Some people who’ve had a laryngectomy are very worried about the change in their appearance. You may feel embarrassed about the laryngectomy stoma, which can affect your self-confidence and may be distressing. It can take time for you to adjust, but help is available.

Your doctor, nurse and speech and language therapist in the hospital can give you expert advice. They can give information and support, and can put you in touch with someone in your area who has also had a laryngectomy to get practical advice.

The National Association of Laryngectomee Clubs| and the Cancer Laryngectomee Trust| have national networks. The support of a partner, family member or close friend can also be very helpful at this time.

Will I always have to breathe through this opening?

Yes, this is your new airway and you will breathe as naturally as you always have without thinking about it. You may initially have a lot of mucous and coughing, but you will see at laryngectomee meeting that others cough no more often than persons who have a larynx.

Why is an opening in the neck necessary?

Before surgery, breathing and food passages have a common passage in the throat; further down they divide into the trachea (windpipe) for breathing and the esophagus (gullet) for carrying food to the stomach. If the voice box (larynx), which controls entry of air into the trachea, is surgically removed (laryngectomy), it is then necessary to relocate the end of the air passage as an opening at the front of the neck. This is called the stoma.

Speech

What are the different communication methods available after total larngectomy.

Tracheo-Esopageal Puncture (TEP)

During the laryngectomy operation, a channel (tract) is made through the wall between the windpipe and the gullet (oesophagus). This tract can be used after your operation for enteral feeding|.

After a few days, a voice prosthesis is inserted into the channel. When you breathe out and cover the laryngectomy stoma with a thumb or finger, air from the lungs passes through the prosthesis and vibrates in your gullet to produce a voice. As with normal speech, movements of your lips, cheeks and tongue shape the sound into words.

The voice prosthesis has a valve that prevents food and fluids from passing into the windpipe. It may take a while to learn how to speak with a voice prosthesis. The voice can sound quite natural, although in women it’s usually a lower pitch than before the operation.

There are several types of valve including Blom-Singer®, Groningen® and Provox® valves. Some types are completely within the laryngectomy stoma and are known as in-dwelling valves. They need to be changed by a doctor, speech and language therapist or nurse. Others (ex-dwelling) have a strap outside the stoma and can be changed by you or your carer.

There are advantages and disadvantages of each type, and your doctor, specialist nurse or speech and language therapist should discuss these with you.

Esophageal (ES)

Another method is a technique known as oesophageal speech. As soon as you have recovered from a laryngectomy, you can be taught this technique. Air is squeezed into the gullet from the mouth. As the air moves up from the gullet, it vibrates and can be used to produce a voice. Movements of the lips, cheeks and tongue shape the sound into words.

Some people find it easy to make oesophageal speech or use a voice prosthesis, but others find it more difficult. It’s usually best to practise little and often. A speech and language therapist can help you have the best speech as comfortably as possible. They will also help you to use your new way of talking for social situations and on the telephone.

Electrolarynx (EL)

Several types of electronic aids are available to help produce a voice. While you are in hospital you may be given one to use while you practise developing your new voice. You may choose to use it as your main way of communicating. The electronic devices are held next to the neck under the chin and make sound vibrations that can be formed into speech. Your speech and language therapist will help you choose the type that suits you best. They will show you how to use it and look after it.

To use an aid properly, or to have good oesophageal speech, you’ll need training from a speech and language therapist. It takes plenty of practise, but it’s well worth the effort.

Electronic Keyboards

Most people with a laryngectomy can learn to speak effectively using one of the techniques above. Some people also like to use electronic keyboards (like small typewriters) to communicate. Mini-laptops or text messaging on your mobile phone can be another good method. Several different types of writing device are available. Your speech and language therapist can show you these.

Day-To-Day

Can I use a shower?

Shower aids are available to prevent water going into the stoma when you have a shower. You can ask your specialist nurse or speech and language therapist about these.

How do I protect the airway (stoma)?

Small devices known as stoma filters are available. They are also known as heat and moisture exchangers (HMEs). They can be attached over the stoma or put onto the tracheostomy tube to warm and moisturise the air. HMEs can reduce the production of sputum and help to prevent coughing and chest infections. Your doctor, nurse or speech and language therapist can show you these devices.

Hands-free valves allow people using a voice prosthesis| to speak without needing to cover the stoma with a finger. Hands-free valves are sometimes called tracheostoma valves. They aren’t suitable for everyone, but you could ask your specialist or speech and language therapist whether they would be appropriate in your case. They are available on prescription.

What effects can I expect after total laryngectomy?

After a laryngectomy, the air you breathe in through the stoma goes directly into the lungs and is no longer warmed and moistened by the nasal passages. The cooler, dry air going into the throat can irritate the lining of the throat and lungs. This can increase the production of mucus (phlegm) and may cause coughing.

It’s very important to keep the laryngectomy stoma covered with a stoma cover or filter. You’ll be shown different types of stoma filter while you are on the ward and will be taught how to use them. It’s also important to avoid getting any liquid into the stoma.

You won’t be able to sniff or blow your nose. When you cough, the mucus will be coughed up through the tracheostomy, not through your mouth.

Why should the stoma be covered?

For hygienic reasons: since the air is no longer filtered or warmed by the nasal passages, foreign matter such as dust or clothing particles, and even air of a different temperature may irritate the sensitive walls of the air passage trachea).
To help keep in moisture: when we exhale, we release moisture from the lungs. By covering the stoma, we help to keep that moisture in the airway, easing breathing and reducing the need to cough.
For personal appearances: an opening in the neck, exposed for all to see, may cause unnecessary surprise and discomfort to friends and strangers.

What do I do about chest infections?

A laryngectomy stoma can make you more likely to get chest infections. If you notice any change in the colour of your sputum, or have a cough that doesn’t go away, it’s important to tell your doctor straight away. They may prescribe antibiotics for you.

Will I be able to smell and taste again?

After a total laryngectomy, your sense of smell and taste may be reduced. This is because you don’t breathe through your mouth and nose. This can go back to normal after a few months, although some people may have long-term problems. You may be able to have some sense of smell by learning the ‘polite yawning technique’, where you yawn with closed lips. This draws air in through the nose, allowing you to smell. It can also improve your sense of taste. Your speech and language therapist may be able to teach you how to do this.

The Future

What are possible long-term or late effects after treatment for laryngeal cancer?

•Problems swallowing (dysphagia) - This can be caused by thickening (fibrosis) of the wall of the gullet (oesophagus), by narrowing of the gullet (stricture), and by a loss of sensation when swallowing. A speech and language therapist can provide help and advice with swallowing problems.

•Low levels of the thyroid hormone thryroxine (hypothyroidism) - This happens when radiotherapy treatment affects the nearby thyroid gland. You will have blood tests to monitor your thyroxine levels. If you develop this condition, you will be given thyroxine tablets.

•Lymphoedema - This is an abnormal collection of fluid called lymph that can cause swelling in the neck. It’s a rare side effect that can happen when lymph nodes have been removed by surgery and/or damaged by radiotherapy.

What are the chances that the cancer will return?

Two things that may increase your risk of cancer of the larynx coming back are smoking| and drinking alcohol. Your cancer specialist or GP can advise you on your alcohol intake and give you information about how to stop smoking. There is also a free NHS smoking helpline and QUIT, which both give help and support if you are trying to give up smoking.

We also have information about eating well if you have cancer, eating well after cancer treatment, diet and caner, and exercise.

Long-term or late effects of treatment
Some side effects that develop during treatment may take a long time to improve or may occasionally become permanent (long-term side effects). Other effects can develop many years after treatment has finished (late effects). You may not experience any late side effects at all, or they may range from being mild to more serious. Any side effects will depend upon the treatment you had. Always let your doctor know about any problems you are experiencing.

What is a laryngectomee organization?

It is a group of people who have had a laryngectomy. The laryngectomees, their families and friends meet regularly to offer encouragement to each other, to share information on resources and to socialize. Speech instruction is often available.

This support is especially valuable to the new laryngectomee. These organizations are usually referred to a Lost Chord Clubs or Nu Voice Clubs.

Will I be able to swim?

Once you have a laryngectomy stoma, you won’t be able to swim without using specialist equipment. This equipment can be used to stop water from going into the stoma. It’s only available through the National Association of Laryngectomee Clubs|, which give training to make sure that people use the equipment safely.

Will I be able to work again?

Many laryngectomees have returned to their former jobs. The answer depends on many factors: your age, your health and the type of work you have been doing. The most important factor is YOU - your determination to recover and do what you feel is best for YOU.