Speaking After Laryngeal Cancer

Q:  I hope you can help me with a real problem that I live with. Five years ago I had a total laryngectomy done because of larngyeal cancer. I have tried using an artificial larynx but it wasn't any good. Then I tried esophageal speech, and I couldn't get a whisper to come out. Can you give me information on any medical invention that is being developed?

I really find it hard to believe that they can sew a person's arm or leg on and replace a heart but not be able to restore a person's voice. I am hoping you will take the time to answer this letter.

A:  I've got good news for you. I caught Bruce Campbell, MD, Professor of Otolaryngology and Communication Science at the Medical College of Wisconsin by phone just as he was about to leave Froedtert Hospital for the Veterans' Hospital and he told me about a technique that has been around for about 10 years called Tracheoesophageal Puncture (TEP). The ENT surgeon creates an opening between the back of the trachea (windpipe) and the pharynx (upper part of the esophagus food pipe). A silicone tubular prosthesis is placed through the openings and the end of the tube is taped to your neck just above the tracheostoma (hole to the outside). This prosthesis forces air into your esophagus and out the mouth causing vibrations which produce a voice.

Dr. Campbell who has done many TEPs says that patients may end up with even a better voice than before the surgery and usually better than esophageal speech which didn't work for you. This is a day surgery performed under general anesthesia. A speech pathologist works with you to fit the prosthesis, teach you how to talk with it care for it. There are 2 types: the newer one stays in for 6 months before wearing out, and older model has to be taken out and cleaned a couple times a month. Do give this a try and write back and let me know if you got your voice back.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.