Total Laryngectomy Rehabilitation at Wake Forest Baptist
Wake Forest Baptist speech-language pathologists specialize in pre-operative counseling,care assessment during post-operative hospital stay, theraphy during and/or after hospitalization, and ongoing management after hospitalization for patients who have had a total laryngectomy, or a surgery to remove the larynx (voice box).
Since vocal folds are removed during surgery, total laryngectomy patients must learn new methods for communicating and swallowing. Patients also experience a change in respiration, as the airway is no longer connected to the mouth and nose, so breathing now occurs through a hole in the throat called a stoma. Our experienced speech-language pathologists help patients every step of the way.
During pre-operative total laryngectomy counseling, we:
- Discuss the physiological and anatomical changes in speech, swallowing and respiration that occur following a total laryngectomy
- Evaluate options for communication without a voice box
- Encourage family members and friends to attend to answer any questions they may have
During post-operative hospital stays, we:
- Assist with care and management of the new airway
- Offer a visit from a member of our local laryngectomy club to provide further support
- Initiate electrolarynx training, at the physician's discretion.
In therapy sessions and during ongoing management after hospitalization, we:
- Help patients find the most optimal form of communication
- Assist with continued care and management of the new airway
- Assess and fit stoma covers, which may include adhesive baseplates, larytubes, larybuttons, or heat moisture exchange cassettes
Communicating After a Total Laryngectomy
There are three common options for communication following a total laryngectomy:
Electrolarynx (also known as artificial larynx)
Electrolarynx, typically the most common form of communication immediately following surgery, is an electronic device that acts as a separate sound source. Voicing is made either by placement against the neck or with a straw in the mouth. Your speech-language pathologist will train you in placement and use of the device.
This is a method of speech in which you learn to swallow air into your esophagus (food tube) and release it back into the throat like a belch. The expelled air causes the muscles of the throat to vibrate to form a sound source. This method does not require any instrumentation.
TEP (Tracheoesophageal Puncture) speech requires the creation of a tract between the breathing tube (trachea) and the food tube (esophagus) by the physician. A small prosthesis is placed in this tract to allow air to travel from the trachea to the esophagus, causing the muscles of the throat to vibrate as a sound source. A speech-language pathologist and physician will help determine if this is an appropriate method of communication.
Stoma Care and Management After a Total Laryngectomy
A speech-language pathologist will assist the patient in caring for their new airway. This includes assessing and fitting for appropriate stoma covers, which may include adhesive baseplates, larytubes, larybuttons and heat moisture exchange cassettes.