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A Basic Explanation

Laryngectomy (surgery to remove the larynx (voice box)) changes the structures of the head and neck area permanently.

Following surgery a laryngectomee (a person who has undergone a laryngectomy) will probably have a tracheostomy tube in place to make breathing easier.

The may have a feeding tube in place together with some drains in the neck area.

Immediately following surgery there will be no voice and patients generally ‘mouth’ words or write down what they wish to say – so pen and paper or a ‘magic slate’ (e.g. magna doodle) are important things you should take into hospital with you.

Mouthing

“Quite good”

“Ok for me but not everyone could understand and I was repeating myself”

“I never actually used mouthing, I was more comfortable writing down although this was very inconvenient”

“Find it easy and people understand what I say.”

“Can only use silent articulation when quiet unless people can lip read”

Writing

“Got frustrated at times as you can’t argue”

“This was my preferred method for the first two weeks until I was able to use oesophageal speech”

“Found I couldn’t write as quick as I thought and ended up missing out words and spelling things wrong”

Once healing is complete, eating and drinking should be unaffected. However smell and taste may be affected as will coughing and sneezing.

Post operative radiotherapy may be necessary where disease is extensive, or where there is disease recurrence.

Time permitting, most patients are offered the opportunity to meet with a laryngectomee prior to surgery or at a later time if that suits them better.

Breathing occurs by inhaling air through the mouth and/or nose which then passes down into the lungs via pharynx. The pharynx is found at the back of the mouth and this area is also used when eating and drinking i.e. food and liquid passes from the mouth into the pharynx and into the oesophagus (food pipe) before entering the stomach.

In normal speech inhaled air then leaves the lungs, travels along the trachea (windpipe) up through the larynx (voice box) and vocal folds which vibrate and produce voice.

   

This picture shows that the larynx has now been removed and there is a tracheostoma “stoma” (hole) which is developed during surgery. Basically, this consists of a small opening in the neck which is formed when the trachea (windpipe) is stitched to the neck during the operation. At this point you can see that there is no longer a connection between your mouth and nose and the lungs. The pharynx is no longer a shared area and at this stage is used primarily when eating or drinking. You will now breathe in and out through the stoma located in your neck and because air is no longer breathed in, warmed and filtered through the nose you will have to permanently protect this area by various means.

   

Artificial Larynx e.g. Servox
This speech aid can be used very soon after surgery. Mouth pieces can be attached and be placed near a patient’s lips or the device can be held firmly and directly against a cheek or the neck. It looks very simple to use but requires a great deal of practice in the first instance. Placement of the device, on-off co-ordination of buttons, pausing, articulation and the rate and loudness of speech all have to be considered.

“Found it easy, but had to get used to taking my finger off the button so people cold understand me”

“Unable to use due to being unable to find a place to place it on my neck to make it work”

“Could not get it in the right place to talk – my son put me off by calling me Darth Vader”

“Works quite well”

   

Oesophageal Voice
The air supplied for oesophageal voice may be taken in by one of two techniques: injection or inhalation. The residue of air in the mouth is passed backwards through the muscle fibres at upper part of the oesophagus (food pipe) and is returned back passed these muscle fibres causing them to vibrate and produce noise which is then shaped into specific sounds by the teeth, lips and tongue. This is often referred to as talking on burps and although it is not the same as a burp the sensation of air moving up the oesophagus is similar. This sound is then worked on and ‘shaped’ to become more refined but this does take practice. Care should be taken that there isn’t an increase in air from the stoma. A speech and language therapist will be available to guide you through this technique.

“Poor”

“This is my method of communication. I find it very easyto use and have no problem other than occasionally it fails for short periods”

“In my opinion this is the best method to use if possible”

“I’m just getting used to doing it when with the family”

   

Surgical Voice Restoration
This involves further surgery. A small puncture allows a prosthesis to be fitted at the back of the stoma and allows air expired from the lungs to be shunted back into the oesophagus up through the pharynx and out through the mouth. To achieve this, an airtight seal must be made and the stoma has to be occluded (covered over). This can be by the thumb or with the use of manufactured devices e.g. HME (heat and moisture exchange system). Again a speech and language therapist will be on hand to guide you through this process.

“Not been fitted yet”

“Unable to have one fitted due to my neck being too short.”

“It’s great. Feels back to normal.”

“Just cannot shout which is yuk – like to make myself heard”

“Not fitted – don’t want one”

All images supplied courtesy and copyright of InHealth Technologies Inc.

 
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