of the voice box and its surrounding structures. This procedure is referred to as a total laryngectomy and renders patients aphonic, or unable to create voice. In addition, the connection between the upper airway (mouth, nose and throat) and the lower airway (trachea and lungs) is lost. As a result, these patients breathe through permanent holes in their necks, known as tracheostomas. Approximately 3,000 individuals undergo a total laryngectomy each year.
Laryngeal cancer is relatively rare, as is the procedure for complete removal of the larynx. It is therefore extremely important that initial postoperative care and rehabilitation be performed by a team of knowledgeable and experienced speech pathologists in conjunction with your head and neck surgeon.
Preoperative Counseling
Alaryngeal voice rehabilitation requires a team approach and begins before surgery in the form of preoperative counseling that involves both a head and neck surgeon and speech pathologist specializing in alaryngeal voice rehabilitation. Patients meet individually with these specialists to learn about postoperative anatomical changes and alaryngeal voice rehabilitation options, to determine which voice rehabilitation option is best and to be educated about the postoperative phase of treatment.
Rehabilitation Options
The three different methods to regain speech following total laryngectomy include:
- An electrolarynx, or electronic speech aid, an external device placed on the neck to provide an electronic sound source which can be shaped into speech by moving different parts of the mouth. An electrolarynx is recommended for all individuals undergoing total laryngectomy, as either a primary or secondary communication option.
- TracheoEsophageal Puncture (TEP) speech, which utilizes a tiny, surgically created opening between the trachea and the esophagus to allow for placement of a small voice prosthesis equipped with a one-way valve. This valve allows exhaled air to pass from the trachea into the esophagus to vibrate muscles and prevents swallowed food and liquid from entering the lungs. TEP speech is by far the preferred method for speaking after a total laryngectomy, and is a viable option for most patients undergoing this surgery.
- Esophageal speech, akin to speaking with a belch, is a learned technique whereby air is swallowed and then brought back up to vibrate in the throat in order to create a sound source that can be shaped into speech. Functional esophageal speech is achieved by approximately 30 percent of patients.
Postoperative Rehabilitation
Immediately following surgery, patients are cared for by specially trained nurses and followed closely by their surgeons. Our speech pathologists are on hand to provide information and training regarding use of an electrolarynx and Humidification Moisture Exchange (HME) system, which helps to filter, warm and humidify air through the stoma, as the mouth and nose are no longer connected to the lungs. Patients also receive a postoperative laryngectomy kit that contains supplies, samples and literature for the rehabilitation process.
Once discharged, patients attend weekly therapy sessions for several months to learn how to care for their tracheostoma and voice prosthesis and speak once again. Once the rehabilitation process is complete, patients return for routine follow-up appointments every three-six months, depending on their specific needs.
