The Electrolarynx

The electrolarynx has been used for decades by laryngectomees for speech communication following the loss of the larynx. More recent advancements in laryngectomy rehabilitation, however, have resulted in the evolution of tracheoesophageal speech, which is now the most common form of voice restoration in this practice.

There are times, however, when TE voicing is not possible, such as the immediate post-operative period or during radiation. During those periods, an electrolarynx is an excellent alternative to TE speech. The electrolarynx also serves as a nice alternative form of communication should a TE speaker have difficulty producing speech for any period of time.

As such, all laryngectomy patients in this practice are encouraged to acquire an electrolarynx. The state of Texas, Department of Assistive and Rehabilitative Services, provides all laryngectomy patients with a voucher good toward the purchase of an electrolarynx. The voucher can be thought of as a gift certificate in a sense, and can be redeemed for an electrolarynx at no cost to the patient, through Atos Medical, Inc. Although the state voucher is not sufficient to cover 100% of the cost of a new electrolarynx in most cases, Atos will accept these as payment in full for certain devices. The SLP staff can assist you in acquiring a voucher, as well as a loaner electrolarynx, also offered through a program with Atos Medical.

Although the SLP staff typically submits the voucher application for all laryngectomy patients, should you have inquiries regarding the state voucher program, more information can be found at: www.dars.state.tx.us/dhhs.

How Does it Work?

The electrolarynx has a vibrating head that serves as a sound source for speech, -in a similar way the vocal cords vibrated to produce a voice. When the vibrating head is placed against the neck, in a manner that allows the sound to resonate in the throat, it allows for speech in a similar way the voice box previously did. There may be some changes required in your speech production in order to be well understood by others, but these are typically simple techniques the SLP staff can train you in.

It is important to remember, however, that he tone the electrolarynx produces, is not a natural sounding voice. Many have termed it “robotic” or mechanical. More recent advancements have given some devices the ability to have intonational changes so that it is not a monotone “voice” that is produced, although the quality remains mechanical in nature.

Despite the less “natural” tone of the electrolarynx, it still allows for very intelligible, or “understandable” oral speech which is always the best method of communication if it can be understood.

Why Use an Electrolarynx?

In this practice, the vast majority of patients will undergo tracheoesophageal voice restoration, utilizing a TEP to restore speech communication. Despite this, it is important that every laryngectomee learn to use an electrolarynx as an alternate means of communication. Although never anticipated, there may be times when TE speech is not possible. Being able to use an electrolarynx ensures your continued ability to communicate orally. This is particularly important in urgent or emergency situations.

Since the state of Texas has the STAP voucher system, every patient is able to acquire an electrolarynx at no cost to them. For this reason, regardless of the means of oral communication you plan to use regularly, the SLP staff will assist you in the process of acquiring the electrolarynx as well as ensuring you are able to use it properly.

There are also very specific instances where TE speech is not/may not be possible:

Post-Operative Recovery

Even if you are provided with a tracheoesophageal puncture at the time of your laryngectomy surgery, it will be necessary for a certain amount of healing and recovery to take place before you are able to use your TEP. Additionally, it may take some time and/or practice for this to be an effective and reliable means of oral communication.

Thanks to a program sponsored by Atos Medical Inc., the SLP staff is able to provide many laryngectomy patients with a “loaner” electrolarynx to be used immediately while the STAP voucher process is completed. This means an electrolarynx can be used immediately post-operatively and serve to “bridge” the recovery period, -allowing for oral communication while more healing is accomplished.

Flap Reconstruction

In some cases, a laryngectomy patient may require more extensive reconstruction, including a “donor” flap or graft that is used to replace/reconstruct a portion of the throat. If this is the case, a tracheoesophageal puncture will not be made during the laryngectomy surgery. It is most important that the new donor flap heal properly before a puncture is placed. Flap reconstruction does not mean you will not be able to undergo tracheoesophageal voice restoration, but puncture/prosthesis placement will be post-poned for several weeks until your doctor is sure the flap reconstruction has healed well.

In this case, the electrolarynx will typically be the only means of oral communication for the weeks prior to receiving the TE puncture.

TEP Issues

Although less common, there are some patients who experience difficulty achieving functional and reliable TE speech. Although the SLP staff will make every effort to work with you in achieving functional TE speech, there may be a length of time before this can be accomplished sufficiently. During this period, an electrolarynx will allow you to continue to communicate orally.

Tips for Using an Electrolarynx

Although it is not difficult to use and electrolarynx, there is a degree of “technique” and practice required to ensure you are understood when you communicate. It is also important the device be in optimal working order. There are several adjustments that can be made to the device to assist in achieving the best quality speech possible. The SLP staff can easily adjust and troubleshoot this device as needed to ensure you are able to produce highly understandable speech. They can also educate you regarding minor adjustments you can make yourself to ensure the device is in proper working order.

Of course, proper training and sufficient practice is required to be able to use this device for communication. The SLP staff will conduct initial training sessions to ensure you are speaking well. It will also require a bit of practice outside of the SLP sessions. As with most skills, the more you practice, the better you will get!!

When learning to use this device, there are some tips that you may find helpful in remembering as you develop your new speech:

“Head” Placement

The head of the electrolarynx must be in full contact with neck tissue. If a portion of the head is exposed to air (not in contact with the neck), less tone will be transmitted into the throat and a “buzz” will be emitted into the air. This will not allow for audible or understandable speech. If the device seems to be buzzing too much, check to ensure the head is completely contacting the skins surface. Even beard whiskers can interfere with proper contact so its best to keep the neck/beard shaved.

Proper Positioning

For every laryngectomy, there will be areas of more/less resonance in the throat. This is determined mostly by the density or thickness of the neck tissues as well as the “space” in the throat region where the device is placed. The most ideal placement is generally in a place where the neck tissues are thinner and somewhat soft, at a level where there is space in the throat to resonate. In general, the more dense or “tough” the neck tissues are, the harder it will be to achieve a nice tone.

The “Sweet Spot”

In golf, tennis and other sports, the “sweet spot” refers to the perfect point of contact between the ball and the club or racket. At this point, there is the best potential for the perfect shot. With an electrolarynx, there will also be a “sweet spot” or position where the EL produces the best resonant tone. The SLP staff will try various positions around your neck, under the chin and even on the cheek to find your own personal “sweet spot.” This spot is rarely the same from person to person so it is important to find your own unique spot and do NOT model after another person.

The Big Mouth Effect

Although you are able to speak in the same manner as before, the typical EL user will need to change their speech pattern somewhat in order to be well understood. It is important to remember that the human ear is designed to listen and understand natural speech. A mechanical tone to the speech present a challenge for the listener, especially those with a hearing impairment. As a result, it is often helpful to articulate more precisely when using an electrolarynx. The SLP staff refers to this as the “big mouth” approach. In a general sense, these are the basic principles:

SLOW DOWN: You will need to speak slower when using an EL. This allows your listener to better adjust to hearing/understanding a mechanical tone. This does not mean you need to speak in an unnaturally slow way or staccato fashion (short and choppy). Rather simply slow your speech down slightly. This is also helpful in assisting allowing you time for more precise articulation.
SPEAK CLEARLY and OVER-ARTICULATE: Very often, people are accustomed to speaking in a comfortable manner that also includes slurring words together or rushing between sounds. When using an EL, it is important to pronounce your words clearly and concisely. Take your time to articulate each sound. At first, this may seem tedious but the more you practice, this will soon feel very natural!
OPEN YOUR MOUTH: Very often, especially in certain regional dialects (including Texas), the local speech pattern results in speaking with a rather closed mouth. Texas men are notorious for not moving there lips too much when they speak!! That is how the Texas drawl came to be! But when learning to speak with an electrolarynx, it is very important to use a nice open mouth when pronouncing your words. This will ensure the clearest speech pattern possible.

Although we’ve come a long way in laryngectomee speech rehabilitation, the electrolarynx remains an important stronghold. Although it may be frustrating to use at first, with proper training and practice, most people can become highly effective EL speakers in a very short period of time. The SLP staff can be very helpful in ensuring you are able to communicate as a laryngectomee, and an electrolarynx can e a very important component in your rehabilitative path.

NOTE: The products and supplies described in the laryngectomy care module have been clinically proven and determined by this practice to provide the most comprehensive, advanced items in alaryngeal rehabilitation. There has been no endorsement, specific or implied, by any manufacturer. In many cases, indications for use, however, are described based upon the indications and specifications set forth by the manufacturer.