VOCAL REHABILITATION AFTER TOTAL LARYNGECTOMY

📌 Overview: After total laryngectomy, the patient loses speech completely. The goal of rehabilitation is to establish a new method of communication.

Methods of Communication
Written Language (Pen & Paper) Aphonic Lip Speech (+ Sign Language) Oesophageal Speech Electrolarynx Transoral Pneumatic Device Tracheo-Oesophageal (TEP) Speech:   - Blom-Singer Prosthesis   - Panje Prosthesis

1. Oesophageal Speech

This is a physiological method where the oesophagus acts as the air reservoir.

• Mechanism: Patient is taught to swallow air, hold it in the upper oesophagus, and slowly eject it into the pharynx.
• Capacity: Can speak 6–10 words before reswallowing air.
• Voice Quality: Rough but loud and understandable.

2. Artificial Larynx

Used in patients who fail to learn oesophageal speech.

A. Electrolarynx

• Transistorized, battery-operated portable device.
• Action: Vibrating disc is held against soft tissues of the neck.
• Sound: Low-pitched sound produced in hypopharynx → Modulated into speech by tongue, lips, teeth, and palate.

B. Transoral Pneumatic Device

• Uses expired air from the tracheostome.
• Mechanism: Air vibrates a rubber diaphragm → vibrations carried by plastic tube to back of oral cavity → converted to speech.

3. Tracheo-Oesophageal Speech (TEP)

Currently a very popular method.

• Principle: Shunting air from the Trachea → Oesophagus/Hypopharynx.
• Mechanism: The vibrating column of air entering the pharynx is modulated into speech.
• Old Method: Skin-lined fistula (Problem: Food entering trachea).
• Modern Method (Prosthesis): usage of Blom-Singer or Panje prosthesis.

⭐ Key Feature of Prosthesis: They have Inbuilt One-Way Valves. This allows air to flow up for speech but prevents food/liquid aspiration into the trachea.