Head and neck cancers account for approximately 3 to 5 percent of all cancers. Their origins are in the oral cavity (mouth), salivary glands, paranasal sinuses and nasal cavity (nose), pharynx (throat), larynx (voice box), and/or lymph nodes in the upper part of the neck. Tobacco and/or alcohol use are the most important risk factors for head and neck cancers. Approximately 85 percent of head and neck cancer cases are linked to tobacco use.
Some common symptoms of head and neck cancer may include a lump in the neck region, a change in the voice such as hoarseness, a growth or sore in the mouth, bringing up blood, swallowing problems, changes in the skin, and/or persistent earache. However, these symptoms may also be indicative of other conditions, so please consult with a physician should any or all of these symptoms arise. Considerations for the patient's plan of treatment may include factors such as the location of the tumor, the stage of the cancer, and the person's age and general health.
Speech Language Pathologists (SLPs) at the Grabscheid Voice and Swallowing Center of Mount Sinai assess and treat speech and swallowing disorders for individuals diagnosed with head and neck cancer. Speech and swallowing difficulties may arise from surgery (e.g. total laryngectomy, hemilaryngectomy, total/partial glossectomy, mandibulotomy, etc.) and/or radiation therapy. Patients with speech difficulties may complain about slurred speech or difficulty articulating sounds, words, and/or sentences. Patients with swallowing difficulties may complain about coughing or choking while eating, difficulty chewing foods, food or liquid coming out of the nose, painful swallowing, significant weight loss, or even a recent bout of pneumonia.
It is optimal for the SLP to establish a relationship with patients before the surgery and/or radiation therapy via a pre-operative assessment. During this evaluation, the clinician can obtain baseline data on the function of the patient's speech and swallow muscles. The SLP will also counsel the patient on structural, functional, and lifestyle changes that may occur as a result of the surgery and/or radiation therapy.
Communication Options for Total Laryngectomees
There are three communication options for individuals that undergo a total laryngectomy surgery: 1) electrolarynx 2) esophageal and 3) tracheoesophageal (TE) speech. Each option has its advantages / disadvantages and may or may not be a communicative option for each individual patient. Please speak to your Speech Language Pathologist about the method(s) that is appropriate for you.
Electrolarynx speech: The electrolarynx is likely the most recognized communicative device for total laryngectomees. It is a battery operated and handheld device that is typically placed in the jaw/neck region and allows the tissue to transmit the electromechnical vibration to the mouth. The sounds are then shaped into words via the articulator muscles (e.g. lips, jaw, and tongue). Many of the newer electrolarynx models have volume and pitch control. An intra-oral attachment can also be used for those that may have stiffening in the neck region from radiation therapy or other conditions that prevent use of the electrolarynx. The electrolarynx is typically easy to learn, but some patients may complain about the mechanical sounding voice quality. Regardless of the primary communication option chosen by the patient, the electrolarynx is always good to have as a backup for those emergency situations.
Esophageal speech: A small amount of air is either injected or inhaled into the upper part of the food pipe (esophagus) to produce a "belch-like sound," which is then shaped into speech via the articulators. It is likely the hardest technique to learn out of the three communicative options. Esophageal speech typically sounds more natural than electrolaryngeal speech, but it may not be intelligible if the individual has poor articulation skills. Esophageal speech also does not require reliance on or purchase of devices or prostheses.
Tracheoesophageal (TE) speech: TE speech is the most recent communication tool for total laryngectomees. The tracheoesophageal puncture (TEP) is small hole (fistula) created just inside the stoma, starting from the back wall of the windpipe (trachea) and leading into the wall of the food pipe (esophagus). A one-way valved silicone voice prosthesis (individuals have a choice of patient- or clinician-maintained devices) is placed into the tunnel to enable TE speech while blocking food/liquids from passing into the windpipe (trachea). The patient's "new" TE voice is produced by momentarily covering the stoma so that exhaled air from the lungs can be directed from the windpipe (trachea) through the prosthesis door and into the food pipe (esophagus). The exhaled air brings on vibration in the area of the throat and food pipe (esophagus) and emerges through the mouth as sound/words/sentences. The TEP can be created at the same time as the total laryngectomy surgery or the patient can opt to have it created at a later time.
- Lauder, E. (1993). Self Help for the Laryngectomee. San Antonio, TX: Lauder Publisher.
- Casper, J. & Colton, R. (1998). Clinical Manual for Laryngectomy and Head/Neck Cancer Rehabilitation. San Diego, CA: Singular.