Speech problems and treatments

Some people with cancers of the head and neck or cancer of the brain may need speech therapy to learn how to speak again after treatment. Speech therapists (also called speech-language pathologists) assess and treat speech problems. They work closely with surgeons and oncologists to make sure you get the help that you need.

Speech is produced when air flows out of the lungs and through the throat. The air vibrates the vocal cords. These vibrations are then formed into words by the throat, tongue, teeth, nasal passages, mouth and lips.

Head and neck cancers and cancer of the brain can result in changes to your speech. Speech problems can happen as a result of a blockage by the cancer or as the result of treatment.

Treatments for these cancers, including surgery, radiation therapy or both, may change the structure or function of the body parts that produce speech. Both the voice itself (frequency, pitch and intensity) and the ability to speak can be affected by cancer and its treatments.

If your voice box (larynx) has been totally removed, you will have to learn new ways to speak using a different vibration source to replace the vibrations of the vocal cords.

If you’ve had radiation therapy to your voice box or a partial removal of your voice box, you can still speak using the vocal cords. There may be some changes to the quality of your voice, including hoarseness, a breathy voice and a weak voice.

If you haven’t had a total laryngectomy, a laryngostroboscope may be used to observe your vocal cords during speech. A camera is attached to a laryngoscope, and flashing lights are used to slow down the image of the moving vocal cords. Laryngostroboscopy may be used to assess speech before, during and after treatment.

If you’ve had the larynx removed, you can learn to speak again, but it takes time, patience and practice. The length of time that it will take to learn to speak again is different for each laryngectomee (a person whose larynx has been removed). Some people learn quickly, while others find it more difficult because changes to each person’s anatomy after surgery or radiation may be different.

Different speech rehabilitation techniques may be used to help a laryngectomee speak or communicate. A speech therapist will help find the method or combination of methods that will work best for you.

Artificial larynx speech involves using an electrolarynx, or artificial larynx, to speak. An electrolarynx is a battery-operated device that produces vibrations, which are then formed into speech by the mouth, tongue, teeth and lips.

There are 2 types of electrolarynxes. Both types of electrolarynxes can be used almost immediately after surgery and are simple to use and maintain. The speech that is produced sounds very mechanical or electronic. The electrolarynx may need repairs occasionally, and you will need to charge or replace the batteries. Some people may not be able to use intra-oral devices because saliva and mucus may plug the sound tube.

• A neck electrolarynx looks like a small flashlight. The end of the electrolarynx is placed against the neck or cheek and, when turned on, it produces vibrations that are transmitted through the tissues of the neck or cheek into the throat or mouth. The vibrations are then shaped into the sounds of speech by movements of the mouth, tongue, teeth and lips.
• An intra-oral electrolarynx has a small tube that is placed inside the mouth and is connected to a transmitter that produces vibrations. The transmitter may be held in the hand or it may be attached to a denture or dental plate in the mouth. A switch is turned on to produce vibrations when the person wishes to speak.

Tracheoesophageal (TE) speech involves using a prosthesis inserted in an opening in the wall that separates the trachea and esophagus. TE voice restoration surgery or TE surgery may be done at the same time as a total laryngectomy or it may be done as a second surgery at a later time.

During the surgery, a small opening is created between the windpipe (trachea) and the esophagus. The surgeon places a small prosthesis with a one-way valve into this hole. This one-way valve allows air to move from the trachea into the esophagus but prevents food passing from the esophagus into the trachea.

To create speech, air is breathed in through the laryngectomy stoma and then the stoma is covered with a finger. Air is redirected through the valve into the esophagus, causing it to vibrate. Speech is then formed with the mouth, teeth, tongue and lips.

There are different types of speech prostheses. Some voice prosthesis valves are attached to the stoma (ex-dwelling valves). These are hands-free and do not require the stoma to be covered. Ex-dwelling valves have a strap outside the stoma and can be changed by the laryngectomee or their caregiver. Other types of prosthesis valves are completely within the stoma (in-dwelling valves) and will need to be changed by a doctor, speech therapist or nurse.

The voice produced by TE speech sounds very natural. Most people can speak in as little as 2 weeks after surgery.

Esophageal speech is a method of inhaling air into the upper esophagus and using it to create the vibrations necessary for speech.

Air is taken in through the mouth and then is pushed down into the esophagus. The tongue is placed against the roof of the mouth to hold the air down. When the person is ready to speak, the air is then forced back into the mouth from the upper esophagus. This causes the esophagus to vibrate. Speech is created using the tongue, lips, teeth and mouth to change the vibration into sounds and words.

Esophageal speech produces a low-pitched or gruff voice that sounds close to normal voice quality. It doesn’t require more surgery and there is no equipment to maintain.

Some people cannot use esophageal speech because of the amount of tissue removed during surgery or because of other physical conditions.

Learning to speak again can be very difficult. Some people find it helpful to have emotional and practical support from other cancer survivors. The International Association of Laryngectomees has a number of support groups in Canada.