The ability to speak is a complex procedure that involves several parts of the body. These include the mouth, the articulators (tongue, teeth, hard palate, soft palate, lips), the respiratory system and the brain. Sometimes, people may experience trauma that affect their ability to speak appropriately. Examples of this include a cardiovascular accident (CVA or stroke) or head and neck cancer. When the trauma is severe and speech is severely affected, SLPs and doctors may opt to remove the larynx. The larynx, commonly known as the voice box, houses the vocal folds giving us the ability to speak. Once the larynx is removed, our ability to speak is impaired. However, there are alternative approaches to speaking once the larynx is removed.
The first is esophageal speech (ES),which is when air is inhaled into the pharyngoesophageal (PE) segment and then expelled into the esophagus. This expulsion brings the PE tissue into vibration thus creating voice. Although it is not implemented frequently, it is essential for SLPs to have an understanding of ES. It can be taught in two different ways: injection and inhalation. The injection method prepares the patient for ES by producing voiceless sounds, attempting esophageal phonation and demonstrations of ES by the SLP. In this stage, the patient gains phonatory skills with ES, such as precision and speed. In the inhalation method, air intake and esophageal phonation are improved. In order for the best results, it is best to teach the inhalation method in conjunction with the injection method.
The second option is the electrolarynx, which involves the use of an external instrument placed against the throat or oral structures. The electrolarynx can also be placed in the oral cavity to facilitate speaking. The electrolarynx falls under the category of an artificial larynx (AL), which is what most patients who undergo a laryngectomy prefer postoperatively. Clinicians recommend using an AL in the immediate days following surgery.
The third and last option is tracheoesophageal (TEP) voice restoration surgery. The surgery can either be performed during the time of the laryngectomy or after surgery. A puncture is made to the posterior wall of the trachea through the anterior wall of the esophagus. Prosthesis is inserted into the puncture and shunts air from the lungs into the esophagus. This causes the upper esophageal sphincter and surrounding tissues to vibrate, thus the sound for voice is created. The pulmonary air is essentially forced to eject through the esophagus. The patient first practices phonation with single words, then phrases. It is important to note that the patient breathing effort remains the same as it did preoperatively.
Overall, all 3 forms of alaryngeal speech are alternative modes to communication after a laryngectomy. AL requires an external instrument for communication while ES and TEP rely on supplementary structures to communicate (i.e. esophagus, pharynx, articulators). ES and TEP are similar since the esophagus is the main mode of communication however; TEP is the only form of alaryngeal speech that requires additional surgery, which is usually done during the time of the laryngectomy.
-Ashley E. M.A, CF-SLP