What does a speech-language pathologist (SLP) do when working with individuals with laryngeal cancer?
The SLP will meet with the person and family before surgery. The SLP will evaluate factors like vocal quality, pitch range, and presence or absence of accent or regional speech variations. This evaluation allows the SLP to understand the person's speech and voice abilities. This understanding helps the SLP plan treatment after surgery.
The SLP will also explain the anatomy and physiology of the larynx, describe how surgery will change this, and provide information on what will happen in the intensive care unit immediately following the surgery.
The person will not have a voice after the larynx is removed. The SLP will provide a pad of paper and a pen or another writing device for expressing basic needs to nurses, doctors, family, and friends immediately after surgery.
After surgery, the SLP's primary goal is to provide the person with a new sound source for speech. There are three primary options:
- Esophageal Speech: A person takes air in through the mouth, traps it in the throat, and then releases it. As the air is released, it makes the upper parts of the throat/esophagus vibrate and produces sound that is shaped into words in the same way it was before surgery: with the lips, tongue, teeth, and other mouth parts. This type of alaryngeal speech is difficult to learn and use effectively, especially in rushed or stressful communication situations.
- Artificial Larynx: The person uses an electronic or mechanical instrument that provides the sound source for speech. Some of these devices are held against the neck, and others have a tube that the patient puts in his mouth. Many people use an artificial larynx as their first means of alaryngeal speech. Effective use still requires training and practice, and some disadvantages exist. The artificial larynx has a mechanical voice quality, requires the use of one hand, and draws attention to the speaker.
- Tracheoesophageal Puncture (TEP): This surgical procedure is one of the more popular methods of alaryngeal speech production. It can be performed at the time of the laryngectomy surgery or afterwards. The surgeon creates a connection between the trachea and the esophagus with a small hole. A small, one-way shunt valve is then inserted into this hole. To speak, the person inhales air through the stoma and into the lungs. Then, he or she covers the stoma with a finger. Air from the lungs is then directed from the trachea, through the shunt valve, and into the esophagus. The esophagus vibrates, creating a sound source for speech. This sound is then shaped into speech sounds in the mouth in the same way it was done before laryngectomy. The SLP will assist the individual in selecting and fitting the prosthesis and can teach proper prosthesis care and use.
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See Also:
Laryngeal Cancer
Laryngeal Cancer: Causes and Number
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