A total laryngectomy is a surgical procedure performed in advanced stages of cancer in or near the voice box. Undergoing a total laryngectomy can be an overwhelming experience, but realize that you are not alone. There are more than 100,000 people worldwide that have undergone the same operation and it is possible to return to a good life.
A total laryngectomy is a surgery during which the voice box, called larynx, is taken out. After a laryngectomy, breathing happens via an opening in the neck (a stoma) instead of the nose and mouth.
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 even possible to enjoy scents and flavors again.
The larynx plays several important roles. 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 breathing, swallowing and smelling.
Your new voice
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 Pathologist to learn to speak again.
There are basically three voicing methods that can be learned after surgery: esophageal voice, electrolarynx and tracheoesophageal voice.
Tracheoesophageal voice 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.
To achieve tracheoesophageal speech (in short: TE speech), a voice prosthesis is placed in a small opening between your trachea and espophagus (sometimes call the windpipe and food tube).
This technique can often be acquired rather soon after the operation and is relatively easy to learn.
You may also be given an electronic device called an electrolarynx. This is a device when placed against your neck and a button is pressed, it generates an external vibrating sound that serves as your voice.
Finally, you may also learn esophageal speech, where you learn a strategy to inject air into the esophagus to cause a vibration and a controlled way to produce sound.
The functions of your nose
Your nose does more than just smell – it heats, humidifies and filters the air your 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 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 mucus. This results in increased coughing (like you have a cold) and your windpipe can feel irritated.
Heat and Moisture Exchangers (HMEs) like the Provox XtraHME have been developed to compensate for the functions of your nose. They help to rebalance the ‘climate’ in your lungs. They are designed to be worn day and night in front of your stoma and help to maintain the heat and humidity of the air you breathe in, which can help normalize mucus production and decrease coughing. Because of this, HMEs are very important and also help you to occlude the stoma for speaking.
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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.
The freedom of hands-free speech
During the past few 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.