After losing a larynx, many patients can regain a voice that sounds quite normal using methods such as tracheoesophageal (TE) voice restoration. Experts say the options for patients who have had laryngectomies are now better than ever before.

The larynx allows us to speak because air from the lungs passing through it makes a sound that passes through our mouth where we form words. When the larynx is removed to treat cancer, the air from the lungs passes through an opening in the neck called a tracheostomy, preventing the patient from making sounds.

A voice prosthesis is a small tube that also makes sound when air goes through it. After laryngectomy, doctors can insert this device into an opening they make between the trachea and upper esophagus. Air passes through this device into the esophagus and then to the mouth where the sound is converted to speech. Because the prosthesis acts as a one-way valve, it prevents food and liquid from entering the trachea.

A recent study in the Netherlands found that 88% of 318 patients who received a TE voice prosthesis and were followed for 10 years had "fair to excellent voice quality," writes lead author Frans J.M. Hilgers, MD, PhD, chairman of the department of otolaryngology-head and neck surgery at The Netherlands Cancer Center. The report was published in the November issue of the Archives of Otolaryngology-Head and Neck Surgery.

In this study, patients used primarily one type of voice prosthesis, known as "indwelling." The main problems patients encountered were that after a few months, the prostheses would begin to leak and needed replacement. This occurred more often in patients who received radiotherapy. Infection was also a problem, and sometimes the device simply fell out. Despite these difficulties, almost all the patients continued to use the device.

"We put in these more modern devices primarily at the time of surgery, which does make a difference," Hilgers says. "Learning to speak again after only ten days, and maintaining the voice in most patients even during post-op radiotherapy, if this is needed, is a considerable gain in comparison with the early days of prosthetic vocal rehabilitation. The fact that there is no waiting period makes the troublesome and difficult time after cancer surgery more bearable if you keep ‘your own’ voice."

Experts say this is an example of the major advances seen in the last decade in this area as doctors and the industry continue to improve voice restoration.. The result is speech that is very similar to that produced by the normal larynx, says Jan S. Lewin, PhD, assistant professor and director of speech pathology and audiology in the department of head and neck Surgery at the University of Texas M.D. Anderson Cancer Center. Lewin has served as a volunteer consultant to the American Cancer Society (ACS) and as director of the International Association of Laryngectomees (IAL), a support group for people who have had laryngectomies.

"The procedure is not so new. It''s been around for about 20 years, but its real heyday has been in the last ten years. We''ve really become expert in helping the patient to be successful," she says.

The future of voice prostheses, Hilgers says, will be in improving models to provide automatic voicing and to make the devices more "robust" so that they need replacement less often.

Laryngectomies are usually done in cases of advanced tumors of the larynx that have not responded to other treatment options and surgery, according to Lewin. Not all centers and speech pathologists around the country are experienced in treating patients who have had laryngectomies. Lewin recommends patients seek treatment at centers that staff doctors with proper training and experience, so patients can have maximum success.

For patients who choose not to have a prosthesis, there are still other options, she adds. Patients can learn esophageal speech, but it is difficult. With this method, the patient learns to trap air in the oral cavity, divert it into the esophagus for sound production, and shape it into speech with the movements of the mouth.

Another choice is the artificial larynx, in which a patient most often uses an electronic instrument that is held against the neck to transmit artificial sound into the oral cavity. The sound is shaped by the movements of the mouth to produce speech. While it is usually easily learned, the drawback of this method is that it sounds mechanical and unnatural and requires the use of at least one hand, Lewin says.

"Some people still continue to prefer this method," she adds. It also provides a good back-up to other speech alternatives, and is great for patients who are healing, she says. For people with dexterity or eyesight problems, these devices are much easier and less complicated than other choices.

"But most people don''t want to be singled out as different," Lewin adds. "That''s the beauty of [TE voice restoration]. The voice is similar to the normal voice."

Laryngeal cancer makes up a small portion of patients nationwide -- only about 10,000 – and not all of these patients need a laryngectomy.