SPEAKING AGAIN

One of the most important things both for the laryngectomee and his family, and for the team looking after him, is to re-establish a communication system as soon and as easily as possible. We use the term "communication" rather than speech as there are many ways of communicating - speech is just one of them. In the early days, writing,gesture,etc., may be the most appropriate but soon we    need something more.

Let us look at the normal way of producing voice. We need a source of air, a vibrating source, lips, tongue and palate (articulators) to shape the sound into words.

Before a laryngectomy

• the source of air is the lungs
• the vibrating source is vocal cords

After a laryngectomy,for oesophageal speech

• the source of air is the oesophagus
• the vibrating source is muscle fibres in the wall of the upper oesophagus/pharynx(PE segment)

In both instances, the articulators are the same-that is why the accent, dialect and the mannerisms of your speech do not change. You will see that after the operation there is no connection between the lungs and the mouth. It is obviously an advantage to have the lungs as the source of air, rather than the small amount whivh can be held in the oesophagus. This gives the possibility of greater power (volume) and length of sentence. It is this which is the principle behind S.V.R., surgical voice restoration - see below, in which a connection is made between the windpipe and the oesophagus and a small device is fitted to shunt the air, This prostheses doe not make sound - it simply re-routes the air.

There are various communication options open to us:

• writing,gesture,mouthing
• oesophageal speech
• 'artificial larynx'/electronic devices
• tracheo-oesophageal - puncture speech
• S.V.R. - 'Blom-Singer' type prostheses

Oesophageal voice

The air from the lungs goes directly to the stoma, and cannot make its way to the mouth at all.

Since it is the mouth-lips,tongue,palate-that shapes the sound into the words, we must find another resource of air which can pass to the mouth. This must be the oesophagus (gullet).

Learning pesophageal speech means learning to take air into the upper part of the oesophagus, then bringing it back causing a small segment of muscle fibres to vibrate as it returns, to produce a sound. To develop such a new skill takes time, although to some it comes quite easily and quickly.

Surgical voice restoration
(T.E.Puncture Speech. e.g. Blom-Singer)

Increasingly, nowadays patients are being offered Blom-Singer or similar prostheses. The descision as to whether it is appropriate must be made by the surgeon; it is not suitable for everyone. The procedure may be done at the time of laryngectomy or may be done later.

Artificial larynges (larynxes)
This covers the various types of electronic devices, etc., which can be used to produce sound. There are two main types.

1. Intra-oral.These feed the sound directly into the mouth by a small tube.

2. Neck placed.These are held against the neck and transmit sound through the tissues. They are not appropriate immediately post-operatively or if the tissues are hard as a result of radiotherapy.
With both types the user articulates in the normal way.

This is a rapidly developing field so types and models are constantly changing. Never buy an artficial larynx without advice and a chance to try various models.

Read "What makes speech?"  by Glenn Peters, MD

See Resource Section

---

Return to:   HOME PAGE

Back to top of page