Cancer of the voice box, or larynx, accounts for about 1 in every 100 cancers. A total laryngectomy is an effective treatment for this type of tumour and around 1500 people have the operation, for laryngeal cancer, every year in the UK. Cancer of the voice box, or larynx, accounts for about 1 in every 100 cancers. A total laryngectomy is an effective treatment for this type of tumour and around 1500 people have the operation, for laryngeal cancer, every year in the UK.

Having a total laryngectomy does mean that you lose the power of speech completely. Obviously this can be extremely distressing and over the years doctors and scientists have tried to find ways to get round this problem.
There are three main methods of voice restoration. These are voice prosthesis, oesophageal speech and the electrolarynx devices.

• Voice prosthesis: are inserted during the laryngectomy operation. A channel (fistula) is made through the wall between the windpipe and the gullet. A valve (voice prosthesis) is inserted into the opening. When you breathe out and cover the stoma with a thumb or finger, air from the lungs is pushed through the valve to produce speech. The valve also prevents food and fluids from passing into the windpipe. It may take a while to learn how to speak with a voice prosthesis. The voice can sound quite natural, although in women it is usually a lower pitch than before the operation. 
• Oesophageal speech: involves learning how to swallow air that can then be used to create sound. The technique is quite complicated and needs a lot of training and support. Some people find it easy to make oesophageal speech but other people find it more difficult. Even when people do get the hang of it they can usually only produce a voice that is quite quiet and low pitched.
• Electrolarynx devices: work as battery powered instruments, which, when pressed firmly against the side of the neck, will transmit vibrations from the airways and turn them into sound. Although probably easier to master than oesophageal speech, the result is an electronic-like voice.

Most people with a laryngectomy can learn to speak effectively using one of the techniques described above.  At least two-thirds of people are able to use a voice prosthesis or oesophageal speech. Some people can go back to jobs which need a lot of talking: for example, telephone operators and salespeople. Some people also like to use small typewriters to communicate with the people around them.  Several different types of writing devices are available.

The type of voice reconstruction recommended may depend on the site or extent of the cancer, or whether there are any post-operative complications and the preference of the patient.  Although support from speech therapists and practice is necessary about 4 out of 5 people do manage it successfully.