Laryngectomy

Also called Total laryngectomy, Voice box removal, Alaryngeal speech, Neck breather

Speaking after the voice box is removed: the valve, the electrolarynx and oesophageal speech, and what each sounds like and asks of the person.

What it is

A laryngectomy is the surgical removal of the larynx, the voice box, usually to treat head and neck cancer. After a total laryngectomy the person breathes through a permanent opening in the neck, a stoma, and air no longer passes through the mouth or nose. The vocal folds are gone, so the natural voice is gone with them.

Speech is not. There are three established ways to produce a new voice, and most people learn at least one. Language, understanding and the person's way of putting things are exactly as they were. Only the sound source has changed.

Who it can help

Anyone facing a laryngectomy, before the operation if at all possible, and anyone living after one. Their families, and the staff on wards and in care homes who may never have met a neck breather and need to know that a person who can't call out still needs to be heard.

It's not a guide to the cancer or the surgery. And it doesn't apply to a tracheostomy, where the larynx stays and speech may return once the tube allows it.

How it works

The commonest method in the UK is the voice prosthesis: a small one-way valve fitted between the windpipe and the gullet during or after surgery. The person covers the stoma with a finger or a hands-free valve, air is diverted up into the gullet, and the tissue there vibrates to make a voice. It's low-pitched and slightly rough, but fluent and immediate, and most people are talking within days. The valve needs cleaning and periodic replacement by a specialist nurse or therapist.

The electrolarynx is a hand-held device pressed to the neck or cheek that vibrates the tissue while the person mouths the words. The voice is mechanical and needs practice to phrase well, but it works from the first week, needs no surgery and is the backup when the valve is out of action.

Oesophageal speech is the oldest method: swallowing air into the gullet and releasing it in controlled bursts to make a voice. It takes months to learn and gives short phrases, but needs no equipment at all. Some people master it and prefer it.

Whichever method, the voice is quiet and breath support is different, so a personal amplifier helps in noise. Text-to-speech on a phone covers the phone itself, which is the hardest environment.

Getting started

Before surgery, ask to meet the speech and language therapist and a laryngectomee visitor from the local club, so you've heard each voice and know what to expect. Decide with the team about a primary valve at surgery.

After surgery, practise the chosen method daily, little and often. Set up a text-to-speech app and a whiteboard for the first weeks, and put a Relay UK app on the phone. Carry a card explaining that you're a neck breather; it matters in an emergency.

In a care home or on a ward, make sure the call bell is reachable and that staff know a shout won't be coming.

Where to get help

The National Association of Laryngectomee Clubs links the local clubs, which are the best source of lived experience and visitor support before and after surgery. Speech and language therapy is part of every head and neck cancer team and continues after discharge; the RCSLT explains the profession. Macmillan Cancer Support covers the cancer side and the practicalities of living after it.