Question

Rehabilitation After Removal Of The Voice Box!

Dr.Ashok Mehta · Accepted Answer

Voice box is also known as the larynx. It helps in breathing, swallowing, and helps the food to stay out of the trachea, which is known as the windpipe. Voice box is generally removed if the patient is suffering from cancer or any other chronic disease.

Removal of Voice Box (Laryngectomy):

In the process of Laryngectomy, surgeons create an opening in the front of the neck by trimming and turning the trachea. This opening is also known as stoma and it becomes the new passage for breathing. During the procedure, a tracheostomy tube is inserted into the stoma to keep and hold it open. A couple of weeks later, the tube is exchanged with a tracheostomy button, also known as a stoma button. While some people leave with a trach tube in while, there are a few who don t need either the button or the tube.

After the Removal of the Voice Box:

For a while after the surgery, a patient is asked not to speak, as the movement of the tongue can disturb the placement of the sutures. For a quick recovery, feeding is done through the tube for a week or so. There are different types of feeding tubes. Surgeons recommend feeding tubes depending on the surgery a patient has had. A humidifier is also placed in the room which prevents the tube from drying out. Patients might have to learn to remove the excess mucus with a suction machine.

Learning to Speak After the Surgery:

Soon after the surgery, an approval is given by the surgeon for speech therapy sessions. It continues until the patient is in the hospital. There are different components involved in this procedure, which are as follows: An artificial larynx, esophageal speech, and transesophageal puncture (TEP).

Artificial Larynx (AL): Learning to speak with an artificial larynx starts when the patient is still in the hospital. With regular practice, patients can communicate through the phone shortly after the surgery. While there are a few people who like to use AL as they can speak right away and there is no requirement of another operation. However, there are a few patients who do not like the mechanical quality and robotic voice.

Esophageal Speech (ES): In this speech therapy, a patient takes the air into the esophageal and releases it. It produces a sound when the top of the esophagus vibrates. It is somewhat different as the air is not coming out of the stomach. Learning to speak with this therapy is difficult. It takes up to 6 months to learn it.

Tracheoesophageal Puncture (TEP): Under TEP, a deep breath is taken in with covered stoma. When exhaled, air would try to come out normally from stoma, it moves via tiny prosthesis to esophagus, which results in the vibration of muscles. Hence, it produces voice. TEP helps to make a natural sounding voice with good sound quality after a few weeks of surgery.

Conclusion:

Choosing a communication method totally depends on an individual's physical and mental status, communication needs, and personal preference. This is why it is always advisable to consult an ENT specialist or speech pathologist for effective therapy. The patient must follow the instructions for better and adequate results.

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