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Methods of Voice Restoration

The inability to speak is usually the most distressing problem confronting the laryngectomy patient. Today, many choices are available to help restore speech. Rapid, effective rehabilitation, particularly speech, is critical to avoid the psychological, social, and economic consequences frequently experienced by the laryngectomee and his/her family. The larynx (voice box), is the organ in the throat responsible for voice production and for preventing food from entering the airway during swallowing. It lies between the pharynx (upper part of the airway) and the trachea (windpipe), forming part of the tube in the throat that carries air to and from the lungs. One function is to prevent choking. When a person is not eating or drinking, the epiglottis stays upright, keeping the larynx open as part of the airway to the lungs. As soon as swallowing begins the epiglottis drops like a lid of the larynx, directing food over to the esophagus (food pipe). A second function of the larynx is voice production. Air from the lungs passes over the vocal cords resulting in vibrations which are modified by the tongue, palate, and lips to produce speech.

  • A. Tongue press to inject air into esophagus
  • B. Air enters esophagus
  • C. Air released from esophagus to produce voice
  • D. Voice shaped into speech
ESOPHAGEAL SPEECH
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ARTIFICIAL LARNYX
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When the larynx is removed (laryngectomy), the top of the trachea immediately below the larynx is attached to a permanent opening (stoma) made in the throat. The patient will then breathe through the stoma. With persistence, the laryngectomee can learn from a speech therapist new ways of speaking, either by esophageal speech where air is injected, then expelled in a controlled way to form voice, or by using a speaking aid device known as an electrolarynx. This device emits a vibrating noise and is hand-held against the throat. By mouthing words, the laryngectomee converts the vibrations to speech. Today, advances in medical technology enable speech production by means of a voice prosthesis. By creating a small surgical passage (TEP, or Tracheoesophageal Puncture), inside the stoma, from the back wall of the trachea into the esophageal wall, a small one-inched valved tube (voice prosthesis) can be placed into this passage to enable tracheoesophageal speech.

STOMA OCCLUSION WITH THUMB
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ADJUSTABLE TRACHEOSTOMA
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Voice is produced by blocking the stoma, either with a finger or an adjustable tracheostoma valve, so that exhaled air from the lungs can be directed from the trachea through the prosthesis into the esophagus (where vibrations are produced) and then out through the mouth. Fluent, conversational speech is usually acquired within a few days. Blom-Singer voice prostheses have set the standard in postlaryngectomy voice restoration since 1979. Drs. Blom and Singer continue to introduce innovative procedures and medical devices allowing thousands of patients worldwide to regain their ability to speak.