Phil Sechtem, PhD, CCC-SLP, and associate professor in the Master of Science in Speech-Language Pathology program, and fellow faculty member Kristen McDougal discuss laryngectomies, the surgery, and recovery process.
Understanding a Laryngectomy
Laryngectomy is a surgical procedure for people who have cancer in the larynx where vocal cords are housed. “Laryngectomies are prevalent with cancers of the head and the neck. Mostly caused by behavior/lifestyle, like smoking or some illness like HPV,” explained McDougal.
The procedure requires the surgeon to remove the patient’s larynx and vocal cords and reroute their anatomy. The removal of the larynx and vocal cords, which removes the cancer, requires some extensive life adjustments.
In a laryngectomy, the surgeon will reroute the airway to the front of the neck forming a stoma, which is a fixed opening that allows people to breathe through their neck (a person who has had a total laryngectomy breathe through their nose and mouth). With the stoma, their lungs are now directly in contact with the outside air. Because the airway is now attached to the stoma and breathing occurs via the neck, choking on foods and liquids is no longer possible as the airway and the foodway are now separated.
Laryngectomies and SLPs
“When the vocal cords are removed, how we breathe and eat can be affected,” explained Sechtem. That’s where speech-language pathologists (SLPs) come in. “We work with the laryngectomy population and do preoperative counseling and things like that for that population,” said Sechtem.
SLPs work with a variety of voice disorders, such as “vocal cord nodules, vocal cord polyps, and cysts. Doctors consult with SLPs to help patients for optimal vocal mechanics and reduce vocal nodes. If they have to have surgery to remove a cyst or polyp, they want them to come out using optimal voice mechanics,” said Sechtem. Or if a person has vocal cord paralysis, where one or two vocal cords don’t move anymore, “we work with them to restore or maximize what they have to work with.”
With head and neck cancer patients, there can be non-surgical approaches to fighting cancer such as radiation or chemotherapy, but each often requires post-treatment recovery with the help of an SLP.
As technology improves and surgeons are better able to isolate the cancer, they may only need to remove a portion of the vocal cord or the larynx, rather than the entire larynx or vocal cord. But even without the surgeon having to reroute the airway, Sechtem explained that “there are still voice problems or swallowing problems that may follow post-surgery.”
SLPs are involved in the process from the beginning. “Prior to surgery, surgeons will refer the patient to meet with an SLP who then will do a preoperative counseling session,” said McDougal. “We educate on the changes of the anatomy, things they’ll need to do to take care of their neck, and the supplies they’re going to need.”
She added, “The SLP will be involved in this person’s life for its entirety because with a laryngectomy you no longer speak the same way. To speak you need air, vocal cords (to vibrate), and a mouth. So before and after laryngectomy, we educate on three options to restore communication.”
- Using an electrolarynx, which is a small sound source that people place on their neck to create vibration essentially substituting the vibration once created by the vocal folds.
- Learning to do esophageal speech, which is taking in or semi-swallowing small amounts of air into the upper esophagus that is used to “burp up” the air and talk on it.
- The most prevalent option is using tracheoesophageal voice restoration which involves the surgeon creating a fistula “hole” between the airway and esophagus (which is called a tracheoesophageal puncture or TEP) and putting in a small voice prosthesis that allows air from the lungs to go through and vibrate their upper esophagus which creates a new sound source for speech.
The Impact of a Laryngectomy
For McDougal and Sechtem, it’s important that people understand what happens with a laryngectomy and how it affects people. “Educating the general population on what a laryngectomy is and having pre-education for the patients so they can be good advocates for themselves, manage their care moving forward because this is a lifelong change. For example, if they fall down and need CPR, CPR on their mouth won’t work. These are huge changes for the patients and the general population should know about that,” said McDougal.
As you work with patients, added McDougal, “you get to know where the patient came from and the life they had before cancer. You can help them set the goal and modify the therapy or skills to figure out how to help the patient get their life back and do the things they love doing.”
Listen to the RMUpload podcast in its entirety here.
Webwhispers for evaluation treatment and recovery from laryngectomy
The American Speech-Language-Hearing Association has many resources and information on voice disorders.
Self Help for the Laryngectomee by Edmind Lauder