Restoration of Voice after Laryngectomy

Abstract

The importance of speech is not fully appreciated until the voice is lost. Speech is more than verbal communication; in addition, vocal intonation displays our emotional state. Cancer of the larynx is the most common head and neck malignancy in the western world1 and for a long time the only available treatment was major laryngeal surgery, (Billroth did the first total laryngectomy in 1873). Fortunately, since the advent of cobalt-60 in the 1950s and the improvement in endoscopic techniques, many patients with early disease can now be cured with radiotherapy alone or with minor surgical interventions that preserve the voice2-5. For some, however-those who do not respond and have residual disease or recurrence, and those who present with advanced diseasea major laryngeal resection provides the only hope of cure6'7. In a minority of cases partial laryngeal surgery, avoiding a permanent tracheostome, is feasible. However, the resulting voice is often poor and swallowing problems, especially aspiration, can be debilitating. In the UK, most patients who proceed to surgery still undergo a total laryngectomy. This involves the permanent separation of the respiratory tract from the upper digestive tract and the removal of the most important anatomical unit involved in voice production. It is a mutilating operation with lifelong functional and psychological consequences. Laryngectomized patients have a relatively favourable prognosis, with a 5-year survival rate of 65-75%8. Although this survival rate has changed little over the past 25 years, developments in post-laryngectomy speech rehabilitation have led to substantial improvements in quality of life. Here we offer a review of voice rehabilitation techniques.