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 a way of restoring speech after a laryngectomy.

You can have TEP at the same time as your laryngectomy operation. Or you can have a minor operation at a later time.

How do you have TEP?

Your surgeon makes a small hole called a fistula to create an opening between your windpipe (trachea) and food pipe (oesophagus).

A valve, called a voice prosthesis is placed into the hole during the operation. This is a one way valve. This means it stops food, fluids, and saliva from going into the windpipe.

Using a voice prosthesis

The voice prosthesis allows you to make a voice 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. 

It will take a lot of practice, and you will need time to build up your confidence speaking with the prosthesis. During this time, you will have a lot of help and support from your speech and language therapist. 

Once you can use this type of voice prosthesis, you might be able to use one that is hands free. They automatically close the stoma when you use your speaking valve. This means you won't have to put your hand up to cover the hole when you want to say anything. 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

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 look after the valve. And will help you until you are confident enough to do it on your own.

You and your family and friends will have a lot of help and support from your speech and language therapist and nurses while you learn how to do this. They also 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.

Help and support

It can take time to learn to speak with a voice prosthesis. Your speech and language therapist and health care team provide help and support and can talk to you about concerns you might have while you learn new ways to speak.