A total laryngectomy is a surgical procedure performed in advanced stages of cancer in or near the voice box.
During the surgery, the voice box known as the ‘larynx’ is taken out. After a laryngectomy, breathing happens via an opening in the neck instead of the nose and mouth.
Over 100,000 people worldwide are currently living with a laryngectomy and with today’s medical advances it is possible to return to a good life. Undergoing a total laryngectomy can be an overwhelming experience, but we want you to know that you are not alone.
It is a life-changing event, but it is possible to enjoy life again after a total laryngectomy. Coughing can be reduced to a minimum, you can learn to speak again and it is possible to enjoy scents and flavours again.
A laryngectomy does not come without consequences, and the voice box plays several important roles within the body, not just talking. It houses the vocal folds that make our voice sound. The larynx also helps us breathe and swallow. Therefore, removal of the voice box not only leads to changes in the voice, but also changes in for example breathing, swallowing, and smelling.
There are many things possible to people who have had a laryngectomy such as hands-free speech, returning to being physically active through sports and regaining a good social life.
After the operation you will most likely work with your Speech Language Therapist to learn to speak again.
Speaking following a Laryngectomy…
Our voice expresses our thoughts and feelings. In fact, it is a large part of our identity. Losing your natural voice can have a large impact on your ability to communicate. The good news is that there are several new ways of making a voice again. After the operation you will most likely work with your Speech Language Therapist (SLT) to learn to speak again.
There are basically three voicing methods that can be learned after surgery: oesophageal voice, electrolarynx, and tracheoesophageal voice (TE speech).
TE speech is the most common speaking method and considered to be the most successful. It creates the most natural sounding, fluent and easiest to understand kind of voice. In order to achieve TE speech, a voice prosthesis is placed in a small opening between your windpipe and food tube. The technique is usually learnt quickly and easily with help of the SLT.
You may also be given an electronic device called an electrolarynx. That is a device you place on your neck and when you press a button it generates an electronic sound that serves as your voice.
Finally, you may also learn oesophageal speech. This kind of speech requires that you swallow small amounts of air from your mouth into your food tube and “belch” the air up.
Can you still use your nose?
Your nose does more than just smell – it heats, humidifies, and filters the air you breathe.
That way, when the air reaches your lungs it has reached body temperature and contains the level of moisture needed for the lungs to function properly.
After the operation you breathe through the stoma in your neck so these heat and moisture functions of the nose are lost. Breathing through an open stoma causes the temperature and humidity in your lungs to drop. The lungs react to this by producing more mucous. This results in you having to cough more (like you have a cold) and your windpipe can feel irritated.
Heat and Moisture Exchangers (HMEs) help you to compensate for the functions of your nose. They help to rebalance the ‘climate’ in your lungs. They are worn day and night in front of your stoma and they help to maintain the heat and humidity of the air you breathe in. That way the mucous production normalizes and coughing decreases. HMEs are very important and also help you to occlude the stoma for speaking.
The freedom of hands-free speech
During the past years, one of the key areas of development has been hands-free speech. Special devices and attachments have been developed that make it possible to use the voice prosthesis without having to occlude the stoma by hand.
Smelling after laryngectomy...
The other important function of your nose is that it allows you to smell. After the operation you do not breathe in via the nose, so you will not smell automatically as you did before. Instead, you can learn to use a special technique called the NAIM (Nasal Airflow Inducing Maneuver) to get air into your nose and smell.