Removal of the voice box (larynx) alters voice, respiration, and swallowing. The inability to speak usually imposes the most significant problems (Figure 1 and Figure 2). Voice rehabilitation is critical to the prevention of psychosocial and economic consequences.
Esophageal voice was for many years the method of choice for speech. Air is injected or inhaled into the esophagus and immediately expelled, which sets the surfaces of the throat into vibration (Figure 3). This method usually takes months to learn and the acquisition of good to superior esophageal voice is infrequent. Many people use an electrolarynx with which speech is usually rapidly acquired (Figure 4). This handheld device produces an electronic sound which enters the throat by holding a vibrating element against the neck tissue. The electrolarynx successfully gives speech to many laryngectomy patients, but has an electronic-sounding voice.
A third method of post-laryngectomy voice restoration emerged with the pioneering of the tracheoesophageal puncture by Mark I. Singer, M.D., and Eric D. Blom, Ph.D. in 1980 (Figure 5). This technique is simple, reproducible, and has a high rate of success.
In this method, a small opening is made through the windpipe into the esophagus. The resultant tracheoesophageal tract is readily visible and allows for easy insertion of a removable silicone valve. This valve effectively prevents closure of the puncture, protects the airway during swallowing, and allows lung air to be directed into the throat for voice production. [More info]
CENTA is respected as the leading center in the world for voice restoration following total laryngectomy. Drs. Freeman, Huntley, Krowiak, and Rigas construct the surgical opening for the voice prosthesis either simultaneous with the removal of the larynx or as a secondary surgery. Dr. Blom fits the voice prosthesis approximately one week following surgery and provides 4-5 therapy sessions to achieve, in many cases, near normal speech.
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