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Communication post-total laryngectomy


The larynx which is also known as Voicebox is situated in the neck region and majorly functions for breathing, speaking, and also protecting itself while swallowing.


What is laryngectomy?


Laryngectomy is the removal of part or all of the larynx (voice box).

In partial laryngectomy, only a part of the larynx is removed. It is usually performed for small cancers of the larynx.

In total laryngectomy, the entire larynx is removed. You will no longer be able to speak in the way you did. It is usually performed due to extensive cancerous lesions of the larynx or severe trauma due to gunshot wounds and other injuries.



laryngectomy before and after diagram

What are the different options available to communicate post laryngectomy?


Communication post total laryngectomy is a challenge for many patients. There are different ways to communicate post total laryngectomy like

  • TEP speech,

  • Esophageal speech,

  • Electrolarynx, etc.


People with throat or voice box cancers who lose their ability to speak following the removal of their larynx (voice box) can learn to produce near-natural-sounding speech by inserting a prosthesis called Tracheoesophageal Prosthesis (TEP prosthesis).


What is TEP Speech or TEP surgery?


It is the most common voice method used by laryngectomees. This surgery requires the installation of a tracheoesophageal prosthesis (TEP). Tracheoesophageal puncture or TEP surgery is often done at the same time as total laryngectomy surgery (Primary Insertion), although it can be done months or years later (Secondary Insertion). Tracheoesophageal speech is considered a gold standard in post-laryngectomy communication.


What is a Stoma?


During a total laryngectomy, the larynx is removed, and the connection between your windpipe (trachea) and mouth is severed. The bottom half of the windpipe is rotated forward and connected to the skin, creating a permanent opening for breathing called a stoma.


throat diagram before and after laryngectomy


What is a Stomal Opening?


During the TEP medical procedure, a surgeon creates a small hole about the size of a pencil eraser in the wall between your trachea and your esophagus, the tube that moves food from your mouth to your stomach. A small one-way valve, called a tracheoesophageal voice prosthesis, is placed inside the hole to direct air into the throat.


tracheoesophageal voice prosthesis

Tracheoesophageal puncture (TEP) INSITU

 Tracheoesophageal puncture (TEP) INSITU


Can someone speak post-total laryngectomy?


Since the vocal cords are completely removed during total laryngectomy surgery, your sound source is lost. TEP surgery with a prosthesis creates a path for air to move from your lungs to the esophagus. This air causes the top of the esophagus to vibrate -- producing a new tracheoesophageal voice.


How does a speech-language pathologist help?


A trained Speech-Language Pathologist guides an individual post insertion of TEP on how to close the stoma as one needs to occlude the stoma to speak. Closing of the stoma with the thumb gives appropriate closure to the stoma and also helps in protecting it from air leaks.


In secondary TEP insertion, before insertion, one should get tested for an air-insufflation test to see whether the patient is suitable for TEP speech. Post-primary TEP insertion one should wait for 2 weeks to start practicing TEP speech whereas in Secondary TEP practicing speech can be started on the next day after surgery.


How frequently is TEP replaced?


Usually every year one should get their TEPs replaced in a daycare procedure for most patients. If there is any leak, one should get tested for that and get a change of prosthesis. If one has leaked and doesn’t get it changed food can enter the airway which causes Aspiration Pneumonia.


What are the advantages of TEP speech?


It generates the most intelligible, fluent, natural-sounding voice in contrast to other alaryngeal speech methods.

While using a TEP, we rely on pulmonary air for speech production, rather than the limited air supply available in esophageal speech. This leads to increased fluency and longer utterance lengths.


What are the disadvantages of TEP speech?


  • It requires continuous care and maintenance. The patient has to clean and care for the TEP daily, and the prosthesis needs to be replaced at regular intervals.

  • Those who rely on the speech and language pathologist (SLP) for TEP changes may have to be seen in the clinic on average every two to three months.

  • Furthermore, patients with stricture or narrowing of the upper esophageal sphincter region may not be able to achieve good voice.

  • Tracheoesophageal prosthesis lasts only a limited period of time and requires repeated replacements. They require continuous maintenance by the laryngectomee to achieve optimal speaking abilities and prevent fluid leakage from the esophagus to the trachea because of the buildup of biofilm by yeast and bacteria. Extending the lifespan of the TEP can reduce the medical expenses associated with its replacement.


Is there swallowing difficulty post total laryngectomy?


A post-surgery patient will be put up on alternate nutrition for 2 weeks post which the patient will be given test feeds to check for leaks. If there are no leaks an individual can have normal foods orally slowly progressing with consistency.

Patients with total laryngectomy usually complain of food sticking in the throat when evaluated instrumentally reveals oesophageal stricture.



How to take care of Stoma?


1. Regular cleaning of the prosthesis and maintaining it clean using the brush provided with the TEP set.

2. Blocking of the prosthesis can lead to reduced loudness of voice.

3. Proper closure of the stoma with a wet damp cotton cloth is necessary to protect the airway from entering dust.

4. Use of a Lary tube on advice is recommended to maintain stoma as narrowing stoma can lead to breathing difficulty which can lead to an emergency and may also lead to attending a surgery called “Stomoplasty”.


Are other communication options available post total laryngectomy?


Yes. Everyone may not fit for TEP due to various reasons. Few other options are also available.

1. A few of them are Electro-Larynx (Also known as Artificial larynx, Artificial voice box, or Laryngectomy speaking device) is placed on the neck region and produces electrical voice because of the coupling effect. The spot will be identified by a Trained Speech-Language Pathologist and gives training to the patients for further use. This Voice box device is often a recommended choice for many patients.


2. Another option widely used is Esophageal speech (also known as Burp Talking) in which one needs to swallow air and release it to produce voice. A trained Speech-Language Pathologist can teach how to use esophageal speech. If you compare Esophageal speech and TEP speech, TEP is a preferred choice for patients because it sounds perceptually normal.


Esophageal speech (also known as Burp Talking)

Why Sounderic?


This always doesn’t need face-to-face sessions. You can get trained to use TEP speech online from your home under the guidance of a trained Speech-Language Pathologist. SLP helps you identify the most appropriate mode of communication post laryngectomy. SLP trains on how to close the stoma, how to coordinate the breath, clean and maintain TEP prosthesis, etc., Most people find it easy to learn and get trained in 6 to 10 sessions. Accessories provided with the prosthesis make it easy to maintain the prosthesis and keep it clean and hygienic.




 

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