Esophageal speech, also known as esophageal voice, is an

airstream mechanism In phonetics, the airstream mechanism is the method by which airflow is created in the vocal tract. Along with phonation and articulation, it is one of three main components of speech production. The airstream mechanism is mandatory for most sou ...

for speech that involves oscillation of the

esophagus The esophagus (American English), oesophagus (British English), or œsophagus (Œ, archaic spelling) (American and British English spelling differences#ae and oe, see spelling difference) all ; : ((o)e)(œ)sophagi or ((o)e)(œ)sophaguses), c ...

. This contrasts with traditional laryngeal speech, which involves oscillation of the

vocal folds In humans, the vocal cords, also known as vocal folds, are folds of throat tissues that are key in creating sounds through Speech, vocalization. The length of the vocal cords affects the pitch of voice, similar to a violin string. Open when brea ...

. In esophageal speech, pressurized air is injected into the upper esophagus and then released in a controlled manner to create the airstream necessary for speech. Esophageal speech is a learned skill that requires speech training and much practice. On average it takes 6 months to a year to learn this form of speech. Because of the high level of difficulty in learning esophageal speech, some patients are unable to master the skill. The

Voice Quality Symbol Voice Quality Symbols (VoQS) are a set of phonetic symbols used to transcribe disordered speech for what in speech pathology is known as "voice quality". This phrase is usually synonymous with phonation in phonetics, but in speech pathology encom ...

for esophageal speech is Œ.

Clinical

Esophageal speech is a skill that can help patients to communicate after a

laryngectomy Laryngectomy is the removal of the larynx. In a total laryngectomy, the entire larynx is removed (including the vocal folds, hyoid bone, epiglottis, thyroid and cricoid cartilage and a few tracheal cartilage rings) with the separation of the a ...

, the most common surgery used for the treatment of

laryngeal cancer Laryngeal cancer is a kind of cancer that can develop in any part of the larynx (voice box). It is typically a squamous-cell carcinoma, reflecting its origin from the epithelium of the larynx. The prognosis is affected by the location of the tumo ...

. In the operation, the

larynx The larynx (), commonly called the voice box, is an organ (anatomy), organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal ...

and the vocal cords are removed completely. After this, the end of the

trachea The trachea (: tracheae or tracheas), also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all animals' lungs. The trachea extends from ...

is sewn onto the edge of an opening cut out at the lower part of the neck, creating an opening (stoma) the patient will breathe from and cough out mucus from. This hole is called a tracheostoma; the patient uses it to breathe through and cough through after the operation.

Character

The air moves from outside the body through the tracheostoma directly to the lungs, without passing through the upper respiratory organs of the

nose A nose is a sensory organ and respiratory structure in vertebrates. It consists of a nasal cavity inside the head, and an external nose on the face. The external nose houses the nostrils, or nares, a pair of tubes providing airflow through the ...

mouth A mouth also referred to as the oral is the body orifice through which many animals ingest food and animal communication#Auditory, vocalize. The body cavity immediately behind the mouth opening, known as the oral cavity (or in Latin), is also t ...

, and

throat In vertebrate anatomy, the throat is the front part of the neck, internally positioned in front of the vertebrae. It contains the Human pharynx, pharynx and larynx. An important section of it is the epiglottis, separating the esophagus from the t ...

. Because it bypasses the vocal folds, speech can be severely impaired, and the development of an esophageal voice becomes necessary. Esophageal speech is produced without an artificial larynx, and is achieved by pumping air from the mouth into the upper esophagus. The esophagus is slightly expanded. The air is then released in a regulated manner through the mouth, with simultaneous articulation of words. Vibration of the pharyngoesophageal sphincter replaces vibration of the glottis to produce the esophageal voice. Many people learn a basic form of esophageal speech as children, when they speak words while burping, e.g. in competitions with friends to see who can say more of the alphabet during a burp. Esophageal speech is quieter and more strenuous than laryngeal speech, and fewer words can be produced successively. Good esophageal speakers can produce an average of 5 words per breath and 120 words per minute. Very good esophageal speakers speak very similarly to TEP speakers. Because of the large, vibrating pharyngo-esophageal segment, the pitch of esophageal speech is very low—between 50 and 100 Hz. In esophageal speech, pitch and

intensity Intensity may refer to: In colloquial use * Strength (disambiguation) *Amplitude * Level (disambiguation) * Magnitude (disambiguation) In physical sciences Physics *Intensity (physics), power per unit area (W/m2) *Field strength of electric, m ...

correlate: a low-pitched voice is produced with low intensity and a high-pitched voice is produced with high intensity. The production of the latter is more exhausting. The

voice The human voice consists of sound made by a human being using the vocal tract, including talking, singing, laughing, crying, screaming, shouting, humming or yelling. The human voice frequency is specifically a part of human sound produ ...

of a speaker without a larynx sometimes has what appears to be a nasal tone to it, even though the nasal passage is no longer connected in a post-surgery

patient. In other esophageal speakers, the tone is more similar to a deep belch.

Tracheoesophageal puncture

Another option for restoring speech after a laryngectomy is the tracheoesophageal puncture or TEP. In this simple surgical procedure, a small puncture is made between the

and the esophagus, and a one-way air valve is inserted. This air supply can be used to cause vibrations of the pharyngoesophageal sphincter in a similar manner to esophageal speech. This surgical procedure may occur during the laryngectomy (primary TEP) or after a period of time (secondary TEP). The prosthesis is placed approximately 10–14 days post operation by a certified

speech language pathologist Speech is the use of the human voice as a medium for language. Spoken language combines vowel and consonant sounds to form units of meaning like words, which belong to a language's lexicon. There are many different intentional speech acts, suc ...

(SLP) who specializes in ENT work. During the placement of a prosthesis, the SLP measures the depth of the puncture, chooses the correct prosthesis, and inserts it with a loading device (the entire process can occur in 30–45 minutes pending complications). Patients return for the puncture to be resized every few months after surgery. When the puncture site stops changing sizes, then a more permanent prosthesis can be placed that will last approximately 6–12 months (indwelling prosthesis). Patients may choose this route, in which case they will return to the SLP for placement every 6–12 months, or may choose a low pressure, or duckbill prosthesis that they can change independently at home every few months. This option has become increasingly popular in the past 10 years, as in many cases intelligible voicing may be achieved within minutes of placement of the prosthesis. Some of the advantages to tracheoesophageal puncture are a higher success rate at about 95% of vocal rehabilitation and a much faster time frame compared to esophageal speech.Pawar, P. V., Sayed, S. I., Kazi, R., & Jagade, M. V. (2008). Current status and future prospects in prosthetic voice rehabilitation following laryngectomy.

Electrolarynx

An electrolarynx is a handheld device which is held against the throat and provides vibrations to allow speech. Electrolarynges may be used immediately post-surgery with an oral adapter (the neck being too tender right after surgery). Esophageal and electrolaryngeal speech (speech with an electrolarynx) may take weeks or months of training for patients to achieve functional voicing.

References

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External links