Speech Therapy after Laryngectomy: Vocal and Swallow Rehabilitation

Cancer of the larynx doesn’t always begin with dramatic symptoms. In fact, early warning signs are often subtle and easy to dismiss as allergies, reflux, or a lingering cold. Because symptoms can look so different from person to person, diagnosis is sometimes delayed.

Three men - Three different symptoms

• Alexander McGuiggan noticed a hoarse voice at Christmas and by March his voice had deteriorated to a whisper.
• Stewart Farmer noticed difficulty breathing that suddenly progressed and he was constantly short of breath.
• Alec Smith noticed a tickly throat and husky voice at the end of the day.  Two years later he had no voice, a bad cough, was breathless and produced huge amounts of phlegm and mucus.

Although their symptoms were different, all three men were diagnosed with cancer of the larynx. Each underwent treatment that included laryngectomy, radiation therapy, and speech therapy. Fortunately, all experienced successful outcomes. With speech therapy, they were able to regain functional speech and safe swallowing.

Speech therapy following laryngectomy teaches individuals how to breathe in a new way, helps restore aspects of smell and taste, and most importantly, enables people to relearn speaking and swallowing. Therapy often begins even before surgery or radiation treatment. To better understand rehabilitation, it is helpful to first understand the larynx, the cancer that affects it, and the treatments involved.

Cancer of The Larynx:

The larynx sits at the upper end of the trachea and contains two bands of muscle known as the vocal cords. These structures:

• Prevent food and liquid from entering the airway
• Play a critical role in breathing
• Enable speech production
• Help coordinate swallowing

 

Laryngeal cancer occurs when malignant cells develop in the tissues of the larynx. Risk factors may include smoking, heavy alcohol use, or exposure to HPV, although in many cases the exact cause is unknown.

Treatment Options For Cancer of the Larynx

Treatment for laryngeal cancer continues to improve, with many patients now able to preserve more natural voice and swallowing function than in the past. Today, treatment plans are often designed to control cancer while avoiding total laryngectomy whenever possible.

Current treatment approaches may include one or a combination of:

• Chemotherapy
• Radiation therapy
• Surgery 

Chemotherapy:  Chemotherapy is sometimes used before or during radiation therapy to shrink tumors or increase treatment effectiveness. It may also be used when cancer has spread.

Radiation Therapy:  Radiation remains a common treatment, but newer techniques allow radiation to be delivered more precisely. This helps reduce damage to healthy tissues and improves swallowing and voice outcomes.

Targeted Therapy and Immunotherapy:  Newer medications help the immune system recognize and attack cancer cells or target specific cancer cell pathways. These treatments are increasingly used when cancer is advanced or returns after initial treatment.

Minimally Invasive Surgical Approaches:  Some cancers can now be removed using less invasive techniques, including:

• Transoral laser surgery
• Transoral robotic surgery (TORS)

These procedures allow surgeons to remove tumors through the mouth without large external incisions. When appropriate, these methods may preserve voice and swallowing function and shorten recovery time.

Organ Preservation Protocols:  Many treatment plans now aim to preserve the larynx using combinations of chemotherapy and radiation, reducing the need for total laryngectomy in selected patients.

Reconstructive and Rehabilitation Advances:  Improved surgical reconstruction techniques and earlier involvement of speech therapy now allow patients to regain communication and swallowing skills more quickly after treatment.

Surgery Options for Cancer of the Larynx

Although advances in treatment have allowed many patients to preserve their voice box, surgery remains the best treatment option for some individuals. In these cases, part or all of the larynx may need to be removed to effectively control the cancer.

Surgical treatment options include:

• Partial Laryngectomy: Removal of only the portion of the larynx containing the tumor.
• Total Laryngectomy: Removal of the entire larynx and sometimes surrounding tissues.

A total laryngectomy results in permanent anatomical changes:

• The trachea is separated from the nose and mouth.
• Breathing occurs through a permanent opening in the neck called a stoma.
• The stoma cannot be reversed or closed.

 

Laryngectomy vs. Tracheostomy

A tracheostomy is a surgical procedure that creates a temporary opening in the trachea.  Although not usually a treatment for laryngeal cancer itself, it may be used to protect the airway before, during, or after cancer treatment:

• If a laryngeal tumor grows large enough to block airflow, a tracheostomy may be performed urgently or electively to allow safe breathing.
• Some patients have significant airway narrowing at diagnosis. A temporary tracheostomy may be placed to stabilize breathing before radiation, chemotherapy, or surgery.
• Swelling following surgery or radiation can temporarily obstruct the airway. A tracheostomy may be placed to protect breathing during recovery.
• After some partial laryngeal surgeries, a temporary tracheostomy helps protect the airway while swallowing and breathing mechanisms heal. It is usually removed once safe breathing is restored.
• If swallowing dysfunction causes food or liquid to repeatedly enter the airway, a tracheostomy may be needed temporarily to protect the lungs.

 While both procedures create an opening in the trachea, they serve different purposes.  Key distinctions are:

Tracheostomy:

• Temporary or permanent airway opening
• Often used to relieve airway obstruction
• Patients can still breathe through nose and mouth
• Voice typically remains normal with a speaking valve

Total laryngectomy:

• Complete removal of the larynx
• Performed to treat laryngeal cancer
• Breathing occurs only through a stoma
• Speech must be relearned using alternative methods
• Changes are permanent

 

 

Pulmonary Changes after Laryngectomy:

Because airflow no longer passes through the nose and mouth:

• Patients cough mucus out through the stoma rather than the mouth.
• Air inhaled is no longer naturally humidified.
•  Moisture must be added by hydrating the stoma cover or filter regularly.

Swallowing Changes after Laryngectomy:

Surgery alters swallowing structures including the epiglottis and hyoid bone, and reconstructs the esophagus. As a result:

• Pressure regulation during swallowing changes
• Saliva flow and muscle coordination may be altered
• Smell and taste often diminish since airflow no longer passes through the nose

Stoma Care After Laryngectomy

Proper stoma care is essential:

• Clean skin around the stoma twice daily.
• If irritation occurs, leave the area uncovered and avoid solvents temporarily.
• Prevent water or foreign material from entering the stoma when bathing or shaving.
• Use cloth towels instead of tissue to avoid particles entering the airway.
• Spray moisture onto the stoma cover rather than directly into the stoma.

Speech Therapy After Laryngectomy

Rehabilitation after laryngectomy typically includes speech therapy for:

• Swallow rehabilitation – transitioning safely back to oral eating
• Pulmonary rehabilitation – learning new breathing and airway protection strategies
• Olfactory rehabilitation – restoring smell and taste abilities
• Vocal rehabilitation – learning alternative speech methods

Swallow Rehabilitation After Laryngectomy:

Swallow rehabilitation after laryngectomy focuses on helping patients safely return to eating and drinking by mouth. Therapy often begins with exercises to strengthen and coordinate the muscles involved in swallowing and may include strategies to improve movement of food through the throat and esophagus. A speech-language pathologist also helps patients learn safe swallowing techniques, modify food textures if needed, and manage challenges such as dryness, tightness, or food sticking during meals. Treatment typically progresses from tube feeding to oral intake as healing occurs, with the goal of restoring safe, comfortable, and efficient eating while maintaining good nutrition and quality of life.

Olfactory Rehabilitation after Laryngectomy:

Since airflow no longer moves through the nose, smell and taste are often reduced. An exercise called the Nasal Airway Induced Maneuver, also known as “closed-mouth yawning,” can help.

By lowering the jaw, tongue, and soft palate while keeping the lips closed, negative pressure is created, drawing air into the nasal passages. Nearly half of patients in some studies regained their sense of smell after training with this technique.

Vocal Rehabilitation after Laryngectomy:

Because vocal cords are removed during laryngectomy, alternative speech methods are required.  There are three options to choose from:

Esophageal Speech:  

Air is swallowed into the esophagus and then released, creating vibrations that can be shaped into speech sounds.

Advantages

• Hands-free speech
• No equipment or additional surgery required

Challenges

• Difficult to master; many patients cannot develop it
• Speech is low volume and limited in length
• Voice quality is often rough or low in pitch

Electrolarynx Speech:  

A handheld device that utilizes vibration is placed against the neck or cheek to produces sound that the mouth shapes into speech. Advances in technology have enabled hands-free options such as Syrinx electrolarynx, that offer improved sound quality, adjustable pitch and tone, and lighter designs, helping users achieve clearer and more personalized speech.

Advantages

• Easy to learn
• Allows immediate communication after surgery
• No additional surgery required
• Useful while learning other speech methods
• Portable and increasingly customizable with newer devices

Challenges

• Voice may sound mechanical compared to natural speech
• Device cost may be a barrier for some users
• Telephone communication may be difficult in noisy environments

Many patients use an electrolarynx early in recovery and may continue using it long-term or as a backup even after developing other speech methods.

Tracheoesophageal Prosthesis (TEP) Speech

A small surgical opening is created between the trachea and esophagus. A one-way valve prosthesis allows air to pass into the esophagus for speech while preventing food or liquids from entering the airway.  Air is directed through the prosthesis when the stoma is covered or when a hands-free valve is used, allowing speech that closely resembles natural voice.

Advantages

• Considered the gold standard
• Faster speech development
• High success rates
• Speech is more natural and intelligible

Challenges

• Additional surgical procedure required
• Manual stoma covering often needed
• Requires adequate lung function
• Prosthesis maintenance is necessary

Hope After Laryngectomy

Encouragingly, laryngectomy rates declined significantly between 1997 and 2008, and new cases of laryngeal cancer also decreased during that time. In addition, modern treatment approaches increasingly aim to preserve the larynx when possible through improved radiation techniques, minimally invasive surgical procedures, and newer drug therapies such as targeted therapy and immunotherapy.

For individuals who do undergo laryngectomy, advances in surgical reconstruction, prosthetic technology, and speech and swallow rehabilitation mean that communication and swallowing function can often be successfully restored. Earlier involvement of rehabilitation specialists also helps patients recover function more quickly and return to daily activities with greater confidence.

By working with a speech-language pathologist trained in laryngectomy rehabilitation, patients can identify the communication method that works best for them and regain independence, confidence, and quality of life.

The clinical team at Therapy Achievements has specialized expertise in evaluating and treating both voice and swallowing disorders, guiding patients through recovery after laryngectomy as well as other conditions affecting speech, communication, and safe swallowing.

With skilled therapy and modern treatment options, patients today have more opportunities than ever to return to eating, speaking, and living well after treatment.