Tracheoesophageal speech: vocal rehabilitation after total laryngectomy

Treatment of laryngeal cancer has evolved over nearly 100 years and includes many methods to conserve the function of speech. It was understood from the inception of total laryngectomy that diversion of exhaled pulmonary air into the pharynx or esophagus would produce satisfactory speech. The effect on safe deglutition of the phonatory fistulae limited the wide applicability of these techniques. The introduction of a silicone bivalve device for use in a tracheoesophageal tunnel permits large numbers of laryngectomees to use tracheoesophageal speech. Acoustic, intelligibility, and aerodynamic studies are described for four laryngectomees and reveal that this method more nearly approximates normal laryngeal speech than conventional esophageal speech. The criteria for contemporary treatment of laryngeal carcinoma are not altered by this rehabilitative method, and expected survival rates are not likely to be affected. The findings and analysis of this method of alaryngeal speech rehabilitation may have important implications for future therapy of laryngeal carcinoma.