A laryngectomy is a surgical procedure that involves the removal of the larynx or voice box. This procedure is often necessary due to conditions such as cancer or severe injury to the larynx. After a laryngectomy, individuals face challenges in communicating effectively as their natural voice is lost. In this article, we’ll take a look at how to best prepare patients, family, and staff to be able to communicate with each other effectively.
Communication Options Following Laryngectomy
The four main communication options for laryngectomy patients are: nonverbal, employing an electrolarynx, using esophageal speech, and using tracheosophageal speech.
Some effective nonverbal communication options include:
- Written communication—In the immediate post-operative setting, written communication can be a valuable tool. A notebook, smartphone, or tablet can be used to share important information or ask questions. Text messaging and email are also effective ways to convey information. Many free apps are available to transform text to speech.
- Voice banking—Consider voice banking before surgery. Voice banking involves recording the patient’s natural voice, which can then be used to synthesize speech in the future, creating a more natural-sounding communication option. This is an especially good option for those patients who may have extended surgeries that impact articulation and future verbal speech.
- Visual aids—Using aids such as picture cards or a communication board can be helpful in conveying specific messages or needs. These aids can be particularly useful in the immediate postoperative period with patients who have limited literacy or those who are physically unable to write.
Anticipating common questions and responses the patient might encounter and being prepared with pre-written or pre-recorded answers can help encourage the best possible nonverbal communication.
Employing an Electrolarynx
One of the primary methods for post-laryngectomy communication is with an electrolarynx. This handheld device produces speech when placed on the neck or with a wand placed in the mouth. Learning to use it effectively takes practice. Here are some tips:
- Placement—Place the device flush against the neck in a location that allows for the best sound conduction or with the wand just inside the lips.
- Pacing—Initiate sound in coordination with phrases and produce short phrases to allow the listener time to process and provide feedback on what is being heard and understood.
- Over-articulation—Increase oral opening and exaggerate lip and tongue movement to maximize speech intelligibility.
Using Esophageal Speech
Esophageal speech is produced at the level of the pharyngoesophageal segment (PES) by inhaling or injecting air into the upper esophagus and then releasing it to produce vibration of the PES. To facilitate success with esophageal voicing, practice increasing phrase lengths and eliminating any secondary behaviors such as stoma blast (air noise produced at stoma), facial grimace, or klunking (noise produced during the injection of air) that the patient produced during voicing.
Using Tracheoesophageal Speech
Tracheoesophageal (TE) speech is produced at the level of the PES using a surgically created puncture and a one-way valve to allow airflow from the lungs through to the upper airway. Achieving a good seal for stoma occlusion, regulating airflow pressure during voicing, and ultimately transitioning to hands-free speech helps to maximize TE speech. Patient selection is key to successful TE speech.
Keys to Successful Communication
Developing effective communication following a laryngectomy takes time and practice. Encourage patience and persistence as your patients work toward effective communication skills.
Be sure to include family, friends and caregivers in the training process. Not only is the patient learning to use their new voice, others are learning to be good listeners. Also, connect your patient with others who have undergone laryngectomies. Support groups offer a platform to share experiences, exchange tips, and learn from others who have gone through similar challenges. Experience is a great teacher.
Effective communication following a laryngectomy is challenging but entirely achievable. With the right tools, resources, and support, individuals can regain their ability to express themselves and engage in meaningful conversations. Whether it’s through esophageal speech, electrolarynx, TE speech, writing, visual aids, or nonverbal communication, there are numerous ways to stay connected and communicate with others. Patience, practice, and a supportive network can make a significant difference in your patient’s journey toward improved communication.
References and Resources
American Speech-Language-Hearing Association (ASHA). (2004). Roles and responsibilities of speech-language pathologists with respect to evaluation and treatment for tracheoesophageal puncture and prosthesis.
Brooks, I. The Laryngectomy Guide.
Doyle, P.C., & Finchem, E.A. (2019). Teaching Esophageal Speech: A Process of Collaborative Instruction. Doyle, P. (eds) Clinical Care and Rehabilitation in Head and Neck Cancer. Springer, Cham.
Graville, D.J., Palmer, A.D., Bolognone, R.K. (2019). Voice Restoration with the Tracheoesophageal Voice Prosthesis: The Current State of the Art. Doyle, P. (eds) Clinical Care and Rehabilitation in Head and Neck Cancer. Springer, Cham.
Kaye R, Tang CG, Sinclair CF. The electrolarynx: voice restoration after total laryngectomy. Med Devices (Auckl). 2017 Jun 21;10:133-140. doi: 10.2147/MDER.S133225. PMID: 28684925; PMCID: PMC5484568.
Lauder, E. Self-Help for the Laryngectomy. https://www.academia.edu/11508367/Self_Help_for_the_Laryngectomee_book
Nagle, K. F. (2019). Elements of clinical training with the electrolarynx. Doyle, P. (eds) Clinical Care and Rehabilitation in Head and Neck Cancer. Springer, Cham.
Tang CG, Sinclair CF. Voice Restoration After Total Laryngectomy. Otolaryngol Clin North Am. 2015 Aug;48(4):687-702. doi: 10.1016/j.otc.2015.04.013. Epub 2015 Jun 18. PMID: 26093944.