Q&A before the operation

Should I have a voice prosthesis inserted during my laryngectomy?

If it is technically and medically possible to insert a voice prosthesis during the laryngectomy, then there are many advantages to doing so. Speech is usually possible days after the operation and without the need for tedious practicing, which is greatly aided by the fact that the talking and breathing rhythm has not changed. Plus important conditions can be created during the laryngectomy to ensure that speaking with the voice prosthesis works well. If the voice prosthesis is inserted later, it will usually require another anesthetic.

When will I be able to speak with the voice prosthesis for the first time after the operation?

Most of the wound should have healed before you start your speech therapy. This usually takes 7-10 days. If you had radiation treatment before the operation, this may significantly delay healing.

How is the voice produced with the voice prosthesis, and what does it sound like?

The actual voice prosthesis cannot produce a sound. It is simply a non-return valve between the air and wind pipes, and closes the connection between them when you swallow. When the tracheostoma is closed with a finger, air flows through the valve into the food pipe and then into the pharynx. The sound for talking is produced by vibration of the mucosal folds in the pharynx, which are caused to oscillate by the inflowing air - a little bit like burping. The frequency of these vibrations is generally low, and depends on the tension in the mucosal folds. The vibrations are then formed into words in the mouth, just as the vibrations from the larynx were before it was removed. The pitch of the prosthetic voice tends to be low and rough, which female larngectomees may find unpleasant. In some patients, the prosthetic voice is much better than the one the patient had with the tumorous larynx.

Prosthetic voice (video)

Are there any alternatives to a voice prosthesis?

There are three main alternatives to a voice prosthesis: a surgical laryngoplasty, the esophageal speech, and the electronic larynx.

Laryngoplasty is an complicated surgical procedure in which a canal is constructed, during the laryngectomy, of skin and muscle flaps taken from the lower arm to create a permanent connection between the air and food pipes. The advantage of the laryngoplasty is that a voice prosthesis will never be required. The disadvantages are that it is a really difficult procedure, and there is often an unpleasant odor when speaking because of the bacterial breakdown of skin deposits in the artificial canal. There are only very few clinics that offer laryngoplasties. The voice produced after a laryngoplasty is exactly the same as the prosthetic voice.

Esophageal speech works without any technical aids, without an esophagotracheal fistula and without having to close the tracheostoma. This means the patient is mostly independent of medical support. Air is swallowed and "burped" up in a controlled manner. This creates oscillations of the pharyngeal membrane that are shaped into words in the mouth. Learning to use this type of speech is much more difficult than talking with a voice prosthesis. It usually requires at least 50 sessions with a speech therapist before the first signs of success are evident. Furthermore, the ructus voice will usually only produce short sentences of a few words and in a very striking speech pattern. Most patients are unable to learn to command the ructus voice well enough to make themselves understood.

The electronic larynx does not require surgical intervention either, or an esophagotracheal fistula or for the tracheostoma to be closed for speech to be produced. An electrolarynx is an electronically operated unit that looks a lot like an electric razor. Its vibrating head is held right against the against the neck, usually just below the lower jaw. Pressing a button on the machine makes it vibrate. This vibration is transferred to the mouth, where the mucous membranes start to vibrate. The resulting sound can be formed into words by moving the mouth and tongue. The electrolarynx is really an emergency solution if other techniques are not suitable, because the voice produced by the electrolarynx sounds quite metallic and somewhat odd. The speaker can only be understood if the person listening is used to the sound. Nor do the oscillations always transfer well from the neck to the mouth; it is a technique that requires practice.

Electrolarynx (Video)

Who pays for the voice prosthesis?

Voice prostheses are aids that are paid for by the health insurance fund in many countries. The patient's health fund is contacted to find out about payment conditions.

Do I have to look after the voice prosthesis myself?

Yes, mostly. A voice prosthesis should be checked once a day in front of a mirror and cleaned if necessary. The further maintenance depends on the type of prosthesis (indwelling or non indwelling concept). 

Which voice prosthesis is the best?

There is no best voice prosthesis. There are over 20 different designs and types of voice prosthesis, and they all have their advantages and disadvantages. A thorough knowledge of the various models will enable your doctor to choose the right one for you.

Can the insertion of the voice prosthesis be reversed?

Yes. If the voice prosthesis is removed, the esophagotracheal fistula will close by itself in many cases. Occasionally minor surgery is required to close it.