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Cancer of the larynx, or voice box, frequently requires treatment by laryngectomy, the surgical removal of the entire structure. Individuals who have this procedure lose their speech and must learn to communicate through laryngeal speech. In laryngeal speech, the patient swallows air into his esophagus, internal pressure is increased, and the patient then expels the air through the pharynx. With practice, this results in an adequate, although distorted speech. Recently, a laryngeal prosthesis has been used to assist this process. Approximately nine years ago, the authors developed a method of creating a window, or fistula, between the esophagus and the pharynx (tracheoesophageal puncture), which enables a clearer and more easily learned method of speech. Once installed, the vocal prosthesis also serves as a valve to prevent bacteriologic contamination of the trachea with food. This study had provided a follow-up evaluation of patients who had this tracheoesophageal puncture procedure (TEP) performed nine years earlier. Approximately 80 percent of the 128 patients developed the ability to speak. This method had few complications and provided a better restoration of speech that when a total laryngectomy was performed. It was concluded that TEP is a reliable and relatively safe alternative treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)