Voice Training Speech Therapy for the Laryngectomee

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Speech Therapy Voice Training For The Laryngectomee

Speech Therapy Voice Training For The Laryngectomee

Voice training is done to find an appropriate source of sound production that can be articulated for communication purposes.

Criteria for selecting sound source include:

degree of tissue loss

esophageal stenosis

physical limitations of the patient

noise level of the patient's environment

motivation level

patient's preference of sound source

Types Of Sound Source

There are mainly three types of sound source a patient can choose from.
1. External man-made prosthesis, or artificial larynx.
2. Sphincter-like junction of the pharynx and esophagus, or esophageal speech.
3. A surgically implanted device, or transesophageal puncture and silicon prosthesis.

Artificial Larynx

The principle of artificial larynx is to have an external mechanical sound source that is substituted for the larynx. Anatomic structures for articulation and resonance are most of the time unaltered.

There are two general types of electrolarynges that are available:
neck type and intraoral type.
1. The neck type is placed flush to the skin on the side of the neck, under the chin, or on the cheek. Sound is conducted via the oropharynx and is articulated normally.
2. The intraoral type is used for patients that can't conduct sound through skin adequately. A small tube is placed toward the posterior oral cavity, and the produced sound is then articulated. The tube has little effect on articulatory accuracy if the patient is taught properly and learns to use it well.

The advantage of artificial larynx is:

voice is restored after surgery immediately

maintenance of the hardware is minimal

The disadvantage, however, is:

the quality of sound may seem mechanical

Esophageal Speech

The principle behind voice training using esophageal speech is that air is of greater pressure in one chamber (oral cavity) will flow to a chamber containing less pressure (esophagus), if these chambers are connected.

Goals of esophageal speech include:

to be able to phonate upon demand

use a rapid method of air intake

short latency between air intake and phonation

produce four to nine syllables per air charge

achieve a speaking rate of 85-129 words per minute

attain good speech intelligibility

There are mainly three methods of esophageal speech.
1. Injection is a method where air in the mouth/nose is compressed by lingual or labial movement and is injected into the esophagus.
2. Swallowing method uses air that enters during oral opening when swallowing. The air is used to produce voice.
3. Inhalation method maintains a patent airway between the nose, lips and esophagus. The stoma is used for inhalation. Air enters the esophagus when the pharyngoesophageal muscle is relaxed during inhalation.

The advantages of this kind of speech include:

no external devices

natural sounding speech

there is a possibility of pitch and loudness control

Disadvantages on the other hand are:

there is reduced length of utterance

it is hard to learn and requires good articulation

Transesophageal Speech

This is another approach to voice restoration. It requires a surgical/prosthesis procedure that makes use of a man-made device inserted into a surgically created midline transesophageal fistula.

Air is conducted from the trachea to the esophagus through the prosthesis to excite the pharyngoesophageal segment for voice training and production.

Advantages include:

rapid restoration

natural sound

normal utterance length

hands-free, minimal maintenance

intelligible tonal language.

Disadvantages are:

the need for surgery

puncture stenosis

candida growth

aspiration of foreign objects