Not everyone who goes through treatment for laryngeal cancer will need to have surgery.
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Your care team will do everything they can to preserve as
much of your voice as possible. But if a partial or total removal of your voice
box (larynx) is necessary, the recovery process will include learning to speak
without your vocal cords.
Fortunately, there are effective ways to restore speech
after a laryngectomy, and a speech-language pathologist will be there to
support you along the way.
“With some of the newer speaking prostheses, a lot of people can still communicate with a human-sounding voice – it’s just deeper and a little more guttural sounding,” says otolaryngologist Paul Bryson, MD.
Understanding larynx cancer
The larynx, or voice box, is an organ in your throat that connects
your lungs to your nose and mouth. It plays a function in your speaking,
swallowing and breathing.
Cancer can develop in any of the three distinct parts of the
- Supraglottis: The upper part above the vocal cords.
- Glottis: The vocal cords.
- Subglottis: The part below the vocal cords, right above the trachea.
Prognosis and treatment options depend on where the tumor is
located and how big it is.
“There are always two goals with treatment: to eradicate the cancer and preserve as much of the function of the larynx as possible,” Dr. Bryson says.
If you and your care team decide that the best option is to
remove all or part of your larynx, there are a few things that will happen
during your surgery.
The trachea (windpipe) and the esophagus (food pipe) will be
disconnected, and part or all of the larynx removed. If lymph nodes have been
affected by the cancer, they may also be removed.
During a total laryngectomy, the surgeon will also create a
permanent hole in your neck – a stoma – that will become your new airway.
The surgeon may also perform a primary voice puncture, which
sets the stage for regaining your voice after surgery. (This can also be done
after your laryngectomy). He or she creates a pathway between your windpipe and
esophagus and places a small, one-way valve (voice prosthesis) in it.
As you recover in the hospital and at home, you’ll stay in
close contact with your care team. A speech-language pathologist who
specializes in post-laryngectomy voice rehabilitation will work with you to
adapt or learn one or more of the following ways to communicate:
Voice prosthesis: If you had a voice prosthesis placed during or
after surgery, you will be able to learn tracheoesophageal speech. When you
cover your stoma with your finger as you exhale, air is redirected through the
valve and into your esophagus. Muscle vibrations
in the esophagus will create sound as the air flows through it, and you can
shape that sound with your mouth and tongue. Newer, hands-free prostheses may
make it possible for you to not have to cover the stoma while you speak.
Some kinds of prostheses need to be taken out and cleaned regularly. Others are designed to only be removed by medical professionals and need to be changed every couple of months. Your care team will help you decide on the right prosthesis for you before surgery.
These battery-operated, handheld devices are easy to use, although the sound
produced has a robotic quality. You hold up the device against your neck, and
it turns vibrations into sounds. You can use your tongue and mouth to turn the
sounds into words.
This method of speech is used less often than others. To do it, you learn to
move air down into your esophagus and release it in a controlled way to create
Regardless of which method is best for you, it’s critical to
be engaged in the education process and lean on your loved ones for support. “I
think the patients that do the best are the ones that have supporting family
and friend networks that help them make their appointments and help them make
the transition,” Dr. Bryson says.