Why is it harder to swallow?
During the laryngectomy surgery, many of the structures in the throat, useful in swallowing before the surgery, are removed. This does not mean a laryngectomee cannot swallow but the process of swallowing is certainly different.
During the laryngectomy surgery, in addition to the vocal cords and “voice box” being removed, the epiglottis and hyoid bone are also removed. The muscles are also reconstructed in a way that changes what happens when they contract.
After learning how the movement of the larynx and hyoid assist in the pharyngeal phase of swallowing, it becomes easier to understand why swallowing feels so different after the laryngectomy surgery. Also keep in mind that the movement of these structures also helps to open the cricopharyngeus to allow food into the esophagus. As these structures are removed, the mechanical help to open the cricopharyngeus is also lost.
All of this contributes to why the trachea or “windpipe” is diverted, sewn to the neck, creating the stoma a laryngectomee breathes through. Without all the structures to drive the swallow and protect the trachea from food entering, it would become impossible to swallow anything, including saliva, without it entering your lungs, creating a very dangerous situation.
Why can’t I choke?
Many patients experience difficulty swallowing before their laryngectomy surgery and the fear of choking can remain quite high following the laryngectomy. Although this is very natural, there is no longer any possible way for you to choke while you are eating.
As part of the laryngectomy surgery, a disconnection or separation is made between the mouth/throat and the lungs. Food material you take in through the mouth can now only go through the throat and into the esophagus, ultimately passing into the stomach.
The trachea, or windpipe, which is blocked when a choking event occurs, has been disconnected from the throat and is now diverted outward, attaching to the neck. Although you may experience difficulty swallowing and have a natural fear of choking, there is no longer any way for a laryngectomee to choke while eating.
Is there anything I can do to help my swallow?
In many cases, there are interventions that can help optimize your swallowing ability, but a formal evaluation is required to first determine the nature of the difficulty you are experiencing, then identify appropriate methods to help you. These methods can be as simple as altering the foods you eat or how you eat them, to formal therapy or even surgery. See Common Treatment Methods (link)