Voice prosthesis after laryngectomy

A voice prosthesis is a 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 after having surgery to remove the larynx (laryngectomy). 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 a 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. 

How do 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 catheter in the hole until the area has healed. Once the area has healed and you are eating and drinking, your doctor takes the catheter out. They then put a small, one way valve into the hole. The one way valve stops food, fluids, and saliva from going into the windpipe.

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 cover your stoma with your fingers so that the air goes through the valve and not out of the stoma. You might also hear this called surgical voice restoration. 

Once you can use this type of voice prosthesis, you might be able to use other types of valves which are hands free. They automatically close the stoma when you are using your speaking valve. This means 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. Your speech and language therapist and doctor can tell you more about this.

Voice prosthesis valves

The main types of valves used in the UK include: 

• Blom-Singer valve

• Provox valve

Some valves are external. This means they are meant to be taken out to be cleaned. Most people can manage to look after these valves themselves.

It is important your valve is kept clean. If it gets blocked, air can't pass through it easily and you won't be able to speak. Your speech and language therapist and nurse show 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.

Some valves are left 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 valve needs changing. 

Your speech therapists and healthcare team make sure you know what to do if you have problems. For example, if you think you have an infection or if your valve falls out. They will let 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. This can be caused by acid indigestion. Your doctor or specialist nurse can prescribe anti indigestion medicines if you have this problem.