People who have undergone a total laryngectomy to remove their voice box may be eligible for tracheoesophageal puncture (TEP) surgery. This procedure is generally not recommended for individuals with poor lung function or conditions that affect wound healing, such as poorly controlled diabetes or severe hypothyroidism.
Dr. Cannon explains that TEP surgery is often performed simultaneously with total laryngectomy, although it can also be done months or years later. During a laryngectomy, the larynx is removed, and the windpipe is connected to the skin to create a permanent opening for breathing called a stoma. The connection between the stoma and the esophagus remains intact.
In TEP surgery, a small hole is created between the trachea and esophagus, where a tracheoesophageal voice prosthesis is inserted. This one-way valve directs air into the throat to help produce sound.
Vess notes that since vocal cords are removed during laryngectomy, TEP surgery with a prosthesis allows air from the lungs to move into the esophagus, causing vibrations that create a new voice.
Learning to use the tracheoesophageal voice prosthesis requires guidance and practice but “it’s not complicated,” according to Vess. Most patients need only a few speech therapy sessions to learn how to use it effectively.
The prosthetic valve typically lasts several months but can last up to a year. Replacement does not require surgery and can be done in under an hour at a doctor’s office or even at home with proper guidance from a speech pathologist.
Dr. Cannon mentions other options for creating speech post-laryngectomy include artificial voice boxes and esophageal speech. An electrolarynx produces electronic-sounding speech through vibrations against the neck, while esophageal speech involves swallowing air to vibrate the esophagus. However, Vess points out that people prefer tracheoesophageal voice for its more natural sound compared to these alternatives.
