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Tracheo-Esophageal Speech Following Laryngectomy

One of the most effective techniques for speaking following a laryngectomy is tracheo-esophageal speech (TE speech). Two other speech techniques, esophageal speech and the electrolarynx are discussed elsewhere.

To understand how TE speech works, you have to be familar with the anatomy of the neck after laryngectomy. That is described elsewhere, but briefly after a laryngectomy the end of the trachea (windpipe) is brought out to the front of the neck. This opening is called the stoma, and one breathes in and out of the stoma. No speech is possible as one exhales through the stoma, since air just travels out without causing any vibration or sound.
Just behind the trachea is the esophagus, which is the tube through which food travels from the mouth to the stomach.

The principle in TE speech is that during exhalation, air is diverted into the esophagus. The air eventually flows out the mouth. That air flow causes the esophagus to vibrate, which produces a sound. By moving the lips. tongue,etc, the sound is articulated into speech.

In order to divert air to the esophagus during exhalation, a small opening called a fistula is created between the trachea and the esophagus. A small valved tube is placed into the opening or fistula to keep it open and to prevent swallowed food and liquid from getting down the trachea. This tube is usually called a voice prosthesis.

The fistula can be created at the time of the original laryngectomy, or at a later time. It is a relatively minor operation.

The diagram shows a side view of the stoma and the voice prosthesis in position. Note that the prosthesis connects the trachea (windpipe) and the esophagus. The prosthesis is constructed with a small valve on the end that goes into the esophagus. This is done to prevent swallowed food from going into the trachea and causing lung problems.

In order to talk, the stoma must be covered with one's thumb during exhalation. This process is shown to the left.

Notice that when the thumb tightly covers the stoma, air will pass from the trachea and into the esophagus. With practice, one can make this air vibrate the walls of the esophagus. This produces a sound that is then modified by the lips and tongue through normal articulation to produce quite normal sounding speech.

The photo to the left was taken with a flexible fiberoptic scope at the upper portion of the esophagus and shows the part of the TE prosthesis that extends into the esophagus. This particular type of prosthesis is called an "indwelling prosthesis" and it can stay in for up to 6 months.

 

 

Advantages and Disadvantages of Tracheo-esophgeal Speech

Advantages
1. The sound quality with TE speech is very good, probably most closely resembling normal laryngeal speech. In contrast, speech using an electrolarynx has a very mechanical sound.

2. Since the air for the speech is coming from the lungs, one can speak for a fairly long time between breaks. With plain esophageal speech, the air comes from the stomach and speech segments are short. There also is better control of the air flow with TE speech.

Disadvantages
1. Not everyone can do TE speech. In some cases the walls of the esophagus are too tight to allow passage of air. In those cases, when one exhales and covers the stoma, air just can't escape. It is like trying to blow against a sealed tube. There is a test that a speech pathologist can do prior to placement of a TE fistula to see if the esophagus will tolerate TE speech.

2. The voice prosthesis must be removed and cleaned periodically. This requires a moderate amount of dexterity, especially in putting it back in the right spot. However, there are now prostheses called "in-dwelling" that are designed to stay in for weeks or months at a time.

3. The stoma must be tightly covered during exhalation in order for air to get into the esophagus. This requires good arm and hand movement, and this may be difficult after a spinal cord injury. There are valves that can be placed over the stoma that divert air into the esophagus, but they do not always work.

4. There can be food that leaks into the trachea.

5. The prosthesis can fall out and the hole will seal over in about 24 hours. If it does seal over, a second operation must usually be done to make a new hole. If the prosthesis falls into the trachea, it must be removed to prevent aspiration.


Permission to re-print some of the images above provided by INHEALTH Technologies, Carpinteria, CA. http://www.inhealth.com
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