Laryngectomy

A laryngectomy is the surgical removal of the larynx (voice box). Most laryngectomies are performed on individuals who have cancer of the larynx. Laryngectomies may also be performed as a measure to help people breathe.

When the larynx is removed, there is no longer a connection between the mouth and the lungs. Consequently, individuals who undergo a laryngectomy breath, cough, and sneeze through an opening in their neck (called a "stoma") created during surgery.

In general, the individual continues to swallow food and liquid through the mouth as they did before surgery.

Effects on Voice

When a laryngectomy is performed, the greatest loss is often the loss of voice. In normal speech, the voice is the sound produced by the larynx. Sound travels up to the mouth, where the sounds needed for speech are formed. When an individual undergoes a laryngectomy, the source for voice is lost. However, the ability to coordinate the lips, tongue, and palate (for speech) is unaffected by surgery.

Role of the Speech-Language Therapist

The main role of the Speech-Language Therapist, in working with individuals who have undergone a laryngectomy, is to help the individual speak again using an alternative source of sound. There are three main methods in which this is done:

• Oesophageal speech: the individual learns to squeeze air down into the oesophagus (food tube) and then bring it up again in a controlled fashion, causing the muscles at the top of the the oesophagus to vibrate and produce sound for speech.
• Tracheo-oesophageal prothesis: a valve is inserted between holes in the tracea (wind pipe) and oesophagus, allowing air to pass from the lungs to the oesophagus. The valve is one-way, and does not allow food to pass from the oesophagus to the lungs. When the patient breathes out and covers the stoma with a finger or valve, air is forced through the muscles at the top of the the oesophagus, which then vibrate, producing a sound source that can be used for speech.
• Electro-larynx: a small instrument that makes a noise when you press a button. If this instrument is held firmly against the neck, or through a tube into the mouth, the sound can be delivered to the lips, tongue, and palate to produce speech.

What you can do

There are a number of "dos" and "don'ts" for communicating with an individual who has undergone a laryngectomy. These include the following:

• understand the person's need to express their feelings
• be patient and wait for the person to talk
• allow the person to speak for themselves
• encourage the person to practice any speech exercises for short but frequent periods
• encourage the person to speak slowly
• help the person to keep active with friends
• find out about mouth to neck resuscitation
• do not overprotect the person
• do not anticipate the person's needs
• do not speak for the person
• do not "nag" the person to practice
• do not encourage whispering
• try not to expose the person to dust, smoke, fumes, or extremes of temperature

More Information

For more information about laryngectomy, or to contact a Speech-Language Therapist, try contacting one of the following:

• your doctor
• your local hospital
• the Yellow Pages
• Massey University Speech-Language Therapy Clinic: (09) 414 0800 ext 41290 / 41277
• the University of Auckland Speech-Language Therapy Clinics: (09) 303 5979
• the University of Canterbury Speech and Hearing Clinic: (03) 364 2408
• the NZSTA Private Practice Register

Other sources of information may be:

• your local hospital's Ear Nose and Throat clinic
• Cancer Society of New Zealand

admin@cancer.org.nz

(04) 494 7270

http://www.cancer.org.nz/