Laryngectomy is the surgical removal of the larynx. The larynx is the “voice box” or vocal cords, which vibrate as air passes over them during exhalation, and this sound is made into our speech by the parts of our mouth. If the larynx is removed, no speech sounds can be made. A partial laryngectomy may allow speech, though in many cases it will be different than the speech was before surgery and may be more difficult for people to understand.
In addition, the trachea s redirected with the removal of the larynx, resulting in a hole in the neck that the laryngectomy breathes through. This is referred to as a “neck breather.” These changes bring about some practical and safety concerns of which you should be aware.
Cautions after surgical treatment for your voice
Notify your healthcare provider about your condition so that they will respond even if you do not speak when you call. Get a medical alert bracelet identifying you as a “neck breather.” This is important because CPR breathing or oxygen given through your mouth is ineffective.
Carry something that can be used as an alarm in an emergency when you would otherwise yell for help. For example, an alarm for a keychain or bell can call attention to you. If you cannot speak or speech is difficult to understand, carry paper and pen to write messages.
Because the air you breathe is not going through your nose, you will have decreased the ability to smell, which can have safety implications. You may not smell smoke from a fire, natural gas or sour food, for example. Make sure you have working smoke detectors and change the batteries every 6 months.
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Need to keep a close watch
Showering: You will need to avoid getting water in the stoma. Options to keep water out: foam filters, stoma covers, or something else that could be used to cover the stoma like a washcloth or baby bib. Many laryngectomies get comfortable with showering over time and require nothing to cover the stoma.
Clean Air: Remember that the air going into the stoma when you breathe goes directly to your lungs. Be cautious about dust, pet hair, aerosol sprays, etc. – anything that can be in the air and inhaled. You may want to use a stoma cover for certain activities where the risk of inhaling something is higher.
Humidification: Prior to surgery, the air you were breathing was humidified by your nose and mouth. After surgery, you no longer have this built-in humidifier and this dry air results in increased mucus production as the lungs try to moisten the air. You will need to learn how to increase the moisture level in the air you breathe and retain this moisture. Tools to do this include using a cool-mist humidifier when sleeping, saline squirts and stoma covers. You can learn much more about humidification from your healthcare team or at the resources listed below.
Find your voice again!
Issues with speech and swallowing are common after laryngectomy, but these issues can arise at any point in a survivor’s life. If you experience any difficulty swallowing at any time, notify your oncology team. A speech-language pathologist (SLP) can help manage swallowing difficulties and help with devices and techniques to assist with your speech. SLPs can be accessed at any time in a survivor’s life for new concerns or to explore newer technologies for speech.
Most people are able to speak again after a laryngectomy. Learning to speak can be difficult at first but ways of communicating have improved. A speech and language therapist will talk with you about these before you have your operation.
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Ways to help you communicate include:
A voice prosthesis valve: The surgeon makes a small channel between your windpipe and gullet (esophagus) and places a small valve in it. When you cover the stoma with your finger and breathe out, air from your lungs goes through the valve, making it vibrate to produce a sound.
Oesophageal speech: This is used less often nowadays. It is a way of drawing air into your gullet to help you speak. As the air moves, it vibrates to produce a voice.
An electrolarynx: This is an electronic aid that you hold under your chin. It makes sound vibrations that can be turned into speech.
Electronic keyboards: Some people prefer to type messages, whether on a keyboard, tablet or phone. Your speech and language therapist (SALT) can tell you about other writing devices as well.
Life after a total Laryngectomy!
Living after a surgical procedure as critical as a total laryngectomy means breathing through a stoma. The nose and mouth will not be useful and a patient has to learn how to speak again. While a laryngectomy does spell changes in your day-to-day life, it is still possible to be as happy and fulfilled. You can continue to be active by going for walks and exercising, or see friends and do most other things you enjoyed before the procedure.
Apparently, one of the biggest differences after a total laryngectomy is losing your vocal cords. This means you won’t be able to speak as you could before, but there are proven ways to regain the power of your speech.
The loss is not limited till here only, the loss of nasal function is another one. This means you will have to adjust to a different way of breathing because you can’t use your nose anymore. A patient may not realize the same but the nose does more than just smell. It plays a huge role in keeping your lungs healthy and working well. Without the nose, the air is cooler and less moist than it should be, causing your lungs to produce more mucus. The important features of your nose can be regained through the lung or pulmonary rehabilitation (Link to pulmonary rehabilitation) though – especially if you choose to use a Heat and Moisture Exchanger (HME).
As you recover from surgery and get back to life, you are sure to encounter situations that you weren’t prepared for. Your healthcare team is there to support you and answer questions. You can always make a follow-up appointment with your ENT surgeon and consult how to better manage and take aftercare.