Esophageal speech, also known as esophageal voice, is an

airstream mechanism In phonetics, the airstream mechanism is the method by which airflow is created in the vocal tract. Along with phonation and articulation, it is one of three main components of speech production. The airstream mechanism is mandatory for sound p ...

for speech that involves oscillation of the

esophagus The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the ...

. This contrasts with traditional laryngeal speech, which involves oscillation of the

vocal folds In humans, vocal cords, also known as vocal folds or voice reeds, are folds of throat tissues that are key in creating sounds through vocalization. The size of vocal cords affects the pitch of voice. Open when breathing and vibrating for speech ...

. In esophageal speech, pressurized air is injected into the upper esophagus and then released in a controlled manner to create the airstream necessary for speech. Esophageal speech is a learned skill that requires speech training and much practice. On average it takes 6 months to a year to learn this form of speech. Because of the high level of difficulty in learning esophageal speech, some patients are unable to master the skill. The

Voice Quality Symbol Voice Quality Symbols (VoQS) are a set of phonetic symbols used to transcribe disordered speech for what in speech pathology is known as "voice quality". This phrase is usually synonymous with phonation in phonetics, but in speech pathology encomp ...

for esophageal speech is Œ.

Clinical

Esophageal speech is a skill that can help patients to communicate after a

laryngectomy Laryngectomy is the removal of the larynx and separation of the airway from the mouth, nose and esophagus. In a total laryngectomy, the entire larynx is removed (including the vocal folds, hyoid bone, epiglottis, Thyroid cartilage, thyroid and cr ...

, the most common surgery used for the treatment of

laryngeal cancer Laryngeal cancers are mostly squamous-cell carcinomas, reflecting their origin from the epithelium of the larynx. Cancer can develop in any part of the larynx. The prognosis is affected by the location of the tumour. For the purposes of staging, ...

. In the operation, the

larynx The larynx (), commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about ...

and the vocal cords are removed completely. After this, the end of the

trachea The trachea, also known as the windpipe, is a Cartilage, cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends ...

is sewn onto the edge of an opening cut out at the lower part of the neck, creating an opening (stoma) the patient will breathe from and cough out mucus from. This hole is called a tracheostoma; the patient uses it to breathe through and cough through after the operation.

Character

The air moves from outside the body through the tracheostoma directly to the lungs, without passing through the upper respiratory organs of the

nose A nose is a protuberance in vertebrates that houses the nostrils, or nares, which receive and expel air for respiration alongside the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passes th ...

mouth In animal anatomy, the mouth, also known as the oral cavity, or in Latin cavum oris, is the opening through which many animals take in food and issue vocal sounds. It is also the cavity lying at the upper end of the alimentary canal, bounded on ...

, and

throat In vertebrate anatomy, the throat is the front part of the neck, internally positioned in front of the vertebrae. It contains the pharynx and larynx. An important section of it is the epiglottis, separating the esophagus from the trachea (windpipe ...

. Because it bypasses the vocal folds, speech can be severely impaired, and the development of an esophageal voice becomes necessary. Esophageal speech is produced without an artificial larynx, and is achieved by pumping air from the mouth into the upper esophagus. The esophagus is slightly expanded. The air is then released in a regulated manner through the mouth, with simultaneous articulation of words. Vibration of the pharyngoesophageal sphincter replaces vibration of the glottis to produce the esophageal voice. Many people learn a basic form of esophageal speech as children, when they speak words while burping, e.g. in competitions with friends to see who can say more of the alphabet during a burp. Esophageal speech is quieter and more strenuous than laryngeal speech, and fewer words can be produced successively. Good esophageal speakers can produce an average of 5 words per breath and 120 words per minute. Very good esophageal speakers speak very similarly to

TEP Tep may refer to: *Tep language Tep is a Mambiloid language of Nigeria. ''Ethnologue'' considers it a dialect of Mambila The Mambilla or Mambila people of Nigeria live on the Mambilla Plateau (in 'Sardauna' local government area of Taraba Sta ...

speakers. Because of the large, vibrating pharyngo-esophageal segment, the pitch of esophageal speech is very low—between 50 and 100 Hz. In esophageal speech, pitch and

intensity Intensity may refer to: In colloquial use *Strength (disambiguation) *Amplitude * Level (disambiguation) * Magnitude (disambiguation) In physical sciences Physics *Intensity (physics), power per unit area (W/m2) *Field strength of electric, ma ...

correlate: a low-pitched voice is produced with low intensity and a high-pitched voice is produced with high intensity. The production of the latter is more exhausting. The

voice The human voice consists of sound made by a human being using the vocal tract, including talking, singing, laughing, crying, screaming, shouting, humming or yelling. The human voice frequency is specifically a part of human sound production in ...

of a speaker without a larynx sometimes has what appears to be a nasal tone to it, even though the nasal passage is no longer connected in a post-surgery

patient. In other esophageal speakers, the tone is more similar to a deep belch.

Tracheoesophageal puncture

Another option for restoring speech after a laryngectomy is the tracheoesophageal puncture or TEP. In this simple surgical procedure, a small puncture is made between the

and the esophagus, and a one-way air valve is inserted. This air supply can be used to cause vibrations of the pharyngoesophageal sphincter in a similar manner to esophageal speech. This surgical procedure may occur during the laryngectomy (primary TEP) or after a period of time (secondary TEP). The prosthesis is placed approximately 10–14 days post operation by a certified

speech language pathologist Speech is a human vocal communication using language. Each language uses phonetic combinations of vowel and consonant sounds that form the sound of its words (that is, all English words sound different from all French words, even if they are th ...

(SLP) who specializes in ENT work. During the placement of a prosthesis, the SLP measures the depth of the puncture, chooses the correct prosthesis, and inserts it with a loading device (the entire process can occur in 30–45 minutes pending complications). Patients return for the puncture to be resized every few months after surgery. When the puncture site stops changing sizes, then a more permanent prosthesis can be placed that will last approximately 6–12 months (indwelling prosthesis). Patients may choose this route, in which case they will return to the SLP for placement every 6–12 months, or may choose a low pressure, or duckbill prosthesis that they can change independently at home every few months. This option has become increasingly popular in the past 10 years, as in many cases intelligible voicing may be achieved within minutes of placement of the prosthesis. Some of the advantages to tracheoesophageal puncture are a higher success rate at about 95% of vocal rehabilitation and a much faster time frame compared to esophageal speech.Pawar, P. V., Sayed, S. I., Kazi, R., & Jagade, M. V. (2008). Current status and future prospects in prosthetic voice rehabilitation following laryngectomy.

Electrolarynx

An electrolarynx is a handheld device which is held against the throat and provides vibrations to allow speech. Electrolarynges may be used immediately post-surgery with an oral adapter (the neck being too tender right after surgery). Esophageal and electrolaryngeal speech (speech with an electrolarynx) may take weeks or months of training for patients to achieve functional voicing.

References

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External links