Voice prosthesis after laryngectomy

A voice prosthesis is the most common way to restore speech after surgery. After surgery to remove the whole of your voice box (total laryngectomy), you are no longer able to speak in the normal way. But there are different ways you can communicate and learn to speak again.

Types of communication

The type of communication you have after a total laryngectomy depends on:

• your situation
• the type and amount of surgery you had
• your preferences

Before surgery, you discuss the different ways you can use to communicate with your doctor and speech and language therapist.

A voice prosthesis, or tracheo oesophageal puncture (TEP) is a common type of communication. But there are other ways, such as oesophageal speech or electrolarynx.

What is a voice prosthesis (tracheo oesophageal puncture or TEP)?

Tracheo oesophageal puncture (TEP) is the most common way to restore speech after surgery to remove your larynx (laryngectomy). But it is not suitable for everyone.

You usually have TEP as part of your laryngectomy operation. Or you can go back for a minor operation to have it done later. This is usually at least 8 weeks after your laryngectomy.

How you have TEP

Your surgeon makes a tiny hole called a fistula at the back of your stoma. The hole creates an opening between your windpipe and food pipe (oesophagus).

Your surgeon might put a tube (catheter) into the hole to keep it open. Or they might put a small valve (voice prosthesis) into the hole during the operation.

You keep the cathether in the hole until the area has healed. You might be able to have liquid food down the tube during this time. Once the area has healed and you are eating and drinking, your doctor takes the catheter out. And puts a small, one way valve into the hole.

If you don't have a catheter put into the hole, you have a feeding tube down your nose (nasogastric tube) for a while.

People who have TEP some time after their laryngectomy, need the catheter to be in place only for a few days. Or you might have the valve (voice prosthesis) put in straight away.

Using a voice prosthesis

The voice prosthesis is a valve that allows you to make sounds by pushing air from your lungs through the valve and up into your mouth. You have to cover your stoma with your fingers so that the air goes through the valve and not out of the stoma.

Once you can use this type of voice prosthesis, you might be able to use other types of valve which are hands free. They automatically close the stoma when you are using your speaking valve. So you won't have to put your hand up to cover the hole when you want to say anything. But hands free valves are not suitable for everyone.

Using a voice prosthesis takes practice. Your speech therapist will help you.

After a while, the muscles deep in your throat grow stronger and vibrate more easily as the air passes through. When you have got used to it, you might be surprised at how well you can be understood.

Voice prosthesis valves

• Blom-Singer valve
• Provox valve
• Groningen valve

Blom-Singer valves and some Provox valves are external valves. This means they are meant to be taken out to be cleaned. Many people look after these valves themselves.

Your valve must be kept clean. If it gets blocked, air can't pass through it easily and you won't be able to speak. Your nurse shows you how to take out the valve, clean it and put it back. You can practice this until you are confident enough to do it on your own.

Groningen and some types of Provox valves are internal valves. You leave them in place until they need changing. This is about every 6 months, or sooner if they are leaking. A specially trained therapist, doctor or nurse must change them. They can do this during your follow up appointments.

Sometimes you might need to switch from one type of valve to another if your needs change.Your medical team makes sure you know what to do if your valve falls out and that you know who to contact for advice.

Difficulty speaking

Occasionally people have difficulty speaking with a speech valve in place. This is usually because the muscles in their pharynx go into spasm. Your speech and language therapist can help you to try and overcome this spasm. Your surgeon might also suggest a treatment to inject some botulinum toxin (Botox) into the muscle to relax it.

Sometimes the problem with speech is caused by swelling of the area around the valve, caused by acid indigestion. Your doctor or specialist nurse can prescribe anti indigestion medicines if you have this problem.