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Extensive cancer of the larynx (upper part of respiratory tract containing vocal cords) and or the pharynx (voice box) sometimes requires the removal of these organs in one surgical block. One method of restoring anatomic continuity is to bring the trachea (the airway) through the patient's neck to a surface opening, a tracheostomy. In order to create continuity of the gullet the stomach is pulled through the diaphragm into the thorax and connected end-to-end (anastomosis) with the cut edge of the pharynx deep within the neck. The redirection of the airway and food passages restores the basic physiologic necessities, but prevents normal speech. Many individuals who are deprived of only their larynx learn so-called esophageal speech, a method in which air is swallowed and then forcible expelled causing the tissues of the pharynx to vibrate sufficiently to produce understandable speech. In many cases in which the stomach is anastomosed with the pharynx, however, patients are unable to produce a satisfactory voice because the stomach is a large distensible organ (unlike the smaller, proportionally thicker-walled esophagus). The present article discusses the author's experience with the use of the Blom-Singer voice prosthesis in these cases. This surgical appliance is essentially a one-way valve that when installed between the repaired pharynx and the trachea allows expired air to be directly shunted to the pharynx. This, together with either manual constriction of the throat or the use of an elastic neck band, provides sufficient resistance to allow expired air to produce a voice. (Consumer Summary produced by Reliance Medical Information, Inc.)

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.)

I am an infectious diseases physician with a special interest in head and neck infections and extensive experience in otolaryngological ailments. Four years ago I was diagnosed with hypopharyngeal carcinoma; [...]