Communication Support After Laryngectomy

Voice loss following total laryngectomy is permanent. Effective communication support depends on close collaboration between nursing staff, speech and language therapists (SLTs), and the patient’s wider multidisciplinary team.

Voice restoration methods

There are three primary methods of alaryngeal communication:

Tracheoesophageal voice prosthesis (TEP)

A small valve is inserted surgically between the trachea and oesophagus. Air is redirected through the oesophagus to produce voice. This is the most commonly recommended method and generally produces the most natural-sounding voice.

Electrolarynx

A battery-powered handheld device held against the neck or cheek produces a mechanical vibration that the patient shapes into speech. It is often used as a bridging method during early recovery before TEP placement.

Oesophageal speech

The patient learns to swallow and control small amounts of air in the oesophagus to produce vibration. This requires significant practice and is less commonly achieved to a high functional level.

Supporting communication on the ward

• Ensure patients have access to pen, paper, or communication aids at all times in the immediate post-operative period.
• Familiarise yourself with the patient’s chosen voice restoration method before discharge planning begins.
• Involve the SLT team early in post-operative care and ensure their recommendations are incorporated into nursing handover notes.
• Signpost patients and carers to peer support groups such as the National Association of Laryngectomee Clubs (NALC).

Documentation

All communication support plans should be documented in the patient’s care record and reviewed at each multidisciplinary team (MDT) meeting. Barriers to communication — including hearing impairment, literacy difficulties, or psychological distress — should be noted and addressed.