Giving patients back their voice
The surgical removal of the voice box during treatment of cancer and other illnesses creates a whole other layer of fear and uncertainty for patients already fighting a big fight. New treatments and specialized services offered by Trident Medical Center’s Head and Neck Specialists give patients options for getting their voice back.
After the surgical removal of their voice box or laryngectomy, many patients have a few options for rehabilitation of their speech. The latest option is a tracheoesophageal voice prosthesis or TEP.
Since the vocal cords are completely removed during total laryngectomy surgery, your sound source is lost but the TEP surgery with a prosthesis creates a path for air to move from your lungs to the esophagus. This air causes the top of the esophagus to vibrate — producing a new tracheoesophageal voice.
Before surgery: Team approach
Hannah Cornett, MS, CCC-SLP, BCS-S, Speech-Language Pathologist, Board Certified Specialist in Swallowing and Swallowing Disorders
As a part of a multi-disciplinary team, the speech pathologist consults with physicians and helps guide the recovery plan based on your specific medical case and your desired option for communication post-surgery.
“I go through all the different options when we meet before surgery,” says Hannah Cornett, speech-language pathologist. “We go over eating and drinking, breathing, surgery and treatment and then communicating and what all will look like post-surgery. Our patients get to understand options and from the non-invasive electro larynx to what most consider the gold standard today, the TEP surgery and what each entail,” she adds.
TEP surgery
A TEP procedure is usually done around three months after the total laryngectomy surgery, although it can be done at the same time as your surgery. Your surgeon will create a fistula (hole) between your breathing pipe and your swallowing pipe, and implant a one-way valve with flanges on either side to hold it in your throat. When you cover your stoma and exhale, you can re-direct air through the valve into your throat. This allows vibration of the tissue in your throat to create a “voice.”
“I try and match people up with a survivor visit,” notes Cornett. “Someone that has already had a laryngectomy so they can see what things will look like on the other side. I try and match them up with a patient who is talking the way they want to be talking, either with an electro larynx or a TEP. It helps them to see people living fully functional lives on the other side.”
Post-surgery
To speak with a TEP, you take a deep breath and then cover the stoma so that when you exhale, the air that would normally come out of the stoma is directed through a little prosthesis (a TEP valve). The air goes through the one-way valve of the prosthesis, then up your esophagus, where muscle vibrations help to produce voice.
It’s not complicated to use – it just takes a little practice post-surgery to build up breathing stamina and to train yourself to inhale and exhale to move air through to make the sound you want.
Post-surgery, it took John Nazarko, age 54, about 3 weeks to get used to his new TEP. After having his larynx removed, he chose the TEP to get him back to speaking more like himself or with a more natural sounding voice after surgery.
“I had to learn how to breathe a little differently. It’s like practicing to hold your breath for swimming, you have to breathe from your diaphragm – like an athlete – now I know what an opera singer goes through,” said Nazarko.
You can either cover your stoma with your finger when speaking, or you can get a "hands-free" valve. A TEP lets you develop a natural-sounding voice and good sound quality within a few weeks after surgery.
“I had to practice, but I felt like I was hearing my voice come through at about three weeks. At first, it was hard because it sounded different, but now everyone says you can even hear my accent, I’m from New Jersey,” grins Nazarko.
Benefits of a TEP
John Nazarko, laryngectomy patient, age 54.
- Produces a more natural sounding voice
- Easy to use with practice
- New “hands free” options are becoming more widely available
Nazarko wanted other patients to know, “In the beginning, it took me a little bit to get used to it. But then I realized the independence I gained. There's nothing worse than accomplishing something or watching something, and you want to go share with your family. And then you start looking for a dry erase board, by the time you get it, you don't even want to talk anymore. You're frustrated. And to be able to instantly convey what was going on in my head, that was a big, big deal for me.”
What the future looks like
For Nazarko, it was “being able to tell my wife every day, "I love you," and to be able to SAY it. It is not the same on a dry erase board. It is not the same sign language. So, to be able to speak and use MY voice. My wife loved my voice.”
If you’re wondering what the future holds for you and where this journey could take you as a patient, Nazarko says “I want other people to know there’s light at the end of the tunnel. At first, I was so lost and I didn’t know how I was going to communicate with my family and feel part of a family again. And now, other people need to know there is a quality of life out there worth fighting for!”