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Removing the larynx removes the voice and separates the airway from the mouth permanently. Speech is restored in most people by a one-way valve set in a small hole between the windpipe and the gullet, which lets breath out through the throat so the throat can vibrate. The valve is a consumable that needs replacing, and people who lose contact with the service stop using it.
Total laryngectomy leaves a person breathing through a stoma in the neck, with no connection between the lungs and the mouth. Three ways of producing speech exist. Tracheoesophageal speech uses a small silicone one-way valve, a voice prosthesis, placed through a puncture between the back wall of the trachea and the front wall of the oesophagus: covering the stoma diverts exhaled air through the valve into the pharynx, which vibrates. Oesophageal speech swallows air and belches it back in a controlled way, which needs no device but is harder to learn. An electrolarynx is a handheld vibrator held against the neck.
The prosthesis is described in the literature as the most effective method, and it is the one most services fit, but it is a device with a life cycle rather than an operation with a result. Its commonest failure is biofilm growth, mostly Candida, which stops the valve closing and causes leakage during drinking; the device is then changed. A controlled in vitro and clinical pilot in 34 patients cultured every removed prosthesis and found Pseudomonas aeruginosa, Staphylococcus aureus and Candida species the most frequent colonisers.
Abandonment is the outcome that matters and is rarely reported. A retrospective cohort of 41 patients at an urban safety-net hospital examined which factors were associated with giving up the prosthesis and returning to writing or oesophageal speech. Three were significant: radiotherapy before the laryngectomy (p equals 0.018), greater distance from the hospital (p equals 0.017), and homelessness or incarceration (p equals 0.043). Insurance coverage of supplies, area deprivation index and substance use were not. The authors' own reading is that long-term voice rehabilitation is an access problem.
Swallowing after laryngectomy is a separate problem from voice and has randomised evidence. A trial randomised 92 patients having total laryngectomy for stage III and IV laryngeal cancer to five targeted swallowing exercises for three months starting two weeks after surgery, with weekly therapy sessions, or to referral for swallowing treatment afterwards as needed. There was no difference immediately after surgery on the Functional Oral Intake Scale or the eating in public and normalcy of diet subscales, and the exercise group scored significantly better at three, six, nine and twelve months.
What comes back, and when: a voice, usually within weeks of the puncture healing, and it is intelligible rather than normal. What does not come back is smell, because air no longer passes through the nose, nose-blowing, and the ability to swim. Heat and moisture exchange filters worn over the stoma restore some of the humidification the nose used to do and are a daily consumable.
Speech needs a vibrating source and a resonating tract. The larynx supplies the source; the pharynx and mouth supply the resonance and the articulation, and those survive the operation. Every method of restoring voice is a way of getting air or vibration back into a tract that still works, which is why intelligibility is achievable and a normal voice is not.
Query for this technology: (TITLE:"Voice after the larynx is removed" OR ABSTRACT:"Voice after the larynx is removed") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Voice after the larynx is removed, not a curated reading list.
Shares Head and neck reconstruction: the free flap, and what it gives back, The devices that do the restoring, and who pays for them, Cancer rehabilitation: the discipline that puts function back, Patients lack understanding, navigation and agency and the tags rejuvenation, survivorship, rehabilitation.
Shares Where rehabilitation is commissioned, and who misses out, Cancer rehabilitation: the discipline that puts function back, Patients lack understanding, navigation and agency, Quality of life and the tags rejuvenation, survivorship, rehabilitation.
Shares Head and neck reconstruction: the free flap, and what it gives back, The devices that do the restoring, and who pays for them, Cancer rehabilitation: the discipline that puts function back, Quality of life and the tags rejuvenation, survivorship, rehabilitation.
Shares Head and neck reconstruction: the free flap, and what it gives back, Swallowing therapy around head and neck radiotherapy, Cancer rehabilitation: the discipline that puts function back, Quality of life and the tags rejuvenation, survivorship, rehabilitation.
Shares Where rehabilitation is commissioned, and who misses out, Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, rehabilitation.
Shares Where rehabilitation is commissioned, and who misses out, Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, rehabilitation.
Shares The devices that do the restoring, and who pays for them, Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, rehabilitation.
Shares Cancer rehabilitation: the discipline that puts function back, Patients lack understanding, navigation and agency, Quality of life, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, rehabilitation.