There are two main ways a person will improve their communication after treatment from Head and Neck Cancer:

• Improving the strength and range oral movement and the structures within the oral cavity like the tongue. The improvement in the oral structures would help with articulation, improve patient’s quality of life and
• Alaryngeal Speech
  • Targets the production of speech using a sound source other than the larynx or the “voice box”
  • Three different types:
    • Electolarynx
    • Esophageal Speech
    • Tracheoesophageal Speech
  • All three types have advantages and disadvantages, but it depends on the patients’s physical, mental and communicative needs.
  • Below, a chart, provided by the American Speech-Language-Hearing Association or ASHA, expands upon the mechanism, advantages, disadvantages, and techniques.

Comparison of Alaryngeal Speech Options

	Artificial Larynx	Esophageal Speech	Tracheoesophageal Speech
Mechanism	An external mechanical sound is introduced into the vocal tract.	Air is introduced into the esophagus and then propelled through the pharyngoesophageal (PE) segment, which vibrates for sound production.	A surgical puncture (known as a tracheoesophageal puncture [TEP]) is performed, creating a fistula tract between the trachea and esophagus that is fitted with a one-way prosthesis. This allows for the shunting of tracheal air into the esophagus; the tracheal air is then propelled through the PE segment to produce sound.
Technique	Neck-placement electrolarynx is placed flush to the skin on the side of the neck, under the chin, or on the cheek. Sound is conducted into the oropharynx and is articulated normally. An intraoral device introduces sound into the posterior oral cavity via a small tube—the sound is then articulated normally. Intraoral devices are used for individuals who cannot achieve adequate sound conduction via external placement on the skin or in the immediate post-op period.	Injection involves using the articulators to increase oropharyngeal air pressure, which, in turn, overrides the sphincter pressure of the PE segment, thereby insufflating the esophagus. Inhalation involves decreasing thoracic air pressure below environmental air pressure by rapidly expanding the thorax so that air insufflates the esophagus.	The individual occludes the tracheostoma to direct air through the prosthesis into the esophagus for phonation. Hands-free valves are also available to allow appropriate patients to speak without using digital occlusion of the stoma.
Speech/Voice Quality	Speech/voice quality is electronic or mechanical and is monotone, with limited variation of pitch.	Voice can be rough; low in intensity/volume; wet in quality (not typically); and low in pitch. Utterance length is short.	Speech/voice is similar to esophageal speech but with better utterance length; intelligibility and volume of speech are generally acceptable.
Advantages	Rapid learning; earliest alaryngeal option (within 2–3 days post-op); does not interfere with acquisition of other forms of speech; the loudness of speech is adequate; low-cost maintenance of device; can be used even when the extent of surgery precludes the use of the PE segment for phonation (e.g., gastric pull-up).	Less conspicuous; hands free; nonmechanical sound; the patient is independent of devices; there are no expenses for equipment; no further surgery is required.	Air supply for speech is pulmonary; allows for natural phrasing of voice; patient has more acoustically normal speech; voice restoration often occurs within 2 weeks of surgery; this form of alaryngeal speech is the most intelligible and acceptable to listeners.
Disadvantages	Dependence on batteries; mechanical sound; loss of hands-free speech; requires ongoing care and maintenance of device; voice quality is “mechanical”; may cause interference with oral movements if oral adapter is used; good manual dexterity is required to operate the device; intelligibility is reduced; voice is difficult for new listeners to understand.	Low fundamental frequency (~ 65 Hz); short phrase duration; low acquisition rate; extended learning period; least natural/acceptable to listeners; least fluent option.	Tract can be difficult for patient to maintain; requires ongoing cleaning and maintenance of valve; requires good manual dexterity for valve maintenance; can lead to aspiration with valve failure or tract enlargement; may require long-term care by an SLP; some items are high in cost.

Along with the chart of communication options for Alaryngeal speech, ASHA provides a video of Barbara Messing out of Johns Hopkins University explaining the different types of speech devices a patient could use.