FAQ7:   What is the best type of alaryngeal speech - - electric or pneumatic artificial larynx, esophageal speech, TEP speech, or something else?

Answer: Yes.

Each form of alaryngeal speech IS the "best" depending on factors such as:

(1) what kind of alaryngeal speech is this individual capable of using? For many, there are no choices because of the nature of their surgery and what will be possible for them. Thus, whatever form of communication they can acquire is "best" for that individual.

(2) how close to laryngeal speech does the individual want or need to come? Will the person be returning to work? If so, what are the speech needs of the job? Also, at this point, there are no electronic or pneumatic artificial larynges which anyone would mistake for a regular laryngeal voice. 

(3) how much money is the person willing to spend, and/or who is paying the bill?The ultimate in no-tech, hands-free, zero cost (unless you pay for speech lessons) method of alaryngeal speaking is esophageal speech, although a significant percentage of laryngectomees (with the percentage being VERY arguable) cannot learn esophageal speech, or learn it well. Next in terms of cost is a pneumatic AL (up to $150). Futher up in cost are the electronic ALs which can cost from $450 to $800. The TEP involves the cost of the operation, and then the ongoing costs of the prostheses (from $35-$125). In the long run, the TEP is the most expensive initially, and to maintain over time. However, insurance and Medicare can soften the blow.

(4) how much of a hassle is the person willing to put up with? Again, the ultimate in no-tech, zero maintenance is esophageal speech. Next is the pneumatic AL. You just have to remember to bring it with you, and if you use the type with a diaphragm, bring a spare in case yours tears. After that would come the electronic AL which needs a fresh battery and which may become non functional if you drop it or dunk it in water. 

TEP users typically have the biggest hassles even if they do not use the glued-on hands-free valve and/or HME (Heat/Moisture Exchange) filter. They have to change the prostheses themselves (every month or so), or go to an SLP or ENT to change it if they use the "indwelling" type (which is changed twice a year). They also have to deal with leaks through the prosthesis or around it, and the need to keep it clean by squirting water and using a little brush. A negative with the TEP is the potential for aspiration pneumonia caused by leaks from the esophagus into the trachea. It is also possible to drop a TEP prosthesis down the trachea. At this point, we have not heard of anyone losing a Servox down theirs (but then, we have not heard from our friend Paul in awhile). The TEP also carries the risk always associated with even a minor surgical procedure under general anesthetic. For a small percentage of individual who fail to obtain TEP speech, they may need to have Botox shots or another operation (the myotomy) to obtain it, although this is usually discovered before the TEP operation.

(5) how intelligible is the method the individual can use? Max Fried, the first editor of the IAL News said in the June 1961 issue, "Good speech is speech that can be easily understood without drawing on the imagination of, or interpretation by, the listener."

To me the best speech would be that which the highest percentage of people can understand. And understandability is related to how close the speech is to larygeal speech in clarity, tone, range, and volume. 

Another factor for some is conspicuousness. It is possible for esophageal speakers and TEP speakers to be completely inconspicuous. It is not unusual for someone to ask an ES or TEP speaker if they have laryngitis. It is hard to imagine anyone making that mistake with a user of any of the ALs.

Still another factor is how long it takes to become proficient with each method. Esophageal speech almost certainly takes longer than either the AL or most TEP users. some TEP users obtain speech instantly. Waiting for the swelling (edema) to go down can cause you to wait awhile to find your AL "sweetspot".

Another benefit of using the TEP is that it gives your lungs a workout since you must move lung air through the prosthesis. This should help maintain some lung capacity. Neither the AL nor ES provides this function.

For most people who can use it, the TEP produces the form of speech which is closest to laryngeal speech because of the capacity of the lungs to sustain it longer than esophageal speech. It is also, on average, louder than ES. However, the ultimate in volume is a good sweet spot and and fresh battery in an AL.

Another fact is that very few people who obtain TEP speech abandon and return to an AL, for example, if their TEP speech is functional. 

Perhaps others will have some additional factors I have left out.

David Blevins, ([email protected])