Outline of voice therapy
In Approximately 10 days after surgery when the esophagus and the surrounding tissues, especially the tracheostoma, are sufficiently healed and the nasogastric tube has been removed, or the same day in the case of secondary TEP puncture, voice training can start. Since the indwelling voice prosthesis is already in place, no time is lost by fitting the device. The first therapy session begins with a short recapitulation of the preoperative information (e.g., explaining the changes in the anatomy and the basic principles of the vocal rehabilitation) and an inspection of the prosthesis to make sure it is not obstructed. Next, the patient is instructed to breathe in gently and to open the mouth and produce a /ha/ sound. In these first voicing attempts the speech pathologist should digitally occlude the stoma for the patient. In most cases, the voice will come through after one or just a few attempts. Usually the best results are obtained when starting with exclamations like “ha” and “hi”. With the fricative /h/ it is easier to start the airflow before phonation than with an isolated vowel. If the voice does not occur easily, the patient is asked to shout. A stronger airflow in this situation helps to initiate the voice. After the first several voicing attempts, the patient can be encouraged to lengthen the vowels and to start with short statements or phrases/sentences of two and three syllables (e.g., “Hello”, “Hi there”, “How are you”, etc.). Furthermore, the laryngectomized patient can now try to occlude the stoma together with the speech pathologist, and then by him/herself.