Laryngeal Cancer and Communication Tools for Patients Who Cannot Talk
Today I wanted to talk a bit about one of the more common reasons people lose the ability to speak: having a laryngectomy as a result of throat cancer.
As a speech language pathologist, I often work with people who have been diagnosed with laryngeal cancer and have had to have surgery as a result.
In this post, I’ll talk about what laryngeal cancer is, how prevalent it is, and some of the ways people can regain their ability to communicate after surgery.
What is Laryngeal Cancer?
The larynx, also known as the voice box, opens up to let you breathe. It also keeps food out of the trachea (windpipe) when you swallow. And, of course, air passing through the larynx causes the vocal cords to vibrate, making sound. You can then use your mouth, teeth, tongue, and lips to modify that sound to create speech.
Laryngeal cancer is cancer of the larynx, and, since the larynx does so much for us, it can be devastating when someone has to have a laryngectomy (surgical removal of the larynx) due to cancer.
During a laryngectomy, the surgeon trims and turns the trachea to create an opening in the front of the neck. This opening, called a stoma, becomes a new passage for breathing, bypassing the nose and mouth.
During the surgery, the surgeon puts a tracheostomy tube (trach) in the stoma to hold it open. This tube might be replaced a few weeks after the surgery with a tracheostomy button (also called a stoma button). Some people choose to leave the trach tube in, and others choose to not use either a tube or button.
How Common is Laryngeal Cancer?
According to the American Cancer Society, there are about 12,380 new cases of laryngeal cancer (9,900 in men and 2,480 in women) in the United States each year. About 3,820 people (3,070 men and 750 women) die from laryngeal cancer each year.
Most people diagnosed with laryngeal cancer are 55 years old or older. The average age at diagnosis is 66.
Black men are more likely than white men to develop laryngeal cancer and, as the statistics above show, men are much more likely to develop laryngeal cancer than women.
There is a bit of good news: both the rate of new laryngeal cancer cases and the death rate have fallen slightly over the past 10 years, most likely because fewer people smoke today than 10 years ago.
Traditional Ways to Regain the Ability to Communicate After Surgery
Learning to speak again after having a tracheotomy is challenging, but not impossible. In fact, there are three traditional ways people can regain the ability to speak after surgery:
1. Esophageal Speech—This is when you pull air into your esophagus and let it back out. The top of the esophagus vibrates, producing sound, which you can learn to modify. The process is difficult and takes some time to learn, often about six months with the help of a speech therapist.
2. Artificial Larynx—Another approach is to use a battery-operated device called an artificial larynx. The device creates a mechanical voice for you as you use your mouth and tongue to create speech. There are two types of AL, one which you place on the side of your neck or under your chin and the other which consists of a tube you place in your mouth. One advantage of this approach is that you can speak pretty much immediately after surgery, and you don’t need a second surgery to use it. The biggest drawback is that many people don’t like the mechanical sounding voice it produces.
3. Tracheoesophageal Puncture—This is a prosthesis that is placed into a small hole the surgeon makes between your windpipe and your esophagus. This often requires a second operation, or you can sometimes have it done at the same time as the laryngectomy. To speak with a TEP, you take a breath in, cover the stoma, which allows the air to then be shunted through the one-way valve of the prosthesis, up your esophagus, where you can use muscle vibrations to produce a voice. With a few weeks of practice, you can develop a natural sounding voice using a TEP.
Another Option: A Speech Assist App
While the three traditional approaches for regaining the ability to speak discussed above are used by many people, some people prefer to look to technology for another alternative.
One option is to use a text to speech and/or picture to speech app to speak for you. Today, there are a number of options on the market, one of which is our own APP2Speak. These AAC apps can be used with your phone or tablet device and they allow you to communicate in several ways.
Text to speech apps allow you to type what you want to say, and the app speaks for you. Picture to speech apps allow you to touch a picture and have the app speak a recorded phrase. Most of today’s AAC speech assist apps can do both.
Using such an app, someone who has had a laryngectomy can communicate without using one of the three traditional approaches discussed above—or they can use the app in addition to one of the traditional approaches, giving them another option. This allows them to choose the best option for a given situation.
APP2Speak and Laryngeal Cancer: A Customer Story
A while back, we shared the story of Bob, who had had a laryngectomy due to throat cancer. His friend Wayne wrote me to share Bob’s story.
Here’s an abbreviated version of the story:
I discovered APP2speak after my best friend Bob, (we’ve been like brothers for 60 years) was diagnosed with throat cancer and was told he had to have a laryngectomy and he would lose his voice.
He’s not as technical as I am and asked me to try and find something that would allow him to communicate with his mobile phone once he became speech impaired. He wanted to be able to text his words and have his phone speak them out for face-to-face communication.
After searching the web for something that might work for him, I kept seeing APP2speak pop up. I went on the website, and it looked like it would be helpful.
I contacted customer support, and that’s when you helped so much. You let me download the 14-day full app trial to my phone. We were off and running.
The two features of the app, text-to-speech and the photo-based pages with their phrases, and the ability to create custom pages and phrases was amazing!
Bob purchased the app (worth every penny) and we began practicing with each other until he was comfortable with using it before his surgery.
The best part about this story is when Bob had his surgery at Tuffs Medical Center in Boston, he woke up from recovery and was able to communicate with the medical staff immediately. The nurses were amazed and had never seen the app before. They took the information down for future patients.
Not only could he text his words to speech, but he found the preloaded photo pages to be extremely helpful!
Now that he’s home, he uses the app every day. He has his custom pages set up for everything from the supermarket to an emergency call photo with critical emergency information.
This app is truly a life changing tool!
Again, I want to thank you.
Don’t Let Laryngeal Cancer Stop You!
Cancer is scary and can turn someone’s life upside down, especially when the cancer affects an organ like the larynx that is so crucial to everyday life.
But with all the options available today through medical interventions and technology, laryngeal cancer doesn’t have to shut down your social life.
If you or someone you know has been diagnosed with throat cancer, I encourage you to explore all the options prior to surgery and find the best choice for you.